[MARMAM] [south_sa] 'Seal finger' case

Mary_Cody at fws.gov Mary_Cody at fws.gov
Tue Jan 30 17:19:23 PST 2007


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
Mary_Cody at FWS.GOV
(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:phager at anmc.org]
      Sent: Fri 1/26/2007 10:03 PM
      To: Kelly, Jane M. (CDC/CCHP/NCCDPHP); Fox-Leyva, Leslie;
      Mary_Cody at fws.gov; dlee at prbo.org
      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
      phager at anthc.org

      From: Kelly, Jane M. (CDC/CCHP/NCCDPHP) [mailto:azk9 at cdc.gov]
      Sent: Friday, January 26, 2007 4:22 AM
      To: Fox-Leyva, Leslie; Mary_Cody at fws.gov; dlee at prbo.org
      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); Mary_Cody at fws.gov; 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:azk9 at cdc.gov]
      Sent: Thursday, January 25, 2007 1:28 PM
      To: Mary_Cody at fws.gov; 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: Mary_Cody at fws.gov [mailto:Mary_Cody at fws.gov]
      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 Mary_Cody at FWS.GOV
      (907) 656-1231
      -----------------------------------------------------------------------

                   "Derek Lee"

                   <dlee at prbo.org>

                   Sent by:
      To
                   marmam-bounces at li         <marmam at lists.uvic.ca>

                   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: dlee at prbo.org
      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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