Anyone Had A Bite Like This Before?

[jaffacakes1]

This is day 5. Small bite swelled slowly in the first few days - puncture was pin sized. Fever followed but that has cleared now and may not be associated.

The swelling was unusual as it was hot and very firm to the touch. No itch. No discharge at all and the infected area has receded in the last day or two hence beyond the pharmacy I have not sought further medical attention.

[Sheryl]

What you have is a nasty cellulitis. I don't know what you got at the pharmacy but you are going to need a full course of antibioics effective against staphylococcus (the most commonly involved bacteria, and one that can be rersistant to some antibiotics) and you may or may not need to have it incised and drained.

If you self prescribed with antibiotics and it seems to be getting better, then continue with it until it is 100% resolved and not less than a week, whichever is longer.

If it does not improve, see a doctor at once. These things can turn aggressive and nasty.

I have had cellculitis myself from what I thibnk was a spider bite. but actually anything at all that punctures the skin can lead to it. What happnes is that the break in the skin affords an entry point for the bacteria normally present on the skin's surface. These same bacteria cause serious infection when in the tissues.

[jaffacakes1]

Thanks Sheryl much appreciate your taking the time to comment. I think the amoxicillin will need to be replaced tomorrow as you suggest !

[jrtmedic]

AS Sheryl observes you appear to have a cellulitis.

I would advise against attempting to cure this by self medicating.

Seek medical advise and be guided by the Drs. recommendation(s)

Mark the boundaries of the swelling/redness (a ball point pen will do the job !) and seek Urgent medical care if the red area seems to be extending beyond the ink mark(s)

[jaffacakes1]

Update - currently at Phuket International having had a small operation to remove a large abscess.

This started innocently enough as a small insect bite but grew quickly into a serious medical issue. I am expected to remain in hospital for the next three days.

Mental note to take anything unusual like this immediately to hospital and not rely on the advice of pharmacists!

[jrtmedic]

Whilst it is always difficult to make judgements over a forum ----I am not surprised and am pleased you sought medical advice.

It is as well remember that the "pharmacist" in reality is often a shop girl and that Pharmacists are not diagnosticians. Whilst I am sure they wish to help what they really want is make a sale !

Now that you have secured appropriate treatment (including an appropriate IV antibiotic ?) I am sure your recovery will be rapid.

Best wishes

Jrt

Edited May 20, 2013 by jrtmedic

[willyumiii]

In Thailand, any small wound, insect bite, cut or burn attracts very small gnat like insects that easily introduce an infection that quickly becomes a medical issue requiring daily medical attention until healed.

This is especially true with any wound below the knee.

I have learned to clean and cover even the smallest scratch if below the knee in the daytime.

At night, I remove the bandage, clean the wound again and then sleep with the wound near a fan to help dry it out.

This method has worked well to deter the bugs and avoid the infections.

[jaffacakes1]

Thanks for your wishes JRT I am indeed on an antibiotic drip as we speak and very comfot

[jaffacakes1]

Thanks for your wishes JRT I am indeed on an antibiotic drip as we speak and very comfot

...rtable at the hospital which is excellent.

Think I might be dressing like a German tourist for a while (socks and sandals) to try and prevent against further attacks in that area. Not pleasant!

[AnotherOneAmerican]

Even the smallest skin breaks can turn into a big problem in the tropics.

Treat all wounds with antiseptic, monitor carefully for inflammation.

Bad luck with that infection, looks nasty, I wish you a quick recovery.

[Loptr]

I had a similar bite on my ankle a few years ago while traveling in the Philippines. Started off as a tiny spot that itched. Within 3 days it looked like your bite. I was put on antibiotics by a doctor, but the infection got worse, with streaks running up my leg and I could not walk on it. A second doctor changed the antibiotics and it began to get better after a few days. My point is don't think that all antibiotics are the same. If it doesn't start getting better within a couple days with the antibiotics you are on now, get a second opinion.

[Sheryl]

Different bacteria respond to different antibiotics. And, as mentioned, the bacteria usually responsible for cellulitis/skin abcesses (staph) includes many strains that are rrsistant to the antibiotics usually used.

In fact the so-called "flesh eating" bacteria that can require amputatiuon to treat, is often stap. Just staph that is unusually resistant to abx.

Hence any skin infection that involves red streaks, areas of redness (as in the OP photo) or abcesses should be watched very carefully and must be treated with correct abx, not the Thai pharmacy standard issue.

[jrtmedic]

Lopter

You are correct ! All antibiotics are Not all the same !

