Fish Pedicure-induced Aeromonas sobria Superficial Necrotic Bullous Dermatitis in a Previously Undiagnosed Diabetes Patient. What are the Risks of Fish Pedicure for Public Health?
Olivier Vanhooteghem *
Department of Dermatology, Sainte Elisabeth Hospital, B-5000 Namur, Belgium.
Dieter Anseeuw
VIVES University College, Wilgenstraat 32, B-8800 Roeselare, Belgium.
Christian Michel
University of Liège, Quai Edouard Van Beneden 22, B-4020 Liège, Belgium.
Michel Penninckx
Department of Microbial Physiology and Ecology, University of Brussel, Bruxelles, B-1050 Brussels, Belgium.
Anne-Madeleine Pironnet
Superior Health Council, Place V. Horta, 40, bte 10, B-1060 Brussels, Belgium.
Anne Simon
Department of Clinical Microbiology and Infection Control, Saint-Luc University Hospital, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
Filip A. M. Volckaert
Laboratory of Biodiversity and Evolutionary Genomics, University of Leuven, Ch. Deberiotstraat 32, B-3000 Leuven, Belgium.
Hilde Beele
Department of Dermatology, University of Gent, De Pintelaan 185, B-9000 Gent, Belgium.
*Author to whom correspondence should be addressed.
Abstract
We describe a patient with previously undiagnosed diabetes who developed superficial necrotic bullous dermatitis due to Aeromonas sobria infection following a fish pedicure (also known as fish spa, fish therapy or Ichthyotherapy). A major concern regarding fish pedicure involves the transmission of viral and bacterial infections. It has been shown that fish tank water contains a wide variety of bacteria, including non-pathogenic as well as potentially pathogenic species. Commonly in fish spas the tank water is heated to a temperature of 25 to 30°C. Such temperatures favour overall bacterial growth and at the same time increase skin porosity upon immersion, hence indirectly promoting potential skin infections. The authors discuss three potential routes of transmission (from fish or tub surface to man, from water to man, and from man to man via the tub water) and analyse the potential risk of bacterial or viral transmission associated with fish pedicures. On the basis of the current case study and the consensus view of experts, the authors advise against fish pedicure, in particular for patients with diabetes or a compromised immune system.
Keywords: Bullous dermatitis, necrosis, infection, skin, Garra rufa, ichtyotherapy, fish pedicure, Aeromonas sobria.