Cuts and Grazes Sustained from Coral

The ocean is not simply a saline solution -- it's full of pathogens. Minor cuts and abrasions can lead to all manner of unfortunate repercussions. That's why I have always made a point of wearing a full suit while diving. Not only that, but we all carry a pathogen of our own on our skin.

Staphylococcus aureus (S. aureus) is a common pathogen that resides as a commensal organism in humans. This pathogen can cause toxic shock syndrome (TSS), a severe condition characterized by sudden onset and rapid progression to multiple organ failure. The skin and soft tissues are common sites of primary infections.

An article in Cureus (www.cureus.com) recently presented the case of a 51-year-old male diving instructor with no significant medical history. He had sustained an injury to his left knee after striking coral while diving, eventually leading to toxic shock.

The day after the incident, the patient developed swelling in the left knee and had a fever. On the third day, he had bowel incontinence and difficulty walking, prompting a visit to a hospital emergency department. He was suffering from low blood pressure, a high pulse rate, and elevated body temperature. He was diagnosed with cellulitis and septic shock and admitted to the intensive care unit. He recovered, but he suffered a great deal from what seemed like a simple coral scrape.

My Simple Coral Scrape

Several years ago, I joined a liveaboard at Hamata, a poorly developed port on the Red Sea in southern Egypt. The water was so shallow that our vessel was unable to get close to shore, and even its inflatable tenders had to stay about 200 feet from land.

The crew carried our bags out, and, newly arrived from the airport at Marsa Alam, we passengers had no choice but to take off our shoes and wade.

In the process, I scraped an ankle on something sharp. I thought it was an insignificant scrape, so I simply covered it with petroleum jelly to stop it from irritating me while diving.

Two weeks later, back in London, I felt a sudden sharp pain in my calf and watched as a golf-ball-sized hematoma formed.

I did not connect it with the graze I got in Egypt. My doctor seemed to think an infected deer tick caused it. (I live between two Royal deer parks.) I got waterproof dressings to cover it and went off on my next trip to Sipadan. (See My Lucky Escape in Undercurrent June.)

The injury didn't get better. By October, my leg had begun to swell, and larger hematomas had appeared. I wasn't feeling well, so I went back to the doctor, who sent me to the hospital as an emergency case, where doctors discussed whether amputation below the knee might be required.

But I was lucky. The hospital registrar in the UK, coincidentally initially from Kota Kinabalu, Borneo, recognized that I was suffering from a coral infection tracking in my lymphatic system. Surgery, antibiotics by drip, and a drain fitted, resolved the problem and, a week later, finally put me on the road to recovery.

My story in last June's Undercurrent prompted Bill Scott (Delray Beach, FL) to write about his experience with an eerily similar treatment and timings. Bill wrote, "I read the article, and it reminded me of my health issue and my own stupidity.

"I made a dive during August last year, off Boynton Beach, looking for lobsters, and managed to ding my right ankle just above the front of the bootie. It didn't even need a bandage.

"Two weeks later, I developed a rather high fever and severe chills. This lasted two days. I recovered, then noticed that my right leg felt a burning sensation and developed large boils, one the size of a tennis ball, but only from the turn of the ankle to the knee, nothing below or above or on the calf.

"After my GP group was completely puzzled, I tried my dermatologist, who had a treatment plan, and she drained the two large boils, since they were going to burst soon. She took two biopsies for the lab, prescribed cortisone, and antibiotics. And if not better soon, I was to call my GP and get admitted to a hospital.

"I spent a week in the hospital. The Infectious Disease group took their own cultures and started with Vancomycin. All this within a teaching hospital, with first-, second-, and third-year surgical residents, ready to debride or start cutting to get rid of the necrotizing fasciitis. The Infectious Disease group kept them at bay.

"They kept me for a week with an antibiotic I.V. in each arm. No one discovered anything from the biopsies. They put in a port and got me out of the hospital with a daily I.V. for 6 weeks. I healed up and was released to dive."

All this from an initially insignificant coral scrape.

A Stingray Scrape

Last June, ocean lover Richard Woulfe (Dallas, TX) went for a dip off San Diego and got stung by a stingray.

He initially received first aid from the lifeguards, but a day later, after flying back to Texas, his foot began swelling. He ended up in the E.R., where he was diagnosed with strep and staph infections. That led to gangrene and a flesh-eating disease inside his foot, all caused by either fragments of the ray's stinger, bacteria in the seawater, or both. He was within hours of losing his foot, but surgeons were able to act in time.

A Burning Wetsuit

Dr. Swee-Pek Quek (El Cerrito, CA.) wrote, "My husband's had a freak accident involving a superheated wetsuit. The gist of it is that he was lying in the sun in his black wetsuit during a surface interval at Bangka, North Sulawesi. When he got up to prepare for his next dive, he felt scalding hot water flow down onto his foot from his wetsuit. It resulted in a second-degree burn.

"A few days later we were rafting down a river in Sumatra with river water splashing on the wound. Some weeks after, the wound still hadn't healed. Then one day, back home in California, he came down with a fever and chills. The doctors tested him for malaria and dengue fever, but the tests were negative. They then took another round of tests and found bacteria in his blood. He had to be admitted right away for sepsis. He's lucky to be alive today."

Be aware that seemingly minor wounds, cuts, and scrapes sustained while diving can be more significant than they appear. If symptoms worsen, seek medical help. Too much delay is a risk you don't want to take. https://bit.ly/4roEJ2S

John Bantin