Post-Tsunami Wound Infections

The recent earthquake and tsunami in Japan have raised concerns because of resulting radiation release by local nuclear power plants. As the country scrambles to protect its citizens by providing potassium iodide (which the thyroid would take up preferentially to the radioactive iodine) to its citizens, there are other health risks to keep in mind, as we learned from the Indian Ocean tsunami in December 2004.

Infections (particularly of the skin and soft tissue) are quite common in this type of natural disaster as a result of lacerations and even small abrasions from debris, which become contaminated with seawater, sweage, and soil. As international travelers return to their homes, it would be prudent to keep these in mind.

 Here is a brief breakdown of some of the organisms. Much of information is derived from an article in The Annals Academy of Medicine and was a good review of pathogens that we do not typically see on a day-to-day basis.  

Staphylococcus and Streptococcus (very common skin bacteria) should always be considered. Skin infections from these bacteria are very common, with or without any disaster. It is a common skin infection seen in regular medical practice.

 Aeromonas – This was the most common bacterial infection seen after the 2004 tsunami. It is a freshwater organism and, as many people rinse wounds in streams and rivers after skin injury, this can cause skin infections, as well. IMPORTANT POINT: the lab must be notified that you are looking for this specifically, as it involves a separate growth medium and protocol.

Pseudomonas – another freshwater bacteria that was quite common in the 2004 Tsunami

Mycobacteria marinum – A freshwater bacteria. Infection can be slow to develop and heal, cause minimal pain, but also can be difficult to treat. May require surgery.  

Vibrio vulnificus – This is a toxin-producing bacterium found in seawater. It can cause skin infections. This is a particularly serious infection for patients with diabetes or severe liver disease, with potential to cause septicemia (infection in the blood) and death.

C. tetani – This bacteria causes tetanus, which is an infection that has a high mortality rate and can occur with exposure to soil or the classic “rusty nail.” It can cause lock-jaw, spasms, and respiratory failure. It is PREVENTABLE. If you take anything away from this blog post, let it be this – stay updated on this shot (you should get this every 10 years. If you cannot remember when you got yours, ask your doctor if you would benefit from getting one, anyway).

Mucormycosis – a fungus found in soil that causes skin and soft tissues, as well, and generally requires specific antibiotics for treatment.

E. coli, Klebsiella, and Proteus are gram negative bacteria found in sewage or fecal matter. (These are also common causes of urinary tract infections.)

Rabies – This can occur due to animal bites during the chaos of natural disasters. There are regimens for rabies prophylaxis on the WHO website

The 2004 Tsunami also taught us that infections could be quite complex and multidrug-resistant. For example, there was a report in the NEJM of “Tsunami sinusitis,” which was caused by inhalation of seawater. The organisms found were Aeromonas, Klebsiella, E. coli, and Proteus.

In summary, the risk of skin infections risk is high after a tsunami. The list provided above is not exhaustive and not a substitute for your own clinical judgment. It is, however, a reminder of some of the more common organisms to keep in mind. It is likely an Infectious Disease specialist consultation would be warranted, as these cases can be quite complex. And don’t forget to keep current on your tetanus immunization.

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About Linda Pourmassina, MD

Internal Medicine physician.
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