A Painful Lesson

WITH BITES AND STINGS FROM MARINE ANIMALS, IT IS ALWAYS PRUDENT TO HAVE THEM LOOKED AT AND TREATED IMMEDIATELY

THE SITUATION
On one of the dives, a diver collected what he thought was an empty moon snail shell. The divers did not realise that a juvenile giant Pacific octopus (Enteroctopus dofleini) had taken up residence in the shell. When the octopus crawled out after the dive, another diver picked it up with her bare hands to return it to the water. But before she could, the octopus bit her three times in the same place, on the back of her left hand. She said the bites felt like bee stings. As the wound bled moderately, the diver rinsed it first with salt water, and then 40 minutes later with soap and fresh water. Swelling appeared within 30 minutes and became severe within about an hour. The diver was a healthy, 32-year-old woman with 130 logged dives. She had no allergies or health problems and had just completed her second dive on day two of her dive trip. Although blue ringed octopus bites are famous for being potentially deadly, bites from most other octopus species are generally not problematic. Recently, however, scientists have come to understand that all octopus bites are venomous to some degree.

IGNORING THE PAIN
About four hours later, this diver went for another dive. Upon surfacing, she felt nauseous and vomited. It must also be noted that she had not previously experienced such symptoms after diving. The nausea receded quickly, however, and the diver went on five more dives over the next two days despite significant swelling and compromised mobility.

INEFFECTIVE SELF-TREATMENT
The diver wore a drysuit and neoprene gloves on every dive. When not diving, she kept the wound dry and applied an over-the-counter antibiotic ointment. She also took an over-the counter antihistamine and applied crushed aspirin to the skin surrounding the puncture site (not directly on the wound), but none of these provided any relief. Significant itching and pain reached their peak five to six days after the incident.

THE CONSEQUENCE OF INFECTION
About three days after the bite, the wound became infected and developed into a dark, quarter-inch lesion surrounded by a raised, reddish area that turned blackish-green nine days after the incident. Moderate pain, significant itching and swelling lasted for more than a month. The lesion took approximately seven weeks to heal, although pain, sensitivity to touch, and itching lasted for three months, with minor flare-ups still occurring four to five months after the incident. The diver’s physician first prescribed a 10- day course of antibiotics. Evolving symptoms and progressive discolouration, however, prompted the doctor to prescribe an additional antibiotic along with an antihistamine for another 10 days to manage the itching. RESULT OF DELAYS IN PROPER CARE The delay in proper wound care may have been a complicating factor. DAN recommends washing marine bites immediately with soap and clean water to minimise the risk of infection. Infection can impair healing and lead to significant tissue damage. Divers should not dive with open wounds because exposure to the aquatic environment, with its myriad of antigens and toxins, can increase further infection.

WATCH FOR SIGNS OF INFECTION
Monitoring the wound is important since signs of infection can appear between a few hours and several weeks following an injury. The immediate swelling the diver experienced may have been a consequence of the initial trauma, but further exposure to the sea on her subsequent dives prolonged the symptoms and likely resulted in a serious infection.

TREAT WOUNDS IMMIDEDIATELY
An additional complication in this case may have been the delay in proper medical care. DAN advises divers to treat wounds caused by marine life like any other animal bite, and seek prompt, medical attention. In this case, the wound was evaluated 10 days after the incident, and the delayed treatment limited the progression of the diver’s recovery. This incident should serve as a reminder that timely treatment of wounds can reduce the risk of serious infection. Whenever possible, divers should photograph their wounds, because images can help medical staff provide more effective and efficient care. Divers should also understand that handling marine life may lead to injuries, some of which can result in serious complications.
World.DAN.org