Antibiotics fall into "family groups " some are good at dealing with a particular bacteria some are not !

Doctors often make a "best guess" based on the most likely organism (germ) to be causing the problem.

Knowledge of the most likely germ to be causing a problem, coupled with a knowledge of that germs sensitivity to antibiotics ,enables the Dr to choose an appropriate medication. On many occasions such knowledge enables the "right" choice to be made but the ever increasing problem of antibiotic resistant organisms (caused by the misuse/abuse of antibiotics) may on occasion require an alteration to be made to the original prescription.

It is my belief that antibiotics should only be available on a doctors prescription and , again you are correct, if a condition does not improve or becomes worse further medical advise should be sought.

.

Edited May 20, 2013 by jrtmedic

[SeaVisionBurma]

I had a similar infection in the Philippines, had a small cut from coral while diving at work.

Within a few days my whole lower leg was swollen, and I had to be medivac'd (spelling??) to Manila from the remote island I was based on.

Took several hours in the ER to have all the dead flesh cut out, and nearly a week in hospital on antibiotics before I was released.

Can't remember exactly what it was, but staph rings a bell.

The doctors said I was lucky - another day or so and I might have had an amputation apparently.

[Sheryl]

Yes, most likley staph. Possible a methicillin resistant starin. Very serious.

Might add that it is precisely overuse/misuse of antibiotics that has led to the proliferation of these resistant strains of what used to eba very easy bacteria to treat.

[jrtmedic]

Organisms called " Vibrio.*** " ( There are many different ones hence the ***) are a particular problem associated with coral cuts/abrasions.

All coral cuts should be cleaned with antiseptic and urgent medical attention sought.

Coral cuts can also allow staph, organisms which may be living on a persons skin to gain entry to the body and cause problems.

Coral cuts/arbasions can result in limb/life threatening infection and must always be treated seriously.

Dive medics and professional divers are usually aware of the risks.

Edited May 20, 2013 by jrtmedic

[richardjm65]

I also had a small coral cut whilst diving in the Philippines, which I immediately scrubbed and cleaned and doused a couple of times a day with Hydrogen Peroxide. It apparently healed well, then blew up again with ugly results. A USN diving doctor found a small fragment of coral and I learned that with coral being a living organism, despite the cleaning, that small fragment had remained in the tiny wound, and its decomposition was what caused an infection that almost cost me my leg.

Since that lesson, I now know that any wound, especially to the leg, and especially in the tropics, requires some intensive and dedicated attention. This also applies to scratches from thorns, animal bites or claw wounds, (however small), and insect stings too.

A friend died a couple of years back as a result of under-estimating the possible effects of an infected insect sting.

[Salapoo]

Leaves thread shuddering.

[SeaVisionBurma]

I also had a small coral cut whilst diving in the Philippines, which I immediately scrubbed and cleaned and doused a couple of times a day with Hydrogen Peroxide. It apparently healed well, then blew up again with ugly results. A USN diving doctor found a small fragment of coral and I learned that with coral being a living organism, despite the cleaning, that small fragment had remained in the tiny wound, and its decomposition was what caused an infection that almost cost me my leg.

Since that lesson, I now know that any wound, especially to the leg, and especially in the tropics, requires some intensive and dedicated attention. This also applies to scratches from thorns, animal bites or claw wounds, (however small), and insect stings too.

A friend died a couple of years back as a result of under-estimating the possible effects of an infected insect sting.

Your diving story is eerily similar to mine - I was also told about the piece of coral being a problem because it is a living organism.

Your advice on paying attention to these wounds in the tropics is spot on.

Sorry to hear about your friend.

[yoslim]

Got cellulitis in my leg a few years ago, got treated with IV augmentin antibiotic. If you take an antibiotic on self medication make sure you take a high dose in one take and not spread it over multiple small takes over the day as they won't allow enough antibiotic in your blood stream at once to properly fight the infection.

Glad you're in the hospital getting better, that picture really looks nasty

[jrtmedic]

Further to my recent post I have now unearthed a reference relating to wounds contaminated with "Vibrio".

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2590478/

[richardjm65]

Thanks, jtmedic, that was an interesting link and it would seem that both SeaVisionBurma and I have some similar experience.

Maybe Jaffacakes1 will get back to us and advise on the progress of his condition. I, for one, wish him the best of luck.

[gerryBScot]

Hi Jaffacakes am pleased to hear you are in hospital and getting this treated and it sounds they are treating it correctly too. I would urge you to be especially careful about re-infection as happened with me, which led to Necrotising Fasciitis, NF.

