When shrimp attack ...me

October 16, 2014 9:40 AM

I was making jambalaya about two weeks ago, and while shelling shrimp I poked myself with a carapace. The wound is not getting better. YANAD/YANMD

So it's weird. It swelled up a bit and hurt the first couple of days, then nearly went away. A few days later the process repeats. But for the last three days it's been swollen and very tender (painful to the touch). The wound is circular and about 2mm in diameter, swollen and a bit firm to the touch. I don't think any of the carapace broke off, but you never know. The shrimp was the frozen jumbo tiger kind; I'm not certain, but most of those come from Thailand around here. It was mostly frozen when it got me.

Obviously, I'm not in septic shock, and I don't have a fever or colored veins running up my arm etc. I will go to the doctor tomorrow, but Dutch GPs are ...well, they often need a bit of prompting. I'd like to know potentially what I'm dealing with here and from someone other than a person who works on a shrimp boat/uses shrimp as live bait (i.e., nearly every google search result and someone winds up with a horrible infection and loses half their body to it, etc.)

posted by digitalprimate to Health & Fitness (13 answers total)

Have you tried putting some topical anti-bacterial cream on it? Bacitracin or something like it. I'd clean it out with hydrogen peroxide then apply that and put a bandage on it. That's just basic first aid if you get a puncture wound.

But since you're two weeks out... go to the doctor. Next time clean it a lot earlier!!
posted by OnTheLastCastle at 9:52 AM on October 16, 2014 [1 favorite]

Have you done anything to treat it yourself yet at all?

If it were me, I would open the wound with a (sterilized!) needle or knife, squeeze all the pus out, wash it thoroughly, apply a lot of triple antibiotic ointment ("Neosporin" in the US), and keep it bandaged. Then I'd wash and reapply ointment and bandages at least twice a day or whenever the bandages get loose / wet / dirty. If it fills up again with pus, I'd open it up and drain the pus again as needed.

That routine has worked very well for me in healing up all infected punctures, cuts, scratches, etc. I've ever gotten.
posted by Jacqueline at 9:56 AM on October 16, 2014 [2 favorites]

After 2 weeks you run the risk that it's closed up around debris or infection, and it'll need to be lanced or re-opened so it can drain.

If you have access to what in English is usually called "Drawing Out Salve" or "Drawing Salve" (or cream, ointment, etc) or Black Salve. They generally have an ingredient called something like icthammol or ichthammol (it's black, which makes the related salves black or tarry brown - it's gross and smells like gasoline but pain stops instantly and it encourages the emergence of whatever's in there). I can get a nasty deep splinter to work its way out by putting a blob on a bandaid and leaving it for several hours or overnight.

It's kind of horse medicine (as in, to draw infection out of hooves) or old-people medicine for boils, but I can usually find it at independent US pharmacies and sometimes at chains so maybe you can find it in the kind of place where you would find old-people medicines. Or a large-animal vet supply.
posted by Lyn Never at 10:00 AM on October 16, 2014

The bugs you're most likely to get from a hand wound with shellfish are Vibrio vulnificus, Erysipelothrix, or maybe Aeromonas. You'll probably get some antibiotics, and expect something from the tetracycline or fluoroquinolone group.

But good god, 2 weeks out, please do not attempt to drain this yourself. These are not organisms that lead to particularly purulent (pus-filled) infections. You'll just hurt yourself and still have an untreated infection with more wounded tissue to access and spread through. FFS.
posted by amelioration at 10:01 AM on October 16, 2014 [15 favorites]

Hot/warm salt water soak or hot compresses to encourage it to open it up. Then lots of warm salt water soaks to flush out all the pus infection if it opens by itself.
posted by wwax at 10:03 AM on October 16, 2014 [1 favorite]

Best answer: OK, I looked up the Infectious Diseases Society of America guidelines, and here's what they say about this (it should alleviate your fears of having your hand rot off, at least):

XVII. What Is the Preferred Treatment for Erysipeloid?
Recommendation
49. Penicillin (500 mg qid) or amoxicillin (500 mg 3 times
daily [tid]) for 7–10 days is recommended for treatment of erysipeloid
(strong, high).
Evidence Summary
Erysipeloid is a cutaneous infection caused by Erysipelothrix
rhusiopathiae a thin, pleomorphic, non-spore-forming grampositive
rod. It is a zoonosis acquired by handling fish, marine
animals, swine, or poultry. One day to 7 days after exposure, a
red maculopapular lesion develops, usually on fingers or hands.
Erythema spreads centrifugally, with central clearing. A blue
ring with a peripheral red halo may appear, giving the lesion
a target appearance. Regional lymphangitis/lymphadenopathy
occurs in about one-third of cases. A severe generalized cutaneous
variety also occurs. Systemic symptoms and leukocytosis are
unusual. Culture of an aspirate and/or biopsy of the lesion establish
the diagnosis; blood cultures are rarely positive. Untreated
erysipeloid resolves over about 3–4 weeks, but treatment
probably hastens healing and may reduce systemic complications.
Based on in vitro susceptibilities and anecdotal experiences,
penicillin is appropriate. Cephalosporins, clindamycin, or
fluoroquinolones should be effective for those intolerant of penicillin.
Erysipelothrix rhusiopathiae is resistant to vancomycin,
teicoplanin, and daptomycin [133, 134, 172, 173].

