Freak Accident! (sorry kinda long)

[TheMagicCookie]

I was recently hospitalized and had three surgeries on my arm because of an infection that was supposedly caused by Chlostridia. It was such a freak accident, I just wanted to see if you guys had ever heard of anything like this.

I was attending a horse show in Michigan where I was showing a baby filly. I went to the fairgrounds on Saturday Oct. 11, and while I was going into the fillies stall, I barely poked myself on a smooth wire attached to the stall door. I thought absolutely nothing of it considering it didn't even draw blood and I continued to get the baby horse ready. I had no symptoms of an infection until I was home on Monday Oct. 12th. I woke up that morning and my arm was slightly swollen, but barely noticeable and I was having some shooting pains down my elbow throughout the day, there was also some weakness in the strength of my arm. I just figured I had slept on my arm funny or my arm was sore from showing the filly because they tend to jerk you around. By Monday night, the pain was still present but now the arm was puffy and very sore to the touch. My forearm was probably twice it's normal size and bright red. I then found an area around my elbow that was squishy and seemed to have subcutaneous air, it made a crackling noise much like styrofoam. I called my Dr. and made an appointment for the next morning to get my arm checked out. At the appointment, the Doc looked at it really quick and said it was just a case of Cellulitis and prescribed Augmentin. I got the prescription filled and then proceeded to vomit the antibiotics back up. I never ran a fever and I had taken the meds with food, so the Doc prescribes another medication. I go home that night and by bedtime, I no longer had a wrist or a hand, it had swelled and was in the same condition as my forearm. I decide to go to the ER in the morning and see if I could get IV antibiotics since the orals obviously had not improved the arm. It's now Wednesday the 15th and I go to the ER where I am placed in observation for 24 hrs on IV antibiotics. At 3:00 A.M, a resident comes in and says he would like to get some X-Rays, no problem. After reading the x-rays, the resident comes back to inform me that I will be going into emergency surgery. I get to surgery at about 5 A.M and am given all the talks about what would happen and so forth. After the operation, the surgeon tells me that I had Necrotic Fasciitis and if I had come to the hospital 12 hours later than I would have lost my arm from the shoulder down. To make this story a little shorter, I was in the hospital for 8 days and had another two surgeries after the first one. The surgeon believed that I would need a skin graft to close the incisions, but luckily it was not needed. I have an incision from my wrist to my elbow on the top and bottom of my arm and two incisions on my hand(over 200 stitches). The infectious disease Dr. said that the poke from the wire could have been the cause.

I am happy to be out of the hospital, I got out on the 23rd. I am now going to physical therapy and am hoping to be back to normal soon. Three of my fingers work and I have half of the normal ability in my wrist and am very hopeful for a full recovery.

My question to you is, have you ever heard of anything like this? and does the diagnosis of Chlostridia sound correct? This was such a freak accident, but it has not affected me much, I am still in high spirits and am calling myself the bride of Frankenstein. Thanks for reading all this, I tried to keep it as small as possible!

[NsgTiger]

I'm not familiar with the dx. But WOW, glad that it looks like everything will be okay. That is so scary how such an apparently benign incident can turn so serious. Best of luck in your recovery!

[LisaRN2B]

Wow! What a thing to go through!

I looked Chlostridia up online, found this:

C. perfringens

This non-motile bacterium is an invasive pathogen that can be contracted from dirt via large cuts are wounds. C. perfringens cells proliferate after spore germination occurs and they release their exotoxin. The toxin causes necrosis of the surrounding tissue (Clostridial myonecrosis destroys muscular tissus). The bacteria themselves produce gas which leads to a bubbly deformation of the infected tissues. C. perfringens is capable of necrotizing intestinal tissues and can release an enterotoxin that may lead to severe diarrhea. Treatment of infection can consist of penicillin G (to kill the organism), hyperbaric oxygen (?), and administration of an antitoxin.

