ABSTRACT
A 19-year-old man presented with a 1.5-cm nodule on the first dorsal metacarpal ray. The patient denied having contact with fish tanks or fish, but recalled handling many reptiles without gloves in the vivarium where he worked. A culture of a skin biopsy specimen yielded Mycobacterium marinum. The clinical outcome was favourable after a 2-week course of intramuscular gentamicin (180 mg daily) combined with a 6-week course of oral clarithromycin (500 mg twice a day). Doctors should be aware that vivariums, in addition to fish tanks, can be sources of M. marinum exposure.
Subject(s)
Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium marinum/isolation & purification , Reptiles/microbiology , Skin Diseases, Bacterial/diagnosis , Animals , Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Gentamicins/therapeutic use , Humans , Male , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium Infections, Nontuberculous/transmission , Mycobacterium marinum/drug effects , Mycobacterium marinum/pathogenicity , Mycobacterium marinum/physiology , Skin/microbiology , Skin Diseases, Bacterial/drug therapy , Skin Diseases, Bacterial/microbiology , Skin Diseases, Bacterial/transmission , Young AdultABSTRACT
BACKGROUND: Suspicion of contagious disease on commercial ships tends to be poorly managed, as there is little capacity to confirm a case on board except for malaria. Here we implemented a point-of-care (POC) laboratory on one container ship and one cruise ship for the rapid syndrome-based diagnosis of infectious diseases on board. METHODS: In 2012 we implemented a POC laboratory on board a freight ship and on board a cruise ship. The POC laboratory ran a total of six different color-coded, syndrome-based kits incorporating 10 different commercially available immunochromatographic tests. The POC tests were taught within 1-hour as part of training to staff without any previous knowledge in microbiology. RESULTS: Compared with terrestrial POCs, specific constraints included the necessity to secure POC devices into the motile ship, to use robust devices, to overcome difficulties in communicating with the core laboratory, and to overcome limited intimacy of patients. However, a total of 36 POC tests were easily performed and yielded contributive negative results. CONCLUSIONS: This first experiment indicates that it is possible to run POC laboratories by nonexpert staff after providing rapid teaching course on board commercial ships. Generalization of on-board POC laboratories is expected to help in improving the medical management of staff and passengers.
