Difficult To Treat Hand Infections On the RiseWhat do children at day cares and prison inmates have in common with homeless people? These are groups of people who are at increased risk of MRSA (pronounced mersa). MRSA stands for methicillin-resistant staphylococcus aureus. MRSA is a staph bacterium that cannot be killed easily by antibiotics and especially not by a class of penicillin known as methicillin.
In this report, hand surgeons from the Naval Medical Center in San Diego review the current state of hand infections in the United States. They discuss the microbiology of microbes that can cause infection, outline risk factors, and present a summary on a dozen conditions caused by infection. The anatomic area of focus is the hand and arm.
We've already told you three groups at increased risk for MRSA and other infections. Other groups at risk include individuals with diabetes, anyone who is immunocompromised, and anyone on long-term antibiotics for any reason.
People who are immunocompromised include organ transplant recipients, anyone with an autoimmune disease (e.g., multiple sclerosis, lupus, ALS). Patients in the intensive care unit, anyone who has had a recent surgery, and patients in close quarters with other patients already infected with MRSA are also at increased risk.
Infections affecting the finger include paronychia (bacterial or fungal infection under the nail fold), felons (e.g., abscess in the nail pulp), herpetic whitlow (infection with herpes virus), and pyogenic flexor tenosynovitis (bacterial infection of the flexor tendon sheath).
Each of these finger infections has its own clinical presentation to help differentiate it from the others. Physicians look at the location and signs and symptoms when making a diagnosis. Swelling, throbbing pain, redness of the skin are common with many of these conditions. So the patient's history becomes a key feature in the diagnosis.
Different groups are at increased risk for each type of infection. For example, chronic paronychia develops most often in swimmers, dishwashers, and bartenders. These are folks who have their hands in water quite often and have moist skin -- a perfect breeding ground for fungus.
Thumb sucking, nail biting, and contact with body secretions (by dentists, nurses, anesthesiologists, and other health care professionals) can transmit herpes viruses. Human or animal bites (especially cat bites) and clenched fist injuries can cause serious wounds that can be infected with one or more of over 40 bacterial strains. Some of these strains are resistant to many different antibiotics. This type of resistance creates an even greater challenge to treatment.
Finger infections can spread to the hand and up the arm. There are natural protective boundaries built into the hand in the form of connective tissue. These boundaries help contain the infection in one area or space. But some infections such as cellulitis spread up the arm via the blood system.
Joints can become infected causing a condition called septic arthritis. The damage done to the joint can be very serious. Bacteria release their own personal arsenal of toxins and enzymes that can destroy joint cartilage and lead to bone infections (osteomyelitis).
One of the worst types of complications from infections is a condition called necrotizing fasciitis. Without proper treatment immediately, necrotizing fasciitis (a flesh eating bacteria) can devour the body and cause death. What can be done to prevent all this tissue damage, loss of function, and in some cases, loss of life?
The first line of treatment is antibiotics. Often a broad-spectrum, more general antibiotic is prescribed until the specific type of bacteria can be identified with a lab culture. Once the offending organism is known, the patient can be switched to an antibiotic known to specifically kill those bacteria.
Severe infections may require hospitalization and surgical intervention. The surgeon may have to make an incision and drain the pus then scrape away any dead or infected tissue. This procedure is called debridement and may have to be repeated more than once until the infection is completely cleared up. Intravenous (IV) antibiotics are usually given while the person is in the hospital and may continue for several weeks to months after discharge.
Sometimes an irrigation drainage system must be put in the hand or forearm. This device bathes the tissues with a saline solution to keep bacteria from forming. In severe cases of septic arthritis, it may be necessary to fuse the joint, replace the joint, or (worse case scenario) amputate the infected finger(s).
Anyone interested in the types of hand infections seen most often in the United States will find this article comprehensive and helpful. Specific details about the surgical treatment of a dozen different types of infections affecting the fingers, hand, and arm are reviewed and discussed. With more and more cases of MRSA and other infections of the hand on the rise, this information is very timely.
Lucas S. McDonald, MD, MPH, et al. Hand Infections. In The Journal of Hand Surgery. August 2011. Vol. 36A. No. 8. Pp. 1403-1412.
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