The link to the site I swiped that from is here:

http://medic.med.uth.tmc.edu/path/00001496.htm

Goodness, I am glad you're going to be ok and didn't lose your arm!

Must edit to add that crepitant cellulitis can be caused by Clostridium perfringens. So, I guess the first dx wasn't necessarily wrong, the rx just didn't work.

[Burnt Out, ASN, RN]

I barely remember Chlostridia in Micro....

Gracious...glad you are doing ok....hope you have a speedy recovery:kiss

[Jay-Jay, RN]

C. perfringens most often causes acute diarrhea, and is one of the leading causes of food poisoning. The type of infection you had is far more dangerous:

1. Gas gangrene (Clostridial Myonecrosis)

Acute necrotic condition of the soft tissue that lead to death and deterioration of a part of the body, caused by interference with blood supply and infection.

Causes: gas forming anaerobic bacteria C. perfringens which grows in tissue that have low oxygen tension caused by trauma or ischemia

- Minor injuries in the immunocompromised patients (diabetes mellitus)

- Any kind of surgery (traumatic or surgical interruption of blood supply)

- Deep contamination of wound due to foreign body, soft tissue trauma and bone fracture

C. perfringens releases Alpha-exotoxin that produces lethal gas, which is rapidly spreading to the muscle causing massive tissue swelling and necrosis.

Clinical symptoms: swollen painful wound with gas bubble in the drainage, felt as crepitus in the soft tissue as well as systemic toxemia and failure of whole body (fever, renal damage and cardiotoxicity).

Horses and other domestic animals can be affected by C. perfringens. They can also carry it in their intestines, and shed bacterial spores without showing signs of illness. No doubt that piece of metal that stuck your finger was infected with C. perfingens spores. It's an anaerobe, so puncture wounds are the ideal way for it to spread. Its relative, C. tetanii (tetorifice, or lockjaw) is also most often spread by puncture wounds.

[gizzy76]

I don't know a lot about it...but I thank God that you are okay! My best wishes for a speedy and full recovery!

[TheMagicCookie]

Thanks everyone, I still can't believe that's how I contracted it, just my luck:) . I also forgot to mention that they took cultures durng surgery but they were unable to grow anything on the samples. They thought it was because I had already been on antibiotics. My stitches come out on Tuesday so I'm quite anxious to start riding again.:)

[LisaRN2B]

Originally posted by TheMagicCookie

Thanks everyone, I still can't believe that's how I contracted it, just my luck:) . I also forgot to mention that they took cultures durng surgery but they were unable to grow anything on the samples. They thought it was because I had already been on antibiotics. My stitches come out on Tuesday so I'm quite anxious to start riding again.:)

That's odd, that they got no cultures to grow (IMO).

Glad you get your stitches out soon. I can understand wanting to get "back in the saddle" again. Had horses myself in my youth...I miss them!

Best of luck to you. Oh, and stay away from sharp metal projections in and around the stalls...geez, who woulda thunk it?

[ERNurse752, RN]

I've seen one case of necrotizing fasciitis before...nasty stuff!

It was also in an arm, and all the tissue except skin, muscle, and bone was removed. We had to pack her arm full of gauze from the wrist to the shoulder.

I'm glad they caught it in time, good luck!

[oramar]

My hubby just poked himself with wire at work. It went in about inch. He was treated and put on antibiotics and salve. He is snorting about how all this fussing is unnecessary. I will show him this post.

[Lecia]

Don't know anything about the infection as I'm still waiting to start nrsng school next fall.

Just wanted to say....

I've shown horses most of my life and have done that same thing numerous times.... scares the life out of me that something so serious could happen from something so commonplace.

I'm glad you're okay and will be back in the saddle soon!!

BTW... How'd your filly do at the show???

[TheMagicCookie]

Well, she would have done a lot better, but she hurt herself in the trailer on the way down and she was off when she was trotting. She stood up really nice, but that's only 50% of the overall judging. It was a jackpot class and it paid money to the 5th place, she got 6th. I had fun anyways.