You don't even have to break the skin...

[Crossy]

Some members may remember my little infection in 2016:-

 

 

The saga continues.

 

About a week ago I took a tumble on some wet and slippery tiles, landed firmly on my <insert a type of donkey> and twisted my left ankle. Some bruising and swelling (and hurt like ...) but didn't seek any treatment (my pride was more injured), loaded up with painkillers and got on with life, things were pretty well ok by Friday.

 

So I woke on Sunday morning with renewed pain in the left ankle, perusing same I had the classic symptoms of cellulitis, pain, redness, warmth, crinkly skin.

 

So off to the doc this morning, nice lady concurred with my diagnosis so I have oral antibiotics this time (Co-amoxiclav 1000mg), an NSAID (Naproxen 250mg), some regular paracetemol and an appointment for next week.

 

Also strict instructions to return immediately if things changed for the worse.

 

Doc noted that the bugs that cause cellulitis are present in the body and don't cause trouble unless they get where they are not supposed to, in my case it was the bruising that gave them a route to the place they shouldn't be.

 

Any unexpected changes, redness, swelling etc. etc. don't take any risks, off to the doc. I know Thai doctors take some stick on TV, but the ones at our local hospitals (both private and public) seem to be reasonably competent. Of course YMMV.

 

  

[sanemax]

Last year during a few hours walk , I felt a twang in my groin area at the very top of my leg where it joins .

  I felt something *go*, but I just ignored it and kept walking .

It felt a bit sore the next day and I just thought that  it was chaffing .

The next day it began to swell up .

There was no abrasion there , it was all inside the skin .

The next day I couldnt get out of bed , my groin area had swollen up and it was spreading .

  I kept drifting in and out of consciousnesses and it was extremely painful if I tried to stand up . 

   I was stuck in bed, unable to move and drifting in and out of consciousness for a few days  .

  After about five days a friend came around to visit and took me to hospital .

   The doctor told me that I had a very serious infection that had spread and if the anti biotics didnt work, they would have to amputate  the infected area .

  Nearly 3 weeks on strong anti biotics cleared the infection and there was no need to amputate .

   But the infection came from no cut or abrasion to the skin.

 

 

 

[Crossy]

One of the "minor" side-effects of Naproxen is "drowsiness".

 

I felt a bit sleepy after taking the pills so I went for a nap, for four hours, totally zonked.

 

[Sheryl]

Yes, you have to be very vigilent about skin and soft tissue infections here.

 

I would add - if ever bitten by a cat, go to a doctor at once, antibiotics are mandatory.  Cat bites are even worse than dog bites in this regard because the wounds tend to be deep very narrow punctures that sort of seal the bacteria into the tissues. I stupidly delayed a day last year -- just one day! -- and paid for it with a massive cellulitis and hand swollen to 10X its size for a month. (It was my own cat so rabies not a concern).

 

That makes twice I've gotten a  nasty cellulitis form a cat bite. I now keep the preferred antibiotic (augmentin) on hand at all times so as to be able to start treatment at once if bitten again.

 

[Speedo1968]

15 hours ago, Sheryl said:

Yes, you have to be very vigilent about skin and soft tissue infections here.

 

I would add - if ever bitten by a cat, go to a doctor at once, antibiotics are mandatory.  Cat bites are even worse than dog bites in this regard because the wounds tend to be deep very narrow punctures that sort of seal the bacteria into the tissues. I stupidly delayed a day last year -- just one day! -- and paid for it with a massive cellulitis and hand swollen to 10X its size for a month. (It was my own cat so rabies not a concern).

 

That makes twice I've gotten a  nasty cellulitis form a cat bite. I now keep the preferred antibiotic (augmentin) on hand at all times so as to be able to start treatment at once if bitten again.

 

Yes dog / cat bites even claw scratches can lead to rapid infection and serious, possibly long term issues.

 

I was scratched on the ankle by a young playful dog, no skin damage just white lines.  Twenty four hours later I had fever, severe swelling and pain.

I went to hospital but as I am allergic to antibiotics ( from many years ago ) and those skin tested at the hospital none were possible.     The infection attacked my Achilles heel and I was unable to stand for almost 3 months.  

I was a bit miffed as I had just taken 3 months to walk again after a stroke.

I used acupuncture for pain relief and to help remove toxins in the blood stream.

[chubby]

cellulitis is a skin infection, generally seen with folks with  edema in their legs, often older folks with congestive heart condition which causes the edema or obese folks,  so  yes your skin if expanded by the edema can get infections, bacterial,  fungal probably being more common.   esp. in the tropics with hygeine from sweating e.g.  Tinea versicolor.

 

certain people carry the wrong kind of Staph  in their noses , I guess you can have it swabbed to check.

 

but IIRC, the issue is the wrong bacteria in the wrong places,  eg  good bugs in your guts , and urinary infections -> septicemia- > shock

[Crossy]

Well, it looks like the pills (antibiotics) didn't have the desired effect ????

 

So I'm on 8 hourly IV antibiotics at least until Wednesday.

 

Doc wanted to admit me, no way, hospitals are full of sick people I might catch something deadly (MRSA anyone?).

 

She also had the "possible surgery if it doesn't respond to this treatment" talk, she didn't actually use the NF (necrotizing fasciitis) word, been there before.

 

 

[dddave]

3 hours ago, Crossy said:

Well, it looks like the pills (antibiotics) didn't have the desired effect ????

 

So I'm on 8 hourly IV antibiotics at least until Wednesday.

