Seabather's eruption--a case of Caribbean itch

Aquatic sports dematoses. Part 2 - in the water: saltwater dermatoses

The second part of this three-part series on water-related dermatoses will discuss dermatologic conditions seen in athletes exposed to saltwater. The vast majority of the following dermatoses result from contact with organisms that inhabit saltwater, including bacteria, cnidarians, and echinoderms. This review also will include other dermatoses affecting saltwater athletes and should serve as a guide for dermatologists, sports medicine physicians, and other medical practitioners in recognition and treatment of these dermatoses.

Seabather's eruption: a clinical and epidemiological study of 38 cases in Santa Catarina State, Brazil

Seabather's eruption (SBE) is an intensely itchy, papule-erythematous dermatitis that occurs predominantly in regions of the body covered by bathing costumes, after exposure to marine water. The planulae larvae of Linuche unguiculata scyphomedusae (thimble jellyfish) are the etiologic agent of the dermatitis, which is frequent in waters of Caribbean, Gulf of Mexico and Florida. The authors report 38 cases of SBE in the State of Santa Catarina (Southern region of Brazil), with emphasis on their clinical and epidemiological aspects, such as profile of victim, topography of the papules and conditions predisposing to the accident.

Health effects of recreational exposure to Moreton Bay, Australia waters during a Lyngbya majuscula bloom

A survey of residents in an area subject to annual toxic cyanobacterial blooms was undertaken to examine potential health effects of cyanobacteria toxins. The survey assessed the health of marine recreational water users in Deception Bay/Bribie Island area in northern Moreton Bay, Queensland, which is exposed to blooms of the nuisance and potentially harmful cyanobacterium Lyngbya majuscula. A postal survey was mailed to 5000 residents with a response rate of 27%. High numbers of people (78%) responding to the survey reported recreational water activity in Moreton Bay. Of those having marine recreational water activity, 34% reported at least one symptom after exposure to marine waters, with skin itching the most reported (23%). Younger participants had greater water exposure and symptoms than older participants. Participants with greater exposures were more likely to have skin and eye symptoms than less exposed groups, suggesting agents in the marine environment may have contributed to these symptoms. Of those entering Moreton Bay waters 29 (2.7%) reported severe skin symptoms, 12 of whom attended a health professional. Six (0.6%) reported the classic symptoms of recreational water exposure to L. majuscula, severe skin symptoms in the inguinal region. Participants with knowledge of L. majuscula were less likely to report less skin, gastrointestinal and fever and headache symptoms. In conclusion, high numbers of participants reported symptoms after exposure to waters subject to L. majuscula blooms but only a small number appeared to be serious in nature suggesting limited exposure to toxins.

Changing paradigms in parasitic infections: common dermatological helminthic infections and cutaneous myiasis

Parasitic diseases caused by helminths, or worms, account for billions of human infections worldwide. Although most human pathogens caused by these organisms are infrequent in the United States, skin manifestations of parasitic diseases are being seen much more frequently in dermatologists' offices due to the increase in immigration and travel. Helminths are notable for their complicated lifecycles often including consecutive developmental phases, in separate hosts or in a free-living state. These parasitic organisms are usually macroscopic, multicellular organisms, and do not breed within their mammalian hosts. Notably, many helminthic diseases present with dermatologic signs and symptoms including skin nodules, cysts, migratory skin lesions, and pruritus. In this section, we discuss cutaneous myiasis as well as the four most common nematode dermatologic conditions seen in the United States.

Cutaneous manifestations of waterborne infections

Although waterborne pathogens are relatively uncommon causes of cutaneous infections, these agents are being recognized with increasing frequency. Humans are exposed to water through a variety of recreational and occupational activities. Poor sanitary conditions in developing nations place the human populations at constant risk. Some aquatically acquired skin infections respond well to therapy, whereas other diseases do not require a specific treatment. However, many of these infections are rare, and effective therapy has not been defined. Gram-negative bacilli constitute the largest group of aquatic pathogens that cause skin infections. Other agents include mycobacteria, fungi, viruses, and amoeba and other parasites. Toxins from aquatic animals and parasites are associated with cutaneous diseases. Because waterborne skin infections, which are caused by a wide variety of pathogens, occur infrequently, most of the literature on the topic are case reports. This paper reviews the aquatic pathogens associated with cutaneous infections in humans and the available treatments.

One Linuche mystery solved: all 3 stages of the coronate scyphomedusa Linuche unguiculata cause seabather's eruption

BACKGROUND

Seabather's eruption (SBE) is a highly pruritic dermatosis affecting swimmers and divers in marine waters off Florida, in the Gulf of Mexico, and the Caribbean Sea. Its cause has been attributed to various organisms but recently to the larvae of the schyphomedusa, Linuche unguiculata.

OBJECTIVE

We attempted to determine whether immature and adult Linuche cause SBE.

METHODS

Episodes of SBE in the Cancun and Cozumel area of the Mexican Caribbean were evaluated during the season of high tourism (January-June). This time corresponds to the moments in the life cycle when the three swimming stages of L unguiculata-ephyrae, medusae, and larvae-can be sequentially observed. Our methods include (1) observations by divers, biologists, and students coinciding with stinging outbreaks and the onset of SBE; (2) serologic evaluation of individuals stung by L unguiculata; and (3) the demonstration of Linuche nematocysts on the affected skin.

RESULTS

All 3 swimming Linuche stages can cause SBE.

CONCLUSION

The offending stages of Linuche can be identified by the cutaneous lesion's morphology and the time of year.

Environmental injuries

Environmental injuries and illnesses can happen in home, work, or recreational settings. The variety and severity of these injuries might require the clinician to call on skills from internal medicine, emergency medicine, and toxicology. Diseases of thermoregulation are hypothermia and hyperthermia. In each instance, treatment is based on the need to restore the patient's core temperature to normal and on monitoring for complications. The victim of a fire might suffer inhalation injury in addition to burns, and it is more likely that the inhalation injury will be fatal. Oxygen deprivation and inhalation of irritant or asphyxiant chemicals contribute to injury. Toxic plants can be the source of poisoning emergencies, especially in children. Misinformation and myths that surround common plants can create diagnostic problems (i.e., which plants really are toxic and require emergency measures). Venomous marine organisms can cause a wide range of injury, from cutaneous eruption to fatal envenomation. Most are encountered in a recreational setting, such as water sports, but keepers of home aquariums are subject to stings from venomous fish. Lightning injury can present many diagnostic and treatment dilemmas. An important point in this regard is that lightning injury and high-voltage electrical injury are different in pathology and require different approaches for treatment. A discussion of electrical, chemical, and thermal burns makes such differences apparent.

Caribbean itch: eight cases and one who didn't (Exercise Blue Calypso Diamond)

Stinging plankton are a potential source of irritation and morbidity for those pursuing aquatic sports in areas where they are numerous. The problem is seasonal, and likely to be familiar to local people. We describe an incident in which a number of military personnel were affected by the stings of the thimble jelly fish (Linuche unguiculata), with a brief review of the biology of the problem and some recommendations for prevention.