AD 2017 Q4

a centimeter, usually isolated but
sometimes in small clusters and
not necessarily painful. There
may or may not be discharge
associated with the wound, and
little or no improvement may
follow what seems to be adequate
care for the wound. This is due in part
to several unique characteristics of this bacterium:
• M. marinum is an opportunistic pathogen: It
causes an infection only when the right conditions
(environmental and patient-related) are met. This
explains why it is often not even considered as
a potential culprit. It could be considered rare.
• M. marinum likes cooler temperatures, which
explains why these wounds tend to flourish in
areas with lower body temperatures such as hands,
knuckles, elbows and knees.
• M. marinum is sensitive only to specific antibiotics,
which explains why the typical antibiotic treatments
are usually unsuccessful.
• M. marinum has a slow life cycle, which means
treatments last a long time. Sometimes patients will
abandon what could have been a successful treatment,
and/or doctors may look for other potential
explanations for the symptoms.
• M. marinum requires specific
culture media that a doctor
would not ask for unless he or she
suspects this pathogen. This explains
why sometimes standard culture results are
negative and diagnoses are delayed.
Allow your doctor to examine the wound and
follow his or her normal procedures. The doctor
will probably ask you how it happened or when it
started. This is where you should let him or her
know about the superficial abrasion in a marine
environment. You may also want to tell your doctor
you read about Mycobacterium marinum (because
you are a prepared and well-informed diver) and are
wondering if this could be the cause. Good medical
practice benefits tremendously from mutual trust and
good communication. Let the doctor examine you and
ask questions, and trust him or her — no dive-specific
medical knowledge is needed for this type of issue.
Finally, remember to always take care of wounds and
clean them thoroughly, even when they seem benign.
The skin is our most effective and efficient means of
immunological defense.
— Matías Nochetto, M.D.
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