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Symptoms and Signs of Fish-Handler's Disease

Doctor's Notes on Fish-Handler's Disease

Fish-handler's disease is a general term that describes an illness that may occur after handling fish or other aquatic organisms. Outbreaks have been associated with occupations (fishermen or lobstermen), hobbies (tropical fish tanks, pet shop workers), or water sports (boating, swimming pool use). At least two different types of bacteria (Mycobacterium and Erysipelothrix) tend to cause the disease.

Symptoms of fish-handler's disease caused by Erysipelothrix rhusiopathiae and other species usually develop two to seven days after infection and may include a sharply defined, red-purple circular area that appears and surrounds the puncture wound; the center usually fades, and sometimes a blister-like lesion may appear. The injured area increases in diameter about ½ inch per day. Symptoms that may accompany the infection include joint stiffness, lymph node swelling, and pain, burning, itching, and swelling at the infection site. In rare cases sepsis (infection of the bloodstream) and endocarditis (infection of the heart valves) may occur. Symptoms of fish-handler's disease caused by Mycobacterium species typically develop about two to four weeks after exposure and may include skin lesions (often multiple and linear but can be single) that can develop slowly over months and appear as nodules, abscesses, or ulcers, with skin color changes. Symptoms that may accompany the infection include joint pain, lymph node swelling, and tendonitis. Rarely, sepsis may occur.

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 3/11/2019

Fish-Handler's Disease Symptoms

Symptoms for fish-handler's disease caused by Erysipelothrix rhusiopathiae and other species are as follows:

  • The disease generally develops two to seven days after injury to the skin and subsequent bacterial infection.
  • A sharply defined, red-purple circular area appears and surrounds the puncture; the center usually fades, and occasionally a vesicle (blister) may appear.
  • The area of injury increases in diameter by about ½ inch per day.
  • Joint stiffness, lymph node swelling, and pain, burning, itching, and swelling at the infection site may accompany the infection.
  • Rarely, the disease may progress to produce sepsis (infection of the bloodstream) and endocarditis (infection of the heart valves).

Symptoms for fish-handler's disease caused by Mycobacterium species are as follows:

  • The disease generally develops about two to four weeks after exposure, although up to nine months postexposure has been reported.
  • Skin lesions are often multiple and linear but can be single.
  • Lesions can appear as nodules, abscesses, or ulcers, with skin color changes, and develop slowly (months).
  • Joint pain, lymph node swelling, and tendonitis may develop.
  • Rarely, the disease may progress to sepsis (infection of the bloodstream).

Fish-Handler's Disease Causes

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, which means it is caused by an infection which resembles erysipelas but is caused by a different organism than that which causes erysipelas. 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 Mycobacterium ssp., mainly the species marinum and fortuitum. Handling tropical fish, coral, cleaning aquariums, swimming pools, fishing, lobster catching, and many other similar activities can introduce these bacteria into cuts and scrapes. This disease is worldwide and can be associated with many organisms that inhabit 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.

Bacterial Infections 101 Types, Symptoms, and Treatments Slideshow

Bacterial Infections 101 Types, Symptoms, and Treatments Slideshow

Bacteria are microscopic, single-cell organisms that live almost everywhere. Bacteria live in every climate and location on earth. Some are airborne while others live in water or soil. Bacteria live on and inside plants, animals, and people. The word "bacteria" has a negative connotation, but bacteria actually perform many vital functions for organisms and in the environment. For example, plants need bacteria in the soil in order to grow.

The vast majority of bacteria are harmless to people and some strains are even beneficial. In the human gastrointestinal tract, good bacteria aid in digestion and produce vitamins. They also help with immunity, making the body less hospitable to bad bacteria and other harmful pathogens. When considering all the strains of bacteria that exist, relatively few are capable of making people sick.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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