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'Fish Pedicure' a Recipe for Bacterial Infection, Researchers Warn

By Alan Mozes
HealthDay Reporter

THURSDAY, May 17 (HealthDay News) -- "Fish pedicures" in health spas can expose recipients to a host of pathogens and bacterial infections, a team of researchers warns.

The practice of exposing your feet to live freshwater fish that eat away dead or damaged skin for mainly cosmetic reasons has been banned in many (but not all) American states, but it is apparently a hot trend in Britain.

So much so that the British researchers sent their warning in a letter published in the June issue of Emerging Infectious Diseases, a publication from the U.S. Centers for Disease Control and Prevention.

Officially known as "ichthyotherapy," the procedure typically involves the importation of what are called "doctor fish," a Eurasian river basin species known as "Garra rufa." The fish are placed in a spa tub, the foot (or even whole body) joins it, and the nautical feeding on dead or unwanted skin begins.

The problem: such fish may play host to a wide array of organisms and disease, some of which can provoke invasive soft-tissue infection in exposed humans and many of which are antibiotic-resistant, according to the scientists from the Center for Environment, Fisheries & Aquaculture Science (CEFAS) in Weymouth.

In the letter, CEFAS team leader David W. Verner-Jeffreys referenced a 2011 survey that suggested the U.K. is now home to 279-plus "fish spas," with an estimated 15,000 to 20,000 fish coming into the country every week from a host of Asian countries.

Verner-Jeffreys noted that in April 2011, 6,000 fish imported from Indonesia for U.K. fish spas were affected by a disease outbreak that caused hemorrhaging of their gills, mouth and abdomen, resulting in the death of nearly all the specimens.

In turn, U.K. scientists uncovered signs of bacterial infection (caused by a pathogen called "S agalactiae") in the fishes' livers, kidneys and spleen.

Following this discovery, Verner-Jeffreys said, his team conducted five raids on imported fish batches coming through Heathrow Airport, which uncovered further signs of infection with a number of additional pathogens. Many of those were found to be resistant to such standard antimicrobial drugs as tetracycline, fluoroquinolone and aminoglycoside.

"To date, there are only a limited number of reports of patients who might have been infected by this exposure route," Verner-Jeffreys said in his letter. "However, our study raises some concerns over the extent that these fish, or their transport water, might harbor potential zoonotic disease pathogens of clinical relevance."

At particularly high risk, the scientists said, were people already struggling with diabetes, liver disease and/or immune disorders.

Verner-Jeffreys suggested that spas offering fish pedicures use disease-free fish raised in controlled environments.

George A. O'Toole, a professor in the department of microbiology and immunology at the Geisel School of Medicine at Dartmouth in Hanover, N.H., added his own concern.

" I would stay away from this experience," he said. "It's probably not feasible to sterilize these fish. And as for the water itself, even if you dump it between patients, these organisms will form rings of biofilm communities attached to the surface of the tubs themselves. It's like a contact lens case that you never disinfect. Simply wiping them down is not good enough. Unless you're incredibly responsible about sterilizing those tubs you're not going to kill them, and they will reseed the next batch of water. The whole thing is a bad idea."

Dr. Philip Tierno, director of clinical microbiology and pathology at New York University Medical Center in New York City, agreed.

"It's a bad idea in several ways," he said. "Because these pathogens can give you a serious wound infection. Or blood-borne infection. Or diarrhea. Or even pose a threat to a pregnant woman's fetus or newborn."

"Really, you have the potential for multiple types of infection," Tierno added. "Because theoretically when you're touching the area that has been nibbled on by these fish, you can still have the organisms there. And then you can inadvertently touch your mouth and introduce them into your system."

More information

For more on foot health, visit the U.S. National Institutes of Health.

SOURCES: George A. O'Toole, Ph.D., professor, department of microbiology and immunology, Geisel School of Medicine at Dartmouth, Hanover, N.H.; Philip Tierno, M.D., Ph.D., director, clinical microbiology and pathology, New York University Medical Center; June 2012 Emerging Infectious Diseases

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