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@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@anmc.org] Sent: Fri 1/26/2007 10:03 PM To: Kelly, Jane M. (CDC/CCHP/NCCDPHP); Fox-Leyva, Leslie; Mary_Cody@fws.gov; dlee@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@anthc.org From: Kelly, Jane M. (CDC/CCHP/NCCDPHP) [mailto:azk9@cdc.gov] Sent: Friday, January 26, 2007 4:22 AM To: Fox-Leyva, Leslie; Mary_Cody@fws.gov; dlee@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@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@cdc.gov] Sent: Thursday, January 25, 2007 1:28 PM To: Mary_Cody@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@fws.gov [mailto:Mary_Cody@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@FWS.GOV (907) 656-1231 ----------------------------------------------------------------------- "Derek Lee" <dlee@prbo.org> Sent by: To marmam-bounces@li <marmam@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@prbo.org Thank you, -Derek Lee Derek E. Lee Farallones Biologist PRBO Conservation Science 3820 Cypress Drive, #11 Petaluma, California 94954 www.prbo.org _______________________________________________ MARMAM mailing list MARMAM@lists.uvic.ca https://lists.uvic.ca/mailman/listinfo/marmam