BALTIMORE -- When Charlie Schneider came back one day in June after being out fishing near his Tilghman Island home, he noticed he was getting chills. His left ankle itched and got worse and worse through the evening. It eventually started to throb a bit, and he couldn't sleep. At 2 a.m., he asked his wife to get an ice pack before discovering that his ankle had swollen to twice its normal size.
He didn't know what had caused the reaction, but his decision to go straight to the hospital ultimately helped save his legs -- and his life.
Schneider, 66, was suffering from an infection caused by the vibrio vulnificus bacterium, which exists naturally in saltwater but is more prevalent in warmer water, said Martin Carter, a retired Department of Health and Mental Hygiene Laboratories Administration employee who speaks to fishing groups about infections, such as this one, that fishermen can be exposed to.
Vibrio infects victims through open wounds exposed to warm saltwater or through the consumption of raw oysters carrying the bacterium. While the bacterium is much less prevalent in colder seasons because it multiplies more prolifically in warmer water, Carter said "really it's not a good idea to eat raw oysters in the summertime."
Schneider hadn't eaten any oysters, though, and both he and Carter said Schneider is a healthy person. Although healthy people are more likely to fight off the spread of infection than those with weakened immune systems, Carter said, healthy people such as Schneider are not immune. He had exposed scrapes and scratches on his ankles to the water while fishing, and that was enough for infection.
When he went to a hospital the night he discovered the infection, he was put on antibiotics, but the medical staff didn't know what he was suffering from. After going to his family doctor only to find a similar result, he returned to the hospital the next morning to see an infectious-disease specialist.
He asked the specialist if he had contracted mycobacterium marinum, also known as fish handler's disease, which he knew about thanks to Carter; she was surprised he knew what that was but said it was vibrio -- something she couldn't treat there. He was taken to the University of Maryland Shock Trauma Center.
At the center, Dr. Thomas Scalea told Schneider's wife that if he had arrived there just 12 hours later, he would have died. By that point, the infection had spread to both legs and he was "very, very sick."
"My wife said she didn't realize a body could swell like that," Schneider said. "It's pretty serious stuff."
He spent the next three weeks in an intensive care unit and endured nine surgeries to cut the infection out while staying ahead of its spreading. He said his legs looked like a fish when it's being made into a filet. A 10th surgery was a skin graft, after which he was taken to another hospital for three weeks to eventually regain the use of his legs.
After first going to a hospital to get the infection treated June 19, he could walk again with the assistance of a cane on Labor Day. Now, he can't walk too far or stand for too long because his legs swell up, though the condition is improving, he said.
Schneider also lost the whole summer for fishing, which he used to do five days a week or more sometimes, and not being able to do so "devastated" him, he said.
"Not being able to move, I couldn't do what I love to do," he said. "But the skin grafts took, I got both my legs and I'm alive, so I'm a happy man."
Schneider was lucky: The Associated Press reported Oct. 11 that 31 people in Florida had been infected with vibrio this year, and 10 of them died.
Fish handler's disease
As Schneider knew, vibrio is not the only disease fishermen and others on the water can be exposed to. Jonathan Mitchell, 55, of Brooklyn Park learned about fish handler's disease the hard way.
While fishing under the Key Bridge during the summer about four years ago, Mitchell said, he slipped while cutting up some chum and nicked his thumb with his knife. It took awhile to notice any negative effects, he said, but his thumb became very stiff and all his fingers also soon stiffened until his hand "just about turned to stone."
Mitchell, who fishes recreationally once or twice a week, went to his endocrinologist, who couldn't identify the problem; he then went to the Johns Hopkins Hospital emergency room, where medical staff treated him with antibiotics for a couple of days, but this didn't solve the problem. He went back to his endocrinologist, who sent him to a disease specialist who recognized the disease right away, Mitchell said.
Mitchell had surgery on his thumb to remove the infection and was then put on an antibiotics regimen that took about three months to remove the infection. The mobility in his hand returned, but the infection later came back "strong," and he had to go through another regimen of antibiotics for almost four months before it was gone for good.
"But I never really got the full dexterity back in my hand," Mitchell said. "It's still -- I can't move my thumb like I used to, and I play guitar. I'm not the greatest guitarist, but it really affected me; I'm not as good as I was before. It was very painful, too."
Although Mitchell survived the disease without facing the threat of death or amputation as Schneider did, Mitchell was concerned about the implications that diseases such as fish handler's disease or vibrio can have for avid fishermen.
"Here we are, you know, we just want to go out and have a good time and go fishing, and you've got to worry about everything now. And what do you do?" he said. "Scary when you want to do something that you like and you think it's a nice, clean-cut sport or, you know, a decent thing to do, and now you've got to be careful doing that, too."
Fish handler's disease starts as a small pimple and grows into a "nasty" lesion, said Carter, who is first mate on a charter boat based in Deale. The disease is found mostly on hands, arms and legs.
Fishermen are at risk for coming into contact with diseases that can be life-threatening even in cases not involving vibrio. Capt. Tawn Tipsword, 44, of Huntingtown was unhooking a fish on his charter boat at Holland Point when he was poked.
After about two days, it got worse, so Tipsword, who recently retired from the military, went to the Andrews Air Force Base emergency room before being sent in an ambulance to Walter Reed National Military Medical Center. He spent seven days of IV antibiotic therapy and surgery to treat a staph infection in his finger.
He initially went to the hospital because Carter called him right after Tipsword posted about the injury on a fishing website. Carter told him to go to the emergency room the next day if it didn't get better, and Tipsword said he followed that advice.
"When I got it, I didn't really think it was that big a deal," he said. "And I got there and it was like, 'Well, this could lead to death and could lead to amputation of your finger or hand.' So they got my full and undivided attention at that point."
Tipsword, who said he is on a boat two to three times a week in the spring and summer, said puncture wounds can be difficult to treat while on a boat because there aren't proper facilities for treating wounds, especially puncture wounds.
Carter said health risks presented by vibrio and fish handler's disease are more significant during the summer because the closer the Chesapeake Bay water gets to human body temperature, the more the microorganisms can grow and multiply. When the water is colder, as it is now, the organisms are much less prevalent.
"Those organisms are going to remain in the bay, and many of them are going to remain in the bay and sort of be almost like dormant," Carter said. "And then when the water temperature gets real warm, then that makes them start to multiply and then if they multiply, then the chances of you encountering that organism is greater."
To prevent infection, Carter advised fishermen to clean wounds with soap and water, and use gloves to prevent puncture wounds from fish, barnacles or crab traps. He also encouraged fishermen to tell medical staff about exposure to bay water when being treated for an infection.
In general, Carter said to enjoy the bay but be aware that it contains organisms that can cause disease.
"If (Schneider) had toughed it out, had waited to go to the hospital, he could've been in a wheelchair or six feet under," Carter said. "This is a health concern that a lot of people have to be aware of."
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