Don't get any water on the wound until it has healed completely and your skin completely covers the wound site.....doesn't actually matter how small the wound site maybe, these bacteria will get in if there is a way. If you get the dressing dirty or wet get it redressed immediately. Basically don't take any chances whatsoever. I had a skin graft last week because the surgical cleaning/debridements required to get rid of the NF left me with a deep cavity under my ankle; I am confined to bed with a large plaster cast on my ankle, currently on Day 8, and this comes off Thursday morning when I'll know if the graft has "taken". So I am hoping......but I am not complaining, I feel lucky and if you check out NF you'll probably understand where I am coming form, a real horror story. Good luck and let me wish you a speedy recovery.

[Kalbo]

Hi Jaffacakes am pleased to hear you are in hospital and getting this treated and it sounds they are treating it correctly too. I would urge you to be especially careful about re-infection as happened with me, which led to Necrotising Fasciitis, NF.

Don't get any water on the wound until it has healed completely and your skin completely covers the wound site.....doesn't actually matter how small the wound site maybe, these bacteria will get in if there is a way. If you get the dressing dirty or wet get it redressed immediately. Basically don't take any chances whatsoever. I had a skin graft last week because the surgical cleaning/debridements required to get rid of the NF left me with a deep cavity under my ankle; I am confined to bed with a large plaster cast on my ankle, currently on Day 8, and this comes off Thursday morning when I'll know if the graft has "taken". So I am hoping......but I am not complaining, I feel lucky and if you check out NF you'll probably understand where I am coming form, a real horror story. Good luck and let me wish you a speedy recovery.

Please forgive the impertinence of my question, but how painful was the NF ?

[gerryBScot]

Hi Jaffacakes am pleased to hear you are in hospital and getting this treated and it sounds they are treating it correctly too. I would urge you to be especially careful about re-infection as happened with me, which led to Necrotising Fasciitis, NF.

Don't get any water on the wound until it has healed completely and your skin completely covers the wound site.....doesn't actually matter how small the wound site maybe, these bacteria will get in if there is a way. If you get the dressing dirty or wet get it redressed immediately. Basically don't take any chances whatsoever. I had a skin graft last week because the surgical cleaning/debridements required to get rid of the NF left me with a deep cavity under my ankle; I am confined to bed with a large plaster cast on my ankle, currently on Day 8, and this comes off Thursday morning when I'll know if the graft has "taken". So I am hoping......but I am not complaining, I feel lucky and if you check out NF you'll probably understand where I am coming form, a real horror story. Good luck and let me wish you a speedy recovery.

Please forgive the impertinence of my question, but how painful was the NF ?

Kalbo I didn't really experience a lot of pain; I am not a doctor or scientist so I can only speculate about my good fortune: I think the lack of pain from the actual infection was because NF dead tissue so there is no blood in the affected areas. I think the NF becomes excruciatingly painful once it spreads and takes hold. I had a lot of mental pain however, aka fear and anxiety: I was really afraid as I knew that this could get very nasty, very quickly. I can't be certain of this but I believe the infection was diagnosed within 48 hours by which time I was in hospital and on intravenous anti-biotics and had a first debridement/surgical cleaning within a few hours of being admitted to hospital. Fortunately the intern surgeon knew what he was treating and what to do. I was in some pain following the debridements, notably the third when the surgeon went in deep and after the skin graft; after the graft I was given some morphine in the recovery room which killed the pain post-operation and some further strong pain killers later on the ward. On Day 2 I didn't need anything.

Everything I read here convinces me of this: don't hang around worrying if you are not feeling well or have obvious symptoms. See a doctor or go to hospital ASAP. The OP here did that and hopefully he will be able to get on with normal life in a few days.

[jaffacakes1]

Hi all - thanks so much for your kind messages. Just thought I would update with a progress report.

The diagnosis was that this small bite had become infected and a large nasty abscess had to be removed from the site (the darkest area you can see is now a cavity the dimensions of a wine cork). I am not in pain until the dressings need to be changed but wven this is subsiding daily.

Tonight is my 5th and last night at Phuket International and the staff and doctors here have been fantastic. Highly recommended.

I have been advised that the wound will take a further two weeks to heal properly and will require daily attention in terms of cleaning the site.

I would certainly echo the excellent advice already given here in terms of taking any unusual bites, infections or rashes to the hospital immediately for a professional diagnosis, no matter how small.

Had I acted immediately rather than procrastinating or taking the advice of a pharmacist this could have been dealt with before it became an issue.

Take care - it's a jungle out there!

[Sheryl]

Thanks for the update and glad you're OK.