Hello Pieter, and everyone-
I'm not a doctor, but Dr. Jane Kelly (Center for Disease Control) asked me
if I could share this with the list. So I'm forwarding the most relevant
emails regarding seal finger treatment (below.) The jist as I understand
it is that, unlike most skin infections, seal finger is notorious for NOT
responding to penicillin type drugs. Instead, tetracycline and doxicycline
are the preferred drugs, and its very important to hit it early and hard.
Perhaps I should have shared this on the listserv earlier, but we had
responded directly to Derek. Seal finger is different from most skin
infections, and unfortunately is not all that uncommon in Alaska, so I had
forwarded the original email to some doc's that I knew had treated it
here.
Mary Cody
Koyukuk/Nowitna National Wildlife Refuge
U. S. Fish and Wildlife Service
Box 287
Galena, AK 99741
[EMAIL PROTECTED]
(907) 656-1231
Thanks, Paul. That is tremendously helpful. Of course none of us can give
specific medical advice without seeing the patient, but I am sure it will
be helpful to the primary care physician to know there is a orthopedist he
or she can contact with experience with seal finger. Thanks again!
Jane
-----Original Message-----
From: Hager, Paul [mailto:[EMAIL PROTECTED]
Sent: Fri 1/26/2007 10:03 PM
To: Kelly, Jane M. (CDC/CCHP/NCCDPHP); Fox-Leyva, Leslie;
[EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc:
Subject: RE: [MARMAM] seal finger
Dr. Kelly,
In regards to a case of seal finger.
The current antibiotic of choice is still doxycycline 100mg bid X 4
to 6 weeks or tetracycline 500mg QID X4 to 6 weeks. Those things are
persistent even while you are compliant with your daily antibiotic
regimen due to mycoplasmas' slow reproductive rate. Seal finger can
look a lot worse than it is. When your whole finger swollen and
oozing from multiple lesions for weeks it is hard to believe anything
is getting better. Elevation and consistent daily range of motion
exercises of joints to maintain flexibility with follow up needed if
at anytime the joints become particularly painful to gentle Range of
Motion which may be a sign of joint infection. The surgical
debridement and irrigation usually are reserved for the infections or
open contamination of the joints. I am hesitant to give medical
advice except in very general terms except to say that this is the
current advice we give to our Community Health Aides who see seal
finger patients in remote clinics with consultation with their
regional doctors.
I recommend that the particular patient have their physician contact
Dr. Bill Paton at ANMC Ortho Dept,. 907-729-1615 for advice. Dr.
Paton is familiar with the treatment and rehabilitation of seal
finger infections and is our most experienced orthopedic surgeon.
Paul K. Hager, PA-C
LT US Public Health Service
Faculty Community Health Aide Training Center
Alaska Native Tribal Health Consortium
4000 Ambassador Drive
Anchorage, Alaska 99508
907-729-2436
[EMAIL PROTECTED]
From: Kelly, Jane M. (CDC/CCHP/NCCDPHP) [mailto:[EMAIL PROTECTED]
Sent: Friday, January 26, 2007 4:22 AM
To: Fox-Leyva, Leslie; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc: Hager, Paul
Subject: Re: [MARMAM] seal finger
Thanks Les, and thanks in advance, Paul, for any information you can
offer on seal finger treatment. Jane
--------------------------
Sent from my BlackBerry Wireless Handheld
-----Original Message-----
From: Fox-Leyva, Leslie
To: Kelly, Jane M. (CDC/CCHP/NCCDPHP); [EMAIL PROTECTED]; Derek Lee
CC: Hager, Paul
Sent: Thu Jan 25 18:51:43 2007
Subject: RE: [MARMAM] seal finger
I'm forwarding to our PA Instructor still connected with Ortho at
ANMC for his expertise (Paul Hager.) FYI Jane, Dr Bill Paton is
still on staff here at ANMC and consulted with CHAP on the new CHAM.
The new CHAM recommends profilactically (for human & animal bites,
not specific to sea mammals); Augmentin 875/125 mg BID X 10 d, but
if PCN allergic, then use ceftriaxone 1 gm IM every 12 hrs for as
long as doctor orders, or clindamycin--300 mg capsules 4 times a day
for 10 d.