So, uh, seriously: don't start cutting yourself. Go get antibiotics.
posted by amelioration at 10:12 AM on October 16, 2014

As much as I respect our colleagues in the microbiology department, incision and drainage will always be the smart move for any superficial abscess with a suspected foreign body. Oral antibiotics aren't going to do much good.

I don't think you should lance yourself, but self medicating with antibiotics may end up making it worse in the long run.

Then again, according to our path lab, I'm just a knuckle dragging ape in a white coat, so what do I know.
posted by hobo gitano de queretaro at 1:00 PM on October 16, 2014 [2 favorites]

I worked in fisheries. The best way to get spines, shells etc out of your skin is to soak the affected area in HOT water and Epsom salts for 20-40 minutes 2-4 times per day. It should come out within 48 hours. You might not see it if it's small.

Antibiotics are important too if there is cellulitis but you have to get the foreign body out. Don't try to cut it out yourself, it's probably tiny and you'll make it worse.
posted by fshgrl at 1:23 PM on October 16, 2014 [2 favorites]

I vote soaking now, and when you see the doctor tell him you've been soaking and it was red and tight and painful (or whatever it was) prior to soaking.

Seconding the hot water, too. I do not understand the value of "warm."
posted by Lesser Shrew at 1:54 PM on October 16, 2014 [3 favorites]

I put both warm/hot because the salt also helps draw out the pus. Vegemite can used on tropical sores/ulcers for this reason too. I have on several occasions have similar sores on my dogs & the vet suggested swimming in the ocean to help open them as the salt helps. I know heat helps open sores too but not everyone can handle hot water that is why I suggested the range.

Sorry for any confusion.
posted by wwax at 2:11 PM on October 16, 2014

Yeah I dunno why hot water works better but it does. I assume it's because you can dissolve a higher concentration of salt in it. I generally dissolve the salt in nearly boiling water, stirring vigorously all the while, then wait for it to cool enough to soak. You get a really strong solution that way.

And while I have cut foreign bodies out of myself many times I would never do that on my hand. Way too many nerves and tendon-y things.
posted by fshgrl at 3:31 PM on October 16, 2014

Best answer: My son was holding his big dog by a leash when the dog bolted after a cat and the leash slashed my son's hand in the palm and across two fingers - it was nasty. He cleaned it the best he could and applied triple-antibiotic ointment and a gauze bandage, repeating the whole affair for at least a week. Overall, the hand was healing nicely, although the spot on the palm, which was deep, was still tender and swollen; there was no more drainage, no pus, etc.

Then one day at work, not quite two weeks after the injury, he developed a fever and went home, where his fever went up hard and fast and he went into shaking chills. He knew he was very sick - sick enough he knew he couldn't drive himself to an Urgent Care/ER - and he'd just had a falling out with his girlfriend, so didn't want to call her. The blasted kid didn't call me - I could have at least sent a cab for him - but he's lunkheaded sometimes. Anyway, he finally decided he was going to die if he didn't get help so he drove himself to an urgent care center near a hospital. They made him call his girlfriend to take him to the ER (the doc told him to "suck it up" and call her or they'd call an ambulance - no way he was going to be allowed to drive the three blocks to the hospital). He was admitted in septic shock and was hospitalized for seven days with sepsis while they slammed him with powerful antibiotics (the sepsis settled in his kidneys and they said it was just lucky that the blood culture came back as quickly as it did, showing E. coli infection).

I think you've done a good job of treating this injury to the best of your own ability, and it's now time to get a physician to look at it. It will probably be lanced and drained and you'll be given oral antibiotics which will prevent the same mess my son just went through.

Seriously - get a doc interested ASAP. My son had no blood vessel "lines" or pus-filled abscess type appearance on his hand, but he wound up in ICU and in some pretty deep trouble.

Get well soon.
posted by aryma at 9:45 PM on October 17, 2014 [1 favorite]

Response by poster: Thanks everyone - doc lanced and drained (what very little pus there was from) the wound, told me to soak it in hot water mixed with a high concentration either baking soda or Biotex Groen which is a laundry pre-wash agent twice a day. Mrs Primate decants the pre-wash into a more manageable container, so I'm not really sure what's in it, and the website is less than helpful. But general the ideas above - don't lance yourself and soak it in a hot water solution of something - were the Official Medical Advice (of my doctor, not yours etc.)

And she also told me in no uncertain terms that if the wound spread even a little bit or if I was even a tiny bit feverish or feeling generally out of sorts to get my ass to the ER as fast as possible. So far, so good.
posted by digitalprimate at 8:50 AM on October 18, 2014 [1 favorite]