Ask KDiTo Ask Dr. Keith Roach M.D
M. marinum bacteria exposure comes via water
DEAR DR. ROACH: I read your recent column about 'flesh-eating bacteria.' Is it in any way related to Mycobacterium marinum?
My son is having multiple surgeries due to this, which was finally and correctly diagnosed after many weeks. It came on slowly over months, and has caused his hand to swell up greatly. He remembered that he did get a cut on his hand while fixing a home water line that was in soil. He was told that it is rare, but it occurs all over this country. There is a creek near us, and recently a local newspaper announced that there was a 'life-threatening' bacteria discovered in that creek, which empties into a local waterway. His treatment was intravenous continuously for over a week, and now three strong antibiotics to be taken for at least a year. Meanwhile, he continues with some surgery. — N.F.
ANSWER: Mycobacterium marinum is a bacteria species closely related to tuberculosis. It is not related to the type of 'flesh-eating' bacteria you read about periodically in the newspaper; those are group A streptococcus, which grows very rapidly (people can go from appearing well to being dead in hours) and needs immediate identification and surgery to treat; M. marinum grows slowly. It is uniquely related to water exposure, especially from fish tanks (both fresh and saltwater). However, it has been reported after exposure to oysters and fish spines, and occasionally in swimming pools.
Treatment for M. marinum usually includes two or more antibiotics taken for months. Your son's infection is worse than I have heard of, requiring surgery and antibiotics lasting over a year.
I looked up your local creek: It is contaminated by fecal bacteria (presumably from untreated sewage), not by M. marinum. I hope your son does well. *** DEAR DR. ROACH: I had prostate cancer, treated with freezing. I have not had an erection since, despite trying Viagra and injections. Nothing has worked in two years. My doctor said it might last six months to a year. Could there be something wrong with me medically, and what can be done to fix my problem? — W.K.E.
ANSWER: Even when performed by the best doctors, there is a risk of permanent erectile dysfunction with any kind of prostate cancer treatment. This is true even with cryotherapy (freezing treatment) for prostate cancer; the risk of losing sexual function still is significant.
Given a lack of effect with injections and oral medications, you should talk to your urologist about a vacuum device or a penile prosthesis. *** DEAR DR. ROACH: I am a 93-year-old retired nurse. I have a problem with 'second time around menopause.' Some nights I wake up warm and need to cool the room with a fan. I had a total hysterectomy many years ago. The nurse in my health office said it is hormonal, but said I am too old to take hormones. Do you have any remedies? — S.H.S. ANSWER: I hate to disagree with your nurse, but I am not as sure about what is causing your new set of hot flashes. It would be unusual for menopausal symptoms to recur after such a long time, so you should consider other potential causes for feeling hot. Thyroid disease, being in a room that's too warm, weight gain and anxiety are common causes. Food sensitivities are an unusual cause, but given how intermittent your symptoms are, it might be worth keeping track of your diet to see if that correlates with the hot flashes at night. Low blood sugar at night can cause similar symptoms, as can rare tumors that secrete substances that make you flush. You need an evaluation before you decide on a remedy. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.