Cutaneous Manifestations Following Exposures to Marine Life Workup

Updated: Jan 12, 2018
  • Author: Zoltan Trizna, MD, PhD; Chief Editor: William D James, MD  more...
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Workup

Laboratory Studies

The following laboratory tests may be helpful:

  • Culture and sensitivity of infected wounds: Consider cultures for atypical Mycobacteria (M marinum) in the presence of granulomatous and ulcerating lesions or sporotrichoid spread. Other test results usually are noncontributory, unless systemic reactions are noted.

  • Intracutaneous tests with species-specific extracts: These can detect immediate and delayed-type reactions.

  • Serologic tests: These may reveal elevated immunoglobulins directed against specific antigens in patients with delayed cutaneous manifestations.

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Imaging Studies

Radiography is indicated to detect foreign body or involvement of deeper structures (eg, joint, bone).

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Procedures

Consider taking a biopsy when diagnosis is in doubt or when tissue culture is indicated.

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Histologic Findings

Histologic findings generally are nonspecific.

In seabather's eruption, superficial and deep perivascular and interstitial infiltrate consisting of lymphocytes, neutrophils, and eosinophils are described.

Biopsy of tissues infected with M marinum shows a mixed suppurative and granulomatous reaction with sparse-to-absent acid-fast bacilli.

Delayed skin reaction can be characterized by liquefaction degeneration of the basal layer.

Polarized light can reveal symmetric structures, corresponding to cross-sections of sea urchin spines.

Infections with V vulnificus show a nonspecific, yet characteristic, picture. Destruction extends into the dermis without an inflammatory cell infiltrate. Vasculitis may be present. Subepidermal noninflammatory bullae can be noted. Multiple organisms are observed.

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