A word of caution: NTM infections

I've been dealing with some health issues that I suspect originated from fishing-related exposure to a very rare bacteria. Last May (2021), one of my fingers began feeling a bit stiff. I shrugged it off as an injury sustained while fishing or working that wasn't significant enough for me to remember in the moment. You know how it is-you whack your hand on something, it hurts for a few minutes, then you move on and forget about it.

I figured even in the worst-case scenario of a fracture, it was a finger and the doctor would tell me to rest it, tape it up, etc. This stiffness and swelling progressed over months and it was clear that the situation was not improving. There was not pain per se, more of an occasional ache, and nothing drastic to suggest that there was a serious problem-just a persistent, now limiting swelling.

My PCP made a diagnosis and told me to rest the hand. After a few weeks, I got an xray which read normal. At this point, I'm worried about work (as a cabinetmaker) perpetuating the condition and am forced to take some time off. A specialist took a look at it and concluded that not much could be done except rest and assured me that there was no trauma and nothing to repair surgically, etc.

An MRI confirmed the original diagnosis of tenosynovitis-an inflammation of the tissue that surrounds a tendon, in this case, my digital flexor tendon which bends my left index finger. My range of motion was limited to about 30% of normal. I received a cortisone shot which alleviated the swelling but after two weeks, the swelling returned.

A couple of months later, I had a surgical procedure to clean out the inflamed tissue from my finger with the goal of restoring range of motion, and also taking a tissue sample to find the cause of the swelling. In the months before surgery, I developed some symptoms of a bacterial infection (lymphangitis) and went on antibiotics, which also alleviated some of the swelling in my finger. This suggested that an infection was causing my hand issues, but not your typical staph-like bacteria-something called a non tuberculosis mycobacterium. They are very rare, slow growing and extremely difficult to diagnose and treat.

Now a couple of months after my surgery, my finger is still swollen and uncomfortable. I have working with an infectious disease specialist to properly diagnose and treat my infection. It will require advanced lab work (PCR testing at the University of Washington), a combination of 2-3 antibiotics taken for several months or more, and potentially more surgery.

I believe that I was exposed to whatever this is while fishing. Around the time symptoms first developed, the only species I would have been fishing for is striped bass, which have terribly sharp dorsal and anal fin spines. I suspect I got a puncture from one of these spines which introduced the bacteria to the tissue deep in my finger.

I don't think this is something that is likely to happen to any of you, but something to be aware of should you develop any similar symptoms....ahhhh the joys of fishing

Wow, sorry to see you with this kind of problem.
It seems all of our fancy doctors and medical professionals are very good at dealing with obvious problems like broken bones, heart attacks. trama.
But when it gets to the odd stuff they are like mechanics with less diagnostic equipment.
Sure they can poke and prod but I am waiting for the tricorder like in star trek.   

Troy

NTM`s are nasty little critters.The critters like to form clubs and party usually in damp or wet places. Definitely opportunistic.

I know they like  peeps depressed immune systems.

Sending positive vibes to your care team and that you heal well and fast

I read an article about something very similar that happened in Socal- just spent 15 mins looking but cannot for the life of me find it... it was 2 commercial fishermen, fishing rockfish out in san diego. they had been out at one reef for a few days and then started having similar symptoms of mobility and joint issues, inflammation, and then eventually it got pretty serious as you're describing.  They ended up going back to the reef and sampling these fish more, bringing some to Scripps in La Jolla to investigate their slime.  I will continue looking for it as the similarity is uncanny.
Wishing you a speedy recovery so you can be back in action

Man… I’m glad they seem to have figured out what’s up.

I had a similar situation, but thankfully it wasn’t an infection in my case.

I was doing some yard work and managed to stick a cactus needle deep into into my knuckle. I pulled it out, but I could tell by looking that the tip of the needle that it had broken off. The pain was gone after a day so, stayed gone for several days, then it came back with a serious vengeance so I went in to Kaiser. My whole finger had swelled up to the point that I could hardly bend it and it hurt like hell. I kept telling the doctors that I KNEW there was something still in there, and they kept telling me to soak, rest, ice, etc, and it should get better.