The previous CHAM edition made specific recommendations for sea
mammal/fish slime and rabbit bites..."tx w/ Tetracycline or doxy" as
you indicated.
Hope Paul can be more help. Leslie
Leslie K. Fox-Leyva MPH, NP/PA
ANTHC-CHAP Training Director
C-CHAP 4000 Ambassador Dr.
Anchorage AK 99508
(907)729-2427
-----Original Message-----
From: Kelly, Jane M. (CDC/CCHP/NCCDPHP) [mailto:[EMAIL PROTECTED]
Sent: Thursday, January 25, 2007 1:28 PM
To: [EMAIL PROTECTED]; Derek Lee; Fox-Leyva, Leslie
Subject: RE: [MARMAM] seal finger
Thanks for making the connection, Mary.
Derek,
The issue with seal finger is several fold: most docs have no
experience with it, the organism (Mycoplasma sp.) that causes it is
not responsive to usual antibiotics used in wound infections,
treatment course is long (4-6 weeks not uncommon) and the penetration
depth of the wound can be miscalculated. There is little soft tissue
on the hand and a bite can penetrate the joint capsule and become
more than a simple soft tissue wound. Tetracycline or Doxycycline I
believe are still the drugs of first choice. But the would might
need to be opened and drained surgically. There may be a joint
infection for which oral antibiotics are not adequate. Some people
unfortunately develop osteomyelitis (infection in the bone) that
needs IV antibiotics for weeks. An MRI can help determine if this is
osteomyelitis or a soft tissue infection (e.g., a more simple "flesh
wound"). The Orthopedic surgeons at ANMC may be the best authorities
on this.
I have lost touch with the ortho docs at ANMC and am not sure of whom
to ask for advice. But by this e mail I am contacting a Nurse
Practitioner at ANMC , Leslie Fox-Leyva, who may be able to help.
Leslie, can you help with this question on seal finger? Could you
ask the orthopods about their clinical experience with seal finger?
This patient is not in Alaska or eligible for care at ANMC but any
advice I am sure would be welcome. I did do a Pub Med search on seal
finger but the search just basically confirmed the information I
provided above.
Jane
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Thursday, January 25, 2007 3:48 PM
To: Derek Lee
Cc: Kelly, Jane M. (CDC/CCHP/NCCDPHP)
Subject: Re: [MARMAM] seal finger
Hi Derek,
Seal hunters along the coast of Alaska get seal finger, and I've seen
a few terrible cases. I think its quite common for seal finger to
recurr, and it can be very resistant to treatment. I've forwarded
your email to Jane Kelly at the CDC in Atlanta. Jane used to work
for the Native Health Service here in Alaska, and is more familiar
with treatments. A friend of mine on St Lawrence Island had a
terrible case that wasn't responding to treatment very well. It
seems to me that I remember it being treated with a combination of
doxicycline and rifampin when it recurred and wasn't responding to
high doses of tetracycline. But I'm NOT a doctor, and I may not be
remembering that accurately. You could also have her doctor check
with the Alaska Native Medical Center in Anchorage Alaska, as they
treat it more often than would be likely anywhere else... ANMC's
main number is
(907) 563-2662.
Its a terrible infection. I'm sorry I don't know any specific doctor
at ANMC to referr you to. Best of luck to you and your volunteer.
Mary Cody
Koyukuk/Nowitna National Wildlife Refuge U. S. Fish and Wildlife
Service Box 287 Galena, AK 99741 [EMAIL PROTECTED]
(907) 656-1231
-----------------------------------------------------------------------
"Derek Lee"
<[EMAIL PROTECTED]>
Sent by:
To
[EMAIL PROTECTED] <[email protected]>
sts.uvic.ca
cc
Subject
01/25/2007 07:20 [MARMAM] seal finger
AM
Anyone who knows anything about the infection 'seal finger'
recurring, and/or not responding to Tetracycline (1.5 g initially,
then 500mg QID), please respond, we have a volunteer who is in danger
of losing her fingers to an antibiotic-resistant infection acquired
from elephant seals. Reply
to: [EMAIL PROTECTED]
Thank you,
-Derek Lee
Derek E. Lee
Farallones Biologist
PRBO Conservation Science
3820 Cypress Drive, #11
Petaluma, California 94954
www.prbo.org
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