 

Doc wanted to admit me, no way, hospitals are full of sick people I might catch something deadly (MRSA anyone?).

 

She also had the "possible surgery if it doesn't respond to this treatment" talk, she didn't actually use the NF (necrotizing fasciitis) word, been there before.

 

 

I had a serious cellulitis infection after bypass surgery and nearly lost my leg.  The antibiotic that finally did the job and contained the infection was "Vancomycin" administered via IV.  I was told that IV antibiotics are far more effective for leg infections than oral and Vancomycin is one of the most effective against advanced cellulitis.  It wouldn't be a bad idea to ask your Doctor if it would be appropriate in your case.

[Crossy]

2 minutes ago, dddave said:

I had a serious cellulitis infection after bypass surgery and nearly lost my leg.  The antibiotic that finally did the job was "Vancomycin" administered via IV.  I was told that IV antibiotics are far more effective for leg infections than oral and Vancomycin is one of the most effective against advanced cellulitis.  It wouldn't be a bad idea to ask your Doctor if it would be appropriate in your case.

 

I will check what they are pumping in when I visit this evening.

 

At least this time my employment contract pays sick pay and the medical includes outpatient.

 

 

[Sheryl]

Every 8 hours...Hope you live near the hospital!

 

I also did mine as an outpatient but in my case I had a once in 24 hours dosage.

 

Have they done a culture?

[Crossy]

4 minutes ago, Sheryl said:

Every 8 hours...Hope you live near the hospital!

I also did mine as an outpatient but in my case I had a once in 24 hours dosage.

Have they done a culture?

 

Yes, we are a 10 minute drive from the hospital, that's why they let me do OPD (I still had to sign a disclaimer).

Not sure about cultures yet, they took about a gallon of blood this morning (which hurt more than the IV).

 

Sadly they won't let me have a hep-lock if I'm OPD, so it's a new hole each visit ????

 

 

[Sheryl]

See what comes back by way of white blood count.

 

I can't say re your situation but in my case, the swelling and pain persisted for a long time after the infection had cleared due to a massive inflammatory response - my inflammation markers were off the charts.  I kept asking for steroids, the docs kept refusing and insisting on more antibiotics (despite normal WBC count and already having done multiple full courses of different drugs, no fever and the redness on the skin having resolved). On and on it went, I am lucky I didn't develop some serious adverse effects from all the different antibiotics. Finally they agreed to a single IV dose of steroids. Pain free and swelling gone within 24 hours.

 

You may indeed have an infection for all I know but keep this possibility in mind especially if your white blood count comes back normal.

 

 

[Crossy]

Thanks @Sheryl I don't have a fever but still significant redness and pain in the lower shin.

 

We'll let them pump this lot through, then ask the awkward questions ????

 

[johng]

Best wishes to you@Crossy
I was laid up in hospital for 2 weeks with cellulitis...they pumped me full of antibiotics and came home feeling great...but maybe no booze and only one cigarette a day helped a bit [emoji481] [emoji39]

[uhuh]

On 9/30/2019 at 4:47 PM, Sheryl said:

Yes, you have to be very vigilent about skin and soft tissue infections here.

 

I would add - if ever bitten by a cat, go to a doctor at once, antibiotics are mandatory.  Cat bites are even worse than dog bites in this regard because the wounds tend to be deep very narrow punctures that sort of seal the bacteria into the tissues. I stupidly delayed a day last year -- just one day! -- and paid for it with a massive cellulitis and hand swollen to 10X its size for a month. (It was my own cat so rabies not a concern).

 

That makes twice I've gotten a  nasty cellulitis form a cat bite. I now keep the preferred antibiotic (augmentin) on hand at all times so as to be able to start treatment at once if bitten again.

 

I got bitten by a cat in the street last night and remembered this post.

The next pharmacy was just 100m away and I bought AMK (= Augmentin) and Fucidine cream. So i took AMK just minutes after the bite. 

Then off to hospital for rabies and tetanus shots.

All is well.

[madmen]

21 minutes ago, uhuh said:

I got bitten by a cat in the street last night and remembered this post.

The next pharmacy was just 100m away and I bought AMK (= Augmentin) and Fucidine cream. So i took AMK just minutes after the bite. 

Then off to hospital for rabies and tetanus shots.

All is well.

lesson learnt on koh larn when a cat was purring and rubbing against my leg so I gave it a gentle pat and it wrapped around my arm in an instant teeth and claws digging in. Damn things are unpredictable, no antibiotics or shots rabies from a cat never crossed my mind

[dddave]

9 minutes ago, uhuh said:

I got bitten by a cat in the street last night and remembered this post.

The next pharmacy was just 100m away and I bought AMK (= Augmentin) and Fucidine cream. So i took AMK just minutes after the bite. 

Then off to hospital for rabies and tetanus shots.

All is well.

Cat bites can get infected with amazing speed.  I was in an EW once waiting my turn. Just as my number came up, the nurse told me I had to wait and they rushed a guy into the treatment area. He was holding his hand and it looked really puffed-up, like he was wearing an inflated rubber glove.  Later, when I was finally called, I asked the Dr. what had happened.  It was a cat bite. He  explained that cat's front teeth are so sharp and smooth, the bite wound often self-seals, trapping the cat's very nasty mouth bacteria inside. It's like the perfect petri dish inside and the bacteria can multiply to billions in an hour.

Outside of rabies, cat bites are more dangerous than dog bites.