Fish-Handler's Disease

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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Fish-Handler's Disease Overview
• Fish-Handler's Disease Symptoms and Signs
• When to Seek Medical Care
• Diagnosis of Fish-Handler's Disease
• Fish-Handler's Disease Treatment
• Synonyms and Keywords
• Authors and Editors

Fish-handler's disease is a nonspecific term that is in the medical and lay literature that describes a disease or syndrome of humans that may occur after handling fish or, in some instances, other aquatic organisms. There are a number of other similar terms that essentially describe the same disease. They are as follows:

• Fish-handler's disease
• Fish handler's nodules
• Fish tank granuloma
• Swimming pool granuloma
• Fish tuberculosis
• Picine tuberculosis
• "Erysipeloid" infection or lesions
• Mycobacteriosis

The disease has so many names because so many different outbreaks have been associated with occupations (fishermen or lobstermen), hobbies (tropical fish tanks, pet shop workers), or water sports (boating, swimming pool use). Researchers also discovered that at least two different genera of bacteria (Mycobacterium and Erysipelothrix) were the main causative infective agents of the disease. These findings added to the proliferation of names. Although some of the symptoms (mainly lesions on the extremities) caused by the organisms are similar, other symptoms, diagnosis, and treatment are somewhat different. This article is designed to discuss these two major causes of fish-handler's disease.

Fish-handler's disease occurs when cuts or scrapes in the skin become infected with the bacteria Erysipelothrix rhusiopathiae and other species. This is an erysipeloid infection. Handling and preparing fish and shellfish and many other similar activities can create small cuts and scrapes in the skin, where bacteria may enter. Developing fish-handler's disease requires deliberate contact with fish, particularly lobster and other shellfish. Fish-handler's disease occurs worldwide wherever fish and shellfish are handled.

Fish-handler's disease also occurs when cuts or scrapes in the skin become infected with the bacteria of the Mycobacterium, type, mainly the species marinum and fortuitum. Handling tropical fish, coral, cleaning aquariums, swimming pools, fishing, lobster catching, and many other similar activities can introduce the bacteria into cuts and scrapes. This disease is worldwide and can be associated with almost any organism that inhabits saltwater, freshwater, or brackish water. One of the newest outbreaks occurred in Chesapeake Bay with about 76% of striped bass found to have an infection with Mycobacterium.

Fish or other aquatic organisms with visible surface lesions should be not be handled with bare hands (wear gloves to help prevent infections) and not eaten. However, cooked aquatic organisms have not been reported to cause fish-handler's disease.