Finally they did did an ultrasound about a month and a half later l, and saw something suspicious. Long story short, I went in for surgery and they found the tip of the cactus needle securely embedded in my tendon. Once it was removed, my finger healed up good as new (plus an X shaped scar on my knuckle from the incisions and stitches).

Pay REALLY close attention if you think a spike of any sort has penetrated deep enough to hit a tendon/joint (or the membranes that protect them). It can get bad quick!

Wishing you a quick recovery!


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I read an article about something very similar that happened in Socal- just spent 15 mins looking but cannot for the life of me find it... it was 2 commercial fishermen, fishing rockfish out in san diego. they had been out at one reef for a few days and then started having similar symptoms of mobility and joint issues, inflammation, and then eventually it got pretty serious as you're describing.  They ended up going back to the reef and sampling these fish more, bringing some to Scripps in La Jolla to investigate their slime.  I will continue looking for it as the similarity is uncanny.
Wishing you a speedy recovery so you can be back in action

I think I remember that article. I also remember watching a YouTube video from some well-known angler (forget…) who went through something much like you describe after getting stuck by a rockfish. I think he said he nearly lost his finger?!?


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Oh man.  This brings back memories of my experience with an adverse reaction to the slime of a European seabream.  My hands burned and hurt for days and luckily it subsided after about a week, but you're going through some long term issues.  I hope they can finally pinpoint an effective cure. 

Thanks for sharing - take care!

Thanks for all of the details, and I hope it is resolved soon.

Yikes. So many strange microbes out there. Does it feel better when you soak it in hot water? Wishing you a full recovery, and thanks for the warning.

That sucks, Matt.  Thanks for sharing it - sounds like something that any one of us might experience.

Get well soon.

These days you should take minor wounds very seriously, there are drug resistant organisms that can totally wreck you. Organisms(especially resistant ones) can go from external to internal via a minor scratch and migrate via the bloodstream and wreak havoc in other parts of your body

I’ve seen it up close a number of times in the ICU, perfectly healthy kids get some minor wound(like an ankle scratch sliding into home plate) and end up with much more serious situations like sepsis and in some cases trashed lungs and all that goes with that. I was talking with a physician about this and even with all our advanced medicine, the cheapest and best insurance against this kind of thing is a recipe I think from WWI called DI DAK SOL (short for “diluted Dakins solution”)

If I had known about this a couple of years ago it would’ve saved me a nasty leg surgery and a week in the hospital and 3+ months recovery. I asked for a derm consult while I was in the hospital and that’s how I learned about it

We now keep DI DAK SOL(and use it regularly) at home and I will be carrying it in the car with the first aid stuff for surf injuries like when my son gets over-amped and surfs right up onto the nearest reef and ends up bleeding from multiple wounds

I had a buddy that did commercial tuna fishing and during a several day-long excursion at sea, sliced his hand open but continued to operate chum and bait with an open wound. Mid-20's and perfectly healthy. Nearly died after he went into shock, and the captain had to race into port with an ambulance waiting at the dock. Almost had to be airlifted out at sea. Went septic from BSI within 2 days of injury. Saw the same thing happen on an episode of Wicked Tuna, almost word for word. Always take caution with open wounds in the outdoors. Even dirt on an open wound is cause for concern. Alcohol and neosporin along with water-proof bandages are always in my kayak. And change the outdoor bandage and re-clean injuries after returning to civilization.

Edit: every fisherman should be up-to-date on their tetanus boosters. We operate rusty sharp metal objects alarmingly frequently

Thank you all for your well wishes and concern. I feel lucky to have the care team I do and feel they are doing a great job, despite whatever limitations exist.

Those of us that work with our hands in the skilled trades or restaurant business (both of which I do/have) practically always have small cuts or skin openings on our hands-makes it difficult to be so diligent...

 DI DAK SOL (short for “diluted Dakins solution”)

I'd like to know more about your use of this med, if you don't mind. 

thanks

Bushy