What started as a small scrape from corner of the family's fish tank five years ago may end in the amputation of a champion teen gynmast's hand.
Hannele Cox, 13, from Oak Hills, Calif., has battled a rare, flesh-eating infection she contracted from the tank when she was 8 and doctors have been unable to stop it from spreading. The bacteria has now spread to the bones of her right hand.
"I can't use that hand at all. I'm in pain all the time," says Hannele.
Over the years, the infection has forced Hannele to quit sports like volleyball and gymnastics, despite having won an American Athletic Union gymnastics championship. The infection has become so severe that the eighth grader has been unable to write or do school work because her dominant hand is constantly shaking with pain.
Mycobacterium marinum, sometimes referred to as fish tank granuloma, usually eats away at only the surface of the skin. But in Hannele's case it has infected several bones in her right hand, a development which could mean amputation of her right hand.
Doctors at the Loma Linda Medical Center and UCLA Medical Center have tried multiple types of antibiotics and two surgeries to remove infected tissue, but the bacteria seems to have become drug-resistant. Fearing she may be infected with a "superbug" strain of the bacteria, the Cox family is seeking further treatment for her with infectious disease experts at Denver, Colo.'s National Jewish Health medical center next week.
"I'm afraid they won't be able to fix it," Hannele says of her upcoming trip to Denver. "I'm afraid they'll mess up again and I'll go through something I didn't have to, like with the past treatments."
Her mother is also looking ahead to the Denver trip with concern.
"When I found out that it had spread to her bones, I think that's the hardest I've cried in this whole thing. I just lost it," says the teen's mom, Amy Cox. "After years of doctors not taking this seriously, this trip [to Denver] is our last hope."
The trip has already been delayed due to insurance issues and in order to afford the medical bills, the family has had to give away their horses to save them the cost of boarding and feeding them.
"It's hard enough to watch your child struggle with constant pain, but she's had to give up so much -- gymnastics, horseback-riding, and now her horses," says Cox.
Fish Tank Bacteria -- Rare Infection, Rare Reaction
The ordeal began when Hannele was only 8-years-old, playing in the fish tank that resides in the family's living room.
"She had already gotten in trouble a few times that week for sticking her arm in the fish tank," says Hannele's mother. "So when she cut her hand on it she hid it from me for a few days because she was worried about getting in trouble. By the time I saw it, it was red and purple and oozing with yucky green stuff. I soaked it in peroxide, but the cut wouldn't go away."
It took months for doctors to recognize that the wound was infected with mycobacterium marinum. They originally thought it was a staph infection or even MRSA.
Then came multiple rounds of antibiotics, some of which made Hannele so sick that she had to quit sports. These drugs and two surgeries on her hand have been powerless against this strain of the bacteria, however.
Mycobacterium marinum is a distant cousin to more serious infections like tuberculosis and leprosy, but it is "exceedingly rare" for it to persist and travel deeper into the tissue as it has in Hannele, says Dr. Michael Iseman, infectious disease expert at National Jewish Health in Denver, Colo.
"The fact that she's had multiple surgeries suggests that this is a more virulent, drug-resistant strain than most," he says.
Danger in the Water?
The bacteria can be found in salt or fresh water and has historically been associated with surfboarding and more recently, fish tanks. The bacteria is harmless unless introduced to an open wound and infections are relatively rare, says Dr. William Schaffner, chair of the department of Preventive Medicine at Vanderbilt University School of Medicine.
Infections can sometimes heal on their own, but "it's a long-lasting infection and, without treatment, it can take one to two years to resolve," says Schaffner. Treatment consists of combinations of antibiotics and surgery.
Fending Off Fish Tank Frights
Mild skin infections with mycobacterium marinum are well-known among aquarium hobbyists, but the most famous disease risk among aquarium enthusiasts is salmonella, says Dr. Christopher Ohl, MD, an infectious diseases expert at Wake Forest University School of Medicine.
Salmonella outbreaks have been periodically tied to fish, amphibian, and reptile pets and the tanks they reside in; the most recent of which occurred this April when 216 people contracted Salmonella from pet African Dwarf Water Frogs.
Overall, however, fish tanks "pose very little risk" when properly maintained, notes Schaffner.
He recommends wearing latex gloves while cleaning pet tanks and washing hands and forearms with soap and water afterwards.
Ohl also recommends cleaning tanks outside or in a bathtub -- not in the kitchen sink, to reduce the risk of contamination. Wash the bathtub with bleach afterwards if used, he says. If you get a cut while cleaning a fish tank, wash the wound with soap and water immediately.