Severe soft tissue infection, presumed related to rental wetsuit

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doctormike

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Hi,

This isn't my story, I'm posting it for a friend who prefers to remain anonymous. But I can communicate any questions that people have to the OP and share the answers here.

This is far from my area of expertise, and obviously there are a lot of variables and unknowns in this case. But I think that it's an important thing to consider.

I hope that people don't get the idea that you should never rent a wetsuit, I do understand that especially for new divers that may pose logistic difficulties. But it's something to be aware of, and it seems like the OP has a few points of advice that may be helpful if you end up needing to rent a wetsuit.

_______________________________________________________________________________


Doctormike - I'd like to share a story about some medical issues I had last year; so that others may benefit from my lessons learned, the hard way.

I was teaching deco procedures, and using my own 3mm wetsuit for the first few days. After about the third day of low 70's water temps; I was finding myself more and more miserable during the dives. Getting a bit soft in my older age, and after reading some of Steve Lewis' excellent articles on body temperature and efficient off-gassing; I decided I should probably grab a bit warmer suit.

I normally NEVER use rental gear, period. I hate trusting my life to gear I don't maintain myself; and I will admit I am a bit of a germ-o-phobe. But, being cold sucks; and getting bent would suck. So....I grabbed the only rental 5mm that fit, and finished the dives. I'll admit, at the time I was not totally comfortable with the suit. It was old, and really stinky. It had obviously been through a few wars. But, my other suits were all back home so it was my only option.

Fast forward a week later, after I got back home. I started getting small pimples on my legs, near my knee caps. They would come to a head, pop, then go away a few days to a week later. They started small, and fairly low in numbers. Over the next few months, they gradually became more frequent; and got a little larger. The first indication I had a problem was when they spread to my scrotum. It literally hurt like hell to even sit down. So...I made my first appointment to see the doc. My primary care physician lanced it; gave me some topical antibiotics and sent me on my way.

About a week later I developed what was the first of the really bad infections on my right leg near my crotch. It was about the size of a golf ball and really painful. About a day later the second one started on the opposite leg, same spot. I made another appointment to see my doc, but by the time I went in they had both grown considerably. He took ended up lancing both, draining about 30cc of fluid from each, and packing the left with about 3 feet of packing, and the right with about 2 feet. I was numb, so no big pain at the time. However, pulling packing without anesthesia was the worst pain I have ever experienced. He sent the cultures off, which were to no surprise ID'd as MRSA. We think it was most likely from the wetsuit, from another diver that had recently rented the suit. There were really no other environmental factors at the time, that would have resulted in the first infection.

Today, I'm left with two cool looking wounds that look like I've been shot. Other than that, the experience should have been avoided at all costs. Here are my lessons learned, and screw ups; so that others may learn.

1) Don't rent wetsuits if you don't need to. There are too many communicable diseases out there. If you do rent, wear skins, and wash well immediately post dive. In fact, there is a problem with Vibrio where I live, so washing after diving is generally a good practice IMO.
2) Don't rely on shops to sanitize rental wetsuits. After some research I found that most of the stuff that would kill MRSA would destroy suits in short order. It would be too costly to destroy wetsuits just to keep them clean - or the solution would be expensive to stock. Either way, financial it doesn't make sense for shops to try this.
3) Don't wait to see the Dr. if you develop skin infections. MRSA is just too prevalent nowadays.
4) Don't be afraid to ask your primary Dr. to do a culture if you have skin infections. I have a wife and kids; and should have been more diligent about getting diagnosed so I didn't bring something back into the house.
5) If/when they give you Hibiclens, or some other antibacterial soap - it will probably kill your septic system if you use it long term. I found that out the hard way to the tune of $5,000.
 
Ouch. Sorry to hear such a horrible mrsa experience. I've got crotch rot from a rental wetsuit. It's bad enough.

Family member contacted Mrsa after a hospital visit. No joke and treatment was difficult.

With sharing gear, I believe infectious diseases should be more of a concern.

Regards,
Cameron
 
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Thanks for sharing & yes, ouch, ouch and ouch!
 
Just to clarify something about MRSA. Staph Aureus (the "SA") part, is a very common organism in the community. Remember that we are all marinating in a sea of viruses and bacteria. Our upper airways are coated with colonies of bacteria, the so-called "normal flora". Generally, these bacteria are not invasive - that is, they just live on the surfaces of the airway. In some cases (like in the intestine), they are actually helpful. When they cause clinical infections it is because they have become invasive, and set up a growing colony within the host's tissue.

MRSA ("methicillin resistant staph aureus") is a subset of SA that have evolved to resist one class of antibiotics. There are lots of resistant bacteria out there, caused by the evolutionary pressure of our overuse of antibiotics. This particular class is hard to kill because unlike other resistant organisms, there aren't a lot of options for treating them. It's not that MRSA strains are intrinsically more invasive or aggressive than other bacteria, it's more that they are harder to contain medically.

For some people, their normal flora include MRSA. These people will ALWAYS grow MRSA when you do a throat culture. They are not contagious, and they are not sick.

Finally, keep in mind the difference between "flesh eating bacteria" (more correctly known as necrotizing fasciitis, or NF), and MRSA. NF is a very aggressive and potentially deadly bacterial infection that spreads along the planes of the deeper soft tissues, causing breakdown of the walls that usually contain infections. While MRSA can be involved in NF, other bacteria are more common, particularly Streptococcus species. Also, it is not clear why these common bacteria sometimes cause such an aggressive infection. In some cases, the host has a problem with the immune system (people on chemotherapy, transplant drugs, diabetes, etc..), but in other cases the hosts are seemingly normal.

I have only seen this in a child once - a 2 year old with an infection in the neck that turned into NF. We had to do aggressive debridement, which is surgically removing the dead and infected soft tissue until you get down to healthy (bleeding) tissue. Fortunately, this did not end up involving the big blood vessels in the neck (the jugular and carotid), although they were exposed during debridement.
 
Small addition to this Catalog of Cooties: I got a Yeast Infection for the Ages using a rental wetsuit sans bathing suit- took three weeks of antifungal treatments to beat it down, I bought and clean my own wetsuit after that.
 
That’s really scary!

Now that I’ve finally committed to buying my own set of gear, I hate to think of all the risks I took when I was renting. The first pieces of gear I bought were my wetsuit, along with mask and fins. I got a very nasty flu once from someone who lent me his mask, and who was just recovering from the flu. Never again. I suppose you can catch things from most gear, with wetsuit, regulator, mask and even fins being rather “personal”.
 
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Yuck. I would think that a plain soap and water soak would kill a lot of those.
 
It also probably has a lot to do with storage. Caribbean dive locations (or other humid warm places) where neoprene never really is allowed to dry out completely between uses will make a good environment for the growth of bacteria and fungi.
 
True. Still, wouldn't you think that a soap and water soak after use would keep the counts down and reduce the likelihood of this?
 

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