Courtesy of MASNA's quarterly newsletter, author (and vitim) Jim craig takes us through his experience in the ER after a brush with Palythoa grandis.

Attack of the Protopalythoa sp.,
 

I thought it might be helpful to share a recent experience I had working with Palythoa this summer  on July 14th.

July 15, 2009 — one day after the "attack" 

Palythoa – by Jim Craig, Saltwater Enthusiasts Association of St. Louis th, I decided to clean these invasive, nuisance polyps off a shelf in a frag tank. They had started growing up on the hard and soft coral frags and stinging them. I was tired of picking them off each frag one by one. So, I took the plexiglass shelf out and scraped it clean of the Palythoa. Somehow, I acquired some little cuts in the top of my right hand during my project.

I knew something was different as soon as I was done because the cuts started to itch like mosquito bites — weird. The cuts didn’t really show any irritation for about a day. But by the morning of July 16

July 16, 2009 — two days after the "attack"

th, I obviously had a well entrenched infection. Judging by the looks of it, I knew the infection was more serious that the ones I sometimes get while working in my tanks. And, my usual treatment of Neosporin was not working. My wife and boss (two different people) had been telling me all day to see a doctor. I thought I would give it just a little longer. Coincidently, my coral friend Rich Dietz (Mr. Firemouth) stopped by my house the night of July 17th. When Rich became alarmed, that was enough pressure to drag myself to the emergency room.

I got there about 10:30 PM that night. Then, I got concerned when the ER staff took me in right away. There were plenty of people waiting who were in more pain than me. (In fact, the infections never really hurt.) I explained what had happened and showed them the "Neurotoxin Warning" sidebar on page 182 of Eric Borneman’s book

The ER staff was worked up with the size and advanced status of infection. They were also quite concerned that it was on my hand. They talked about losing functionality of the hand — and "losing the hand." By now, my right forearm was starting to ache. They were pretty close to admitting me that night, but didn’t. Not sure why. Maybe because I had little pain and no fever — I just don’t know. The ER doctor prescribed two antibiotics: levaquin and doxycline. He told me to go to Barnes-Jewish hospital in St. Louis if my hand didn’t improve by the next day.

Aquarium Corals. That was probably the only smart thing I did — thanks Eric! (Eric’s sidebar is on page 11.) I took the antibiotics about midnight. They were amazing! The next morning the swelling in my hand was nearly gone, and my arm had stopped hurting. Drugs = good. That day my family doctor referred me to a plastic surgeon to monitor the healing. I saw the plastic surgeon the same day. He took cultures. However, he wasn’t very confident that anything would grow since I had already started taking the antibiotic. On a follow-up visit, I learned that no typical strains of bacteria had grown and the culture was negative for aVibrio infection. He also requested a culture for Mycobacterium. Fortunately, the results came back negative on September 17th.

By July 31, the sores were nearly healed and I can walk again (okay, just kidding about the walking!). All in all, I was very lucky. I was dumb not to get medical treatment sooner. I am very lucky because the drugs were INCREDIBLY effective. Still, I wouldn’t recommend this stunt. Rest assured, my hands and arms will be fully protected for my next round of similar to the species with which Jim had his run in (photo from University of Florida Museum of Natural History website) Palythoa cleaning!

July 30th — 16 days after the "attack" 

The more I think about it, the less I think there was any actual bacterial infection. There was never any discharge from the sores and they never hurt. I believe it was the palytoxin that caused the irritation and necrosis of my skin in the center of those sores. The sores left scars that I think will be noticeable for several years.

Palythoa, it wouldn’t hurt to make sure you have a current tetanus vaccination. That was something the ER doctor was also very interesting in confirming that I was current.

Editor’s note:

Jim Craig resides in southern Illinois and has been propagating corals for at least 10 years. He is a fixture at SEASL meetings and donates corals at each meeting for the club’s raffles. At SEASL’s September 12, 2009 meeting, Jim made a point of demonstrating a number of types of gloves that can be used by aquarists.

I'd like to add as an aside for Jim Craig and his physician that I think it's important to note that palytoxin has been found in other marine organisms, including dinoflagellates (primarily Ostreopsis)

Neurotoxin Warning

Follow-up to "Attack of the Palythoa"– by Eric Borneman, University of Houston spp.) which may be the source of the toxin in Palythoa – that the palythoids have a symbioses with the microbes. It has also been found in Radianthus anemones. It is also a delayed haemolysin, and the "infection" may not wind up being an infection but a delayed type III or IV hypersensitivity reaction helped along by the small cuts Jim obtained allowing, in essence, a drug delivery system for the toxin. However, even the nematocyst venom could produce lesions like this if they enter a break in the skin. Vibrio, Aeromonas, can also produce antigenic analogues of palytoxin, so even if the culture was negative, the toxin could have caused the effect and you may never know the cause. It is good that they are healing, and the lesions remind me of many such lesions I have gotten while diving with a similar healing response. I have never found antibiotics to be effective, and the itching sensation is even more reason to suspect that this was the Type II reaction followed by the antibody independent type IV response which would best be treated with anti-inflammatory / antihistamines like corticosteroids or the like rather than antibiotics. – by Eric Borneman, University of Houston

The heavy mucus coat of these species must be treated with great respect. It is important to wear hand protection when touching these animals — especially if the handler has any breaks in his or her skin.

An aquarist from Washington once contacted me for the name of a marine medical facility. He had been feeling very ill for several days after handling some

While many aquarists routinely handle corals, including zoanthids, without incident, it is still a very good idea to maintain a safe health protocol when working with these animals. Wearing gloves or making sure that no breaks in the skin are present is a start. Proper hand washing, even using a bactericidal soap (such as Hibiclens), is also a good precaution.

Palythoa, and most related zoanthids including the Protopalythoa species, produce a chemical called palytoxin in their mucus and gonads. Indigenous Pacific tribes used this neuro-muscular agent to tip spears in order to paralyze prey animals and enemies. This is a potent toxin and can be deadly to humans. Certain fishes that prey on zoanthids, like filefishes, may even be responsible for bringing palytoxin into the food chain. Protopalythoa polyps and was concerned about the possibility of palytoxin poisoning. I gave him the numbers of several contacts, but felt that if it were palytoxin, he probably wouldn’t have been able to communicate with me. As it turns out, he had acquired a Vibrio infection, probably from the extensive populations of Vibrio that inhabit coral mucus. Another aquarist inadvertently put his fingers in his mouth after handling Palythoa polyps. His mouth became numb, and for some time afterward he experienced a metallic aftertaste. He may have been very fortunate to escape with such minor symptoms.