Infection from coral sting:Help!!

[tracydr]

I was in Bonaire 3 weeks ago and fell getting in at the Hilma Hooker. I had immediate pain/swelling in several fingers of each hand. The right hand cleared up within a week. The left one looked far worse initially, turning a lovely purple/blue/black color on the lesions within three days. They then ruptured and felt a little better. (although considerable swelling and itching still persisted). One week later they suddenly became worse so I decided that I probably had cellulitis (only in the left 3rd/4th fingers). I started on clindamycin and had a few days of improvement. Then, worse again. Added omnicef to the treatment. Again a few days of improvement, then worse. Omnicef was discontinued when I developed migraines thought to be related to the medication. Completed 10 days clindamycin, 300mg qid and about 6 days of omnicef 600mg daily. The day omnicef was discontinued doxycycline 100mg bid (chosen because of MRSA suspicion) was added. Have done 7 days of doxy. Two days ago, again after initial improvement, lesions became much worse, almost as bad as when antibiotics were first started. At the same time, began having mild systemic illness with headache, low grade fever, sweats and malaise. Today, things are worse with increased tenderness, redness and itching.
Any recommendations? At this point there is not much to culture. (should have done that but there really wasn't much to culture when infection seemed to have started either).
I have had in the recent past a serious infection of the fascia of my head, neck and chest. This organism was never identified but was suspected to be either staph or strep. At that time I was on multiple antibiotics (I think in the hospital they seemed to have switched regimens with every doctor that rounded on me daily). I went home on Impaz IV and augmentin. This was 6 months ago and I have done well since, although I ran a low grade (99.4-100.4) fever for a very long time without any change in CBC. I'm very concerned as I work urgent care and deal with nasty MRSA abscesses on a daily basis. This however, is not looking or acting like MRSA.
Thanks in advance for any help!!
__________________
Dr. Tracy

 

[DandyDon]

Were you self tread, Doc - or did you consult other physicians...?

 

[tracydr]

Consulted one of my colleagues but she is not a diver. Hate to make an appointment with the infectious disease doctor I saw last winter because he doesn't take my insurance, but I'm beginning to think I may have to.

 

[DandyDon]

I guess you've heard all the suggestions about physicians self treating - a fool for a patient, isn't that how they go?

There were and still are many free or covered resources from physicians and special medics who know more about salt water born infections than you may have studied. Sorry if I seem rude, but damn!

Please call DAN at least, now - numbers in my Sig.

 

[TSandM]

I guess one of the questions is whether the lesions you are having are infectious or inflammatory. I know that people can show prolonged and relapsing immunologic reactions to fire coral venom (eg. http://www.mf.uni-lj.si/acta-apa/acta-apa-01-1/4-clanek.html) and sometimes respond to steroids. It's a shame that none of this was cultured, but it sounds as though a wound biopsy and quantitative culture may be in order by now.

I don't think you can continue to treat this yourself -- Doesn't sound as though you are getting anywhere with it.

 

[tracydr]

Not treating myself. I do question the ability of my colleague however, and being a saturday with several days of work coming up I'm sort of in a bind. I considered the recurring inflammation and that is a very good point. In fact, not entirely sure if that's not whats going on.
I will make an appt with infectious disease next week. In the meantime, calling DAN.

 

[TSandM]

You might try a concentrated topical steroid on the affected area, while you're waiting to see the ID guy.

 

[DandyDon]

Tracy, I wonder if this history you mentioned in another thread could be connected? http://www.scubaboard.com/showthread.php?t=195719

I spent a month getting treatment for a horrible fasciitis of the chest, neck and head last winter and it just about did me in. IV antibiotics for 3 weeks and one week of hospitalization.

 

[dvrliz1]

Hi Tracy!

So sorry to hear about this! I remember when working in the states when MRSA was a "nosocomial" infection! It is amazing how prevelant it is becoming in the general public. Even though it is not what you have, it is really getting out there. Keep me updated and let me know how are are doing!

Liz

 

[Hemlon]

Diving related injury? Go to a dive knowledgable doctor.

Simple, like Don said.