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Finger infection

My sister has a finger infection that doctors have not yet been able to diagnose. She is waiting to see a specialist, but has not yet been able to schedule an appointment after several attempts to do so. It started as a hangnail but progressively got worse. I have photos, but I don't see a place to upload them. How can I get these photos to you? The fingertip of her right ring finger is swollen with white dead skin which looks more like a fungal infection. No apparent necrosis, but the fingernail has separated and also *appears* to be infected with fungus. She has had IV antibiotics twice as well as antibiotic and antifungal pills, and it was non-responsive to the drugs. Tested negative for MRSA. Finger hurts and is pinkish-red. It is dry with no discharge.

2 Responses
563773 tn?1374246539
Thanks for posting your query.

I have seen the photographs posted in your profile.

From the history that you have provided it looks like paronychia of the nail which progressed to infection of the fingertip. Paronychia is a soft tissue infection around a fingernail that begins as cellulitis but that may progress to a definite abscess. It is of two types: acute caused by bacterial infection and chronic caused by fungal infection.

From your sister’s symptoms, the hangnail might have started the chain of events by causing first paronychia which then progressed to infection of the fingertip causing a felon. A felon is a fingertip abscess deep in the palm side of the finger. It usually is caused by bacterial infection, but a herpes virus called herpetic whitlow and, more rarely, fungi also can cause felons. In herpetic whitlow, small bubble-like cysts on the skin, called vesicles, and repeated episodes are there which distinguish it from bacterial or fungal infection. It is less likely to be the cause in your sister’s case. Hence it can either be bacterial or fungal infection.

Your sister has taken many antibiotics and antifungals but they have provided little help. In that case, the best treatment is incision and drainage followed by a round of general antibiotics which in turn is followed by specific antibiotics or antifungals after the reports of pus/ blood sample of the effected site specify whether it is bacterial or fungal infection.

Incision and drainage for a felon is an OPD procedure in which the doctor makes the whole finger numb by injecting an anesthetic once into each side of the finger. Then he or she will make one or more small cuts in the tip of the finger to allow the pus to drain out. A narrow gauze strip may be left in the wound to hold it open for continued drainage. It is followed by broad spectrum antibiotics and sending the pus sample to the lab for bacterial and fungal culture examination. Once the culture reports come, her doctor will prescribe specific antibiotics or antifungals.

If it’s not treated, a finger pulp infection can cause a number of complications like spreading of the infection to the bone of the finger causing osteomyelitis, skin necrosis, septic arthritis and tenosynovitis (when the infection spreads to the sheath that surrounds the tendons in your finger). Hence my sincere suggestion would be to get it evaluated from a specialist and get the above mentioned treatment.

Hope that this information helps and hope that your sister will get better soon.

Wishing you good health.

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