Human hand bite causing soft tissue infection and finger amputation: a case report

A 50-year-old female patient presented to our institution with a human bite wound on her left hand. Her complaints started 15 days ago after her husband bit her hand. Oral antibiotics and local wound treatment had been given by another medical center to which she first presented. The treatment was changed to intramuscular antibiotics after her complaints worsened. The patient was neither hospitalized nor immobilized. She then presented to our clinic with deep wound infection. After hospitalization, intravenous (IV) antibiotics were given and open debridement was performed. F b hemolytic streptococci were isolated in cultures and IV antibiotic therapy was revised. The wound care and circulation of the second digit worsened despite the new therapy. As a result, ray-amputation through the second proximal metacarpal was performed. After amputation, the wound responded well to antibiotics and infection was resolved at the wound site. After one-year follow-up, she had minimal functional disability and all hand joints had full range of motion. In conclusion, hospitalization, IV antibiotic therapy and effective debridement should be performed in elderly patients who are at risk to achieve a favorable outcome.

Ýnsan ýsýrýðý sonrasý elde geliþen yumuþak doku enfeksiyonu ve parmak amputasyonu: Olgu sunumu

Kliniðimize baþvuran 50 yaþýndaki diyabetik kadýn hasta, yaklaþýk 15 gün önce kocasý tarafýndan sol elinden ýsýrýldýðýný bildirdi. Baþvurduðu diðer bir merkezde ilk olarak oral antibiyotik ve lokal pansuman, ardýndan intramuskuler antibiyotik tedavisi verilmiþ, ancak enfeksiyonun ilerlemesi üzerine hastanemize sevk edilmiþti. Acil olarak yatýrýlan ve debridman yapýlan hastadan alýnan kültürlerde grup F streptokok üremesi oldu ve bu etkene yönelik uygun intravenöz (ÝV) antibiyotik tedavisine baþlandý. Verilen tadaviye raðmen ikinci parmak dolaþýmýnda kötüleþme olmasý nedeniyle, karpometakarpal eklem seviyesinden amputasyon uygulandý. Amputasyon sonrasý tedaviye cevap veren hasta tamamen iyileþti ve poliklinik kontrollerinde yara yerinde herhangi bir enfeksiyon bulgusu görülmedi. Bir yýl sonraki kontrolünde fonksiyonel kýsýtlýlýðý minimal, tüm eklem hareket açýklýklarý tamdý. Sonuç olarak, risk faktörleri taþýyan ve tedavisi gecikmiþ hastalarda ÝV olarak olasý etkenlere yönelik antibiyotik tedavisi baþlanmalý, etkili debridmanlar uygulanmalý ve en önemlisi hastalar hastaneye yatýrýlarak takip ve tedavi edilmelidir.