Toga Akira, Balaji Ayush, Nagura Shigeki
Department of Orthopedic Surgery, Saiseikai Yokohama-shi Tobu Hospital, Yokohama, Kanagawa, Japan.
Hull York Medical School, University of York, York, UK.
Int Med Case Rep J. 2022 Nov 25;15:685-692. doi: 10.2147/IMCRJ.S385264. eCollection 2022.
Peripheral human bite wounds are rarely serious and are typically treated medically, with the most complex cases requiring only minor amputation or excision of the infected site. There are few to no reports documenting the development of purulent tenosynovitis, necrotizing fasciitis, and osteomyelitis from these lesions. Major amputations are required only rarely in these cases.
A 71-year-old woman presented with an uncontrolled infection following a self-inflicted bite wound to her left middle finger. A bacterial culture of the lesion revealed methicillin-resistant (MRSA). The infection could not be controlled with antibiotics or additional interventions, including debridement and minor amputation. She contracted severe COVID-19 while in the hospital which limited the available treatment options. In an attempt to control the infection, the patient ultimately underwent a major amputation of the distal left forearm. While recovering from the procedure, the patient succumbed to septic shock and cardiopulmonary arrest.
The unusual progression of this case may be attributed to the interventions required to treat acute COVID-19 as well as a variety of confounding factors. For example, vasopressors and steroids used to treat severely-ill patients compromise the local and systemic physiologic responses to acute bacterial infection. It is important to reconsider clinical expectations during the pandemic and intervene as early as possible to prevent ongoing damage and clinical deterioration.
人类外周咬伤伤口很少严重，通常采用药物治疗，最复杂的病例仅需对感染部位进行小范围截肢或切除。几乎没有报告记录这些损伤引发脓性腱鞘炎、坏死性筋膜炎和骨髓炎的情况。这些病例很少需要进行大截肢。
一名71岁女性因左手中指自伤咬伤后出现感染失控前来就诊。对该损伤进行细菌培养显示为耐甲氧西林金黄色葡萄球菌（MRSA）。使用抗生素或包括清创术和小范围截肢在内的其他干预措施均无法控制感染。她在住院期间感染了严重的COVID-19，这限制了可用的治疗选择。为控制感染，患者最终接受了左前臂远端的大截肢手术。在术后恢复过程中，患者死于感染性休克和心肺骤停。
该病例的异常进展可能归因于治疗急性COVID-19所需的干预措施以及各种混杂因素。例如，用于治疗重症患者的血管加压药和类固醇会损害机体对急性细菌感染的局部和全身生理反应。在大流行期间重新审视临床预期并尽早干预以防止持续损伤和临床恶化非常重要。
