Symptoms and Signs of Fish-Handler's Disease

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 10/18/2021

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.

What Is the Treatment for Fish-Handler’s Disease?

Persons with cases of suspected fish-handler’s disease should seek medical care. Immediate treatment for fish-handler’s disease includes:

  • Clean all wounds thoroughly with soap and water
  • Oral antibiotics are needed to treat the skin infection
  • Pain may be relieved over-the-counter (OTC) pain medications such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil)
  • Severe infections can cause sepsis, a life-threatening medical emergency, and may need hospitalization for intravenous (IV) antibiotics
  • Most cases of fish-handler’s disease go away completely with treatment. Severe cases may need prolonged treatment with antibiotics (weeks or months) and in very rare cases, the illness can be fatal.

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