Updates By Carol A. Kemper, MD, FACP
Stingray Fasciitis
Source: Barber GR, Swygert JS. N Engl J Med 2000;342:824.
A middle-aged man stepped off his boat in Tampa Bay, Fla., and was struck by a stingray, causing a deep laceration to the shin and anterior tibialis muscle. Although the wound was promptly irrigated and sutured, within four days he developed fever and necrotizing fasciitis of the anterior tibialis muscle requiring extensive debridement. Wound cultures yielded a lesser known vibrio species, Photobacterium damsela (formerly Vibrio damsela). He responded well to a combination of doxycycline and tobramycin, followed by doxycycline and cephalexin for two weeks as an outpatient, although a split thickness skin graft was later required. P. damsela is a virulent pathogen that can result in rapidly fatal infection in both immune competent and incompetent hosts, including soft tissue infections and sepsis. The organism has been associated with brackish water and diseased fish.
Clinicians should be aware of the risk of vibrio infection complicating penetrating injuries occurring in brackish water. Similar to that for penetrating bite wounds from dogs and cats, prophylactic antimicrobial therapy for such deep soft tissue injuries is probably warranted.
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