A scratch that Hannelé Cox suffered as she quickly pulled her hand out of a fish tank five years ago has had dire consequences.
The wound became infected with rare and invasive bacteria that won’t go away and could lead to amputation of her hand, she and her family fear.
Her mother, Amy Cox, has scoured the Internet looking for experts who have treated people with Mycobacterium marinum, known as fish tank granuloma. The bacteria produce skin wounds and attack deeper tissues and bones the longer they are untreated. It is not contagious.
The infection’s intense pain forced Hannelé, who once dreamed of Olympic competition, to give up gymnastics. Now, the 13-year-old can barely use her dominant right hand to write — forget about playing volleyball, the sport she took up and grew to love after gymnastics.
“It affects my whole lifestyle,” she said. “My dream was to be an Olympic champion. I would walk around the house on my hands. That was a big part of my life that gotten taken away. I went through a depression.”
Cox’s search recently led her to a Denver, Colo., mycobacterial infection specialist who she is hopeful can heal Hannelé, who has battled the infection since she was in third grade.
Meanwhile, Hannelé is to have a third surgery next week at UCLA. Doctors are to remove dead and contaminated skin and take cultures to better identify an unidentified infection in Hannelé’s hand bone, Cox said. It is believed that Hannelé will be prescribed medicine that she could be expected to take for several months as doctors await biopsy results and develop a treatment plan.
“The good news is the infection is not in her bones in her arm,” Cox said. “The bad news is the infection is in the bone in her hand.”
fish tank
The Coxes’ 55-gallon fish tank sat on a ledge near the front door of the family’s house near Hesperia in San Bernardino County’s High Desert. It contained a few freshwater fish.
Hannelé shook her head and said she doesn’t touch it anymore.
“I am the only one who touches and cleans the fish tank,” Cox said.
Back in 2006, there was no way to know the tank was home to Mycobacterium marinum, Cox said. The fish, ordinary Tetras, looked normal.
Mycobacterium marinum is a slow-growing bacteria commonly found in fresh and saltwater bodies worldwide. Human Mycobacterium marinum skin infections are uncommon and usually are acquired from aquariums and fish that have fish tuberculosis. Most human infections occur after the bacteria enter the body through small cuts and scrapes.
Hannelé, then 8, had been told to keep her hands out of the tank. On June 30, 2006, she scraped a knuckle on the plastic lid of the aquarium as she rushed to pull her hand out of the tank and dry her hand before she got caught, she said.
“I was trying to catch a fish,” Hannelé recalled. “It wasn’t even a deep cut.”
Days later, Cox, a medical transcriptionist, saw an oozing, open wound on her daughter’s hand and treated it with hydrogen peroxide.
“I figured it wasn’t a big deal,” said Cox, who didn’t find out until weeks later how Hannelé injured her hand. Her daughter finally explained what happened during a doctor’s appointment.
Still, the information about the fish tank didn’t help Hannelé’s doctor, who prescribed ineffective antibiotics, Cox said. She then took Hannelé to Dr. Jeffrey Rattet, a San Bernardino dermatologist and acquaintance who first diagnosed the infection.
“I’ve seen five of them in 32 years,” he said. “It’s just not something you see.”
Diagnoses sometimes come after prescribed medicines fail and possibilities are eliminated, he said.
“You don’t want to start biopsying everything that walks in the door,” Rattet said. “There’s a lot of weird stuff out there. You just have to know when to pull the trigger.”
Doctors at Loma Linda University Medical Center and UCLA have tried to treat Hannelé’s infection, Cox said. But it always returns.
Hannelé has had two surgeries to remove dead and contaminated tissue and have cultures taken for analysis. She also spent several months on medicines, one of which made her violently ill and unable to attend school for at least one academic year.
Cox began looking for mycobacterium experts on the Internet following Rattet’s diagnosis and found Adrian Lawler, a marine scientist and retired aquarium director on Mississippi’s Gulf Coast. Lawler has written about Mycobacterium marinum and said he successfully treated himself after getting the bacteria.
“With about five years of antibiotic treatment, the strain of Mycobacterium marinum in young Ms. Cox’s body has gotten stronger and stronger, becoming similar to the ‘superbug’ status we give to other antibiotic-resistant bacteria,” he said.
positive attitude
The top of Hannelé’s hand looks normal, except for swelling and her surgical scars near the base of middle finger and its knuckle. But her hand and most of her arm persistently and intensely ache as if she has arthritis.
Hannelé said she tries to maintain a positive attitude and her outgoing personality, despite the pain. Hannelé understands that she could face hand amputation.
“I’m trying to find some way of saving her hand,” Cox said. “I’m not taking no for an answer.”
Reach Lora Hines at 951-368-9444 or lhines@pressenterprise.com
