Marine trauma includes bites from sharks, barracudas, moray eels, seals, crocodiles, needlefish, wahoos, piranhas, and trigger fish. Shark bites may also cause substantial tissue loss with hemorrhagic shock and delayed infection. Minor trauma is usually due to cuts and scrapes from coral that can cause local stinging pain, erythema, urticaria, and pruritus. Marine wounds can be infected with routine skin flora, such as Staphylococcus and Streptococcus, along with bacteria unique to the marine environment. The most serious halophilic organism is the gram-negative bacillus Vibrio, which can cause rapid infections marked by pain, swelling, hemorrhagic bullae, vasculitis, and even necrotizing fascitis and sepsis. Immunosuppressed patients, particularly those with liver disease, are susceptible to sepsis and death (up to 60%) from Vibrio vulnificus. Another bacterium, Erysipelothrix rhusiopathiae, implicated in fish handler's disease, can cause painful, marginating plaques after cutaneous puncture wounds. The unique marine bacterium Mycobacterium marinum, an acid-fast bacillus, can cause a chronic cutaneous granuloma 3 to 4 weeks after exposure.