How an insect bite caused olecranon bursitis

A typical minor reaction to an insect bite

Make no mistake about it - my partner Paul is susceptible to insect bites - FACT! If anyone is going to spend their summer brushing off troublesome ticks and aggravating arachnids, you can put money on it being Paul.

Granted, not every bite he begrudgingly accepts will cause an unpleasant reaction but he has certainly encountered his fair share of puss-filled blisters as a result of an insect's venomous puncture wound.

The first of the photos on this hub show a classic bite and less severe reaction on the leg. What started off as a mosquito bite, soon transformed into a large blister, filled with puss, and the area of skin surrounding the blister is typically red, raised and hot - and incredibly itchy.

The blister should not be manually popped as this can increase the risk of infection however when they get so large, as what happened in this case, it did in fact pop and consequently antibiotics were needed. The new skin left was raw and painful. A scar remains two years later.


An insect bite causing minor infection

In the early stages of this mosquito bite, a blister has formed.
In the early stages of this mosquito bite, a blister has formed. | Source
The mosquito bite has now developed into a much larger blister, filled with puss.
The mosquito bite has now developed into a much larger blister, filled with puss. | Source
This blister popped and left a raw patch of new skin. A scar remains on the leg two years later.
This blister popped and left a raw patch of new skin. A scar remains on the leg two years later. | Source

The first signs of a severe infection

During the summer of last year, Paul and I was preparing a barbeque for family and friends. We spent the morning erecting marquees, cleaning the house and garden and preparing a copious amount of food and drink.

Paul had suffered an insect bite the previous day at work, just near his elbow. But apart from some minor itching, it wasn't causing him too much grief and so we continued with what turned out to be a fantastic day.

During the early evening however when most of the guests had started to filter home, I noticed Paul was particularly quiet and not himself. I put it down to tiredness - it had been a long day after all.

But it wasn't exhaustion Paul was suffering and he was far from ok.

The telltale signs of his infection began with shivering. It was a warm summer's evening and he was huddled in a thick, hooded jacket shaking like a leaf. His skin was clammy and he felt generally unwell in himself. The bite on his arm was causing some discomfort and was by now, red, swollen and hot.

We didn't panic. The plan was we would get some antihistamines or antibiotics if he still felt unwell the following day. It was just an insect bite after all.

Paul went to bed for the first of many restless nights.

The following days

After a further 24 hours of trying to treat the bite ourselves, and realising antihistamines were not working, Paul's whole arm was now very painful, more swollen and very red so admitting defeat, he visited the doctors. Antibiotics were prescribed and over the course of a few days, Paul did start to feel better in himself and the swelling had subsided.

However, the infection continued to multiply inside Paul's arm and unbeknown to us was far from under control. Several days later, the wound started to open and puss began to leak. Every time he outstretched his arm, the puss would literally drip out. He wasn't feeling sick so continued to work but was taking bandages with him to replace regularly because of the seeping puss.

A return visit to the doctor was necessary, but this time they would not prescribe more antibiotics and Paul was advised to go to the Accident and Emergency department at our local hospital. The infection would need more aggressive treatment.

At the hospital, staff were horrified that this was caused by an insect bite. Blood tests, observations and swabs were taken before a Doctor confirmed bacteria from the bite had entered the bloodstream and caused an infected bursa - otherwise known as olecranon bursitis.

Paul was admitted to hospital for a procedure called incision and drainage, along with two days of intravenous antibiotics.

Hospital treatment

After the incision and drainage operation took place the following day, I popped in to see Paul. Despite a lack of appetite, he seemed well. I thought perhaps the anaesthetic or large dose of antibiotics were taking effect so I didn't stay for long so he could rest. At this point I expected him to come home the next day.

24 hours after the operation,I went back in to see him and noticed a puddle of green liquid on the floor beside his bed. Looking up at his thickly bandaged arm, I was horrified to discover the green liquid was puss oozing from the site of the wound. He was still not eating much and for the first time since this happened, I could see now he was very poorly.

The doctors took off his bandages and confirmed the obvious. The operation had failed to clear this infection and a repeat operation was scheduled for the following day. There was an open hole where the incision and drainage took place and liquid-puss poured out. What was going to be a two-day admission was now estimated at eight days. He would need a further week of strong intravenous antibiotics. All this over an insect bite.


The first operation left a hole in his elbow

This is the elbow after the first incision and drainage. You can see the wound is still oozing puss and therefore a repeat operation was scheduled.
This is the elbow after the first incision and drainage. You can see the wound is still oozing puss and therefore a repeat operation was scheduled. | Source

The next stage of treatment

Following the second incision and drainage, Paul's whole arm was wrapped so thick with bandages, it was a relief and no surprise that we would not see the wound leak further. The doctors explained they had to make a larger incision but were confident they were on top of the infection this time.

Paul's family and I were growing increasingly concerned over Paul himself though. He lost a lot of weight in a very short space of time and looked gaunt and grey. We were reassured the medicines he was taking to fight the infection were the cause of his appetite loss but we were nonetheless very scared.

After a further couple of days, the bandages were again removed and we were shocked to see the state of his elbow but also ecstatic to hear that, after more swabs and blood tests, there was no further sign of infection. Paul needed to complete the course of intravenous antibiotics then would be free to come home.

After a total of 9 days in the hospital and a loss of two stone in weight, Paul was back home recovering. However, not before a visit from a Microbiologist to give us more worrying news.


Wound is left open to heal

After the second operation, the wound has been cut further to remove the infection and left open to heal
After the second operation, the wound has been cut further to remove the infection and left open to heal | Source

The final chapter

The microbiologist confirmed Paul's blood tests proved positive for a rare cryptococcal infection. It is unknown if related to the bite and it is a disease typically spread by inhaling pigeon faeces. When Paul was first bitten, he was working up a ladder, cleaning guttering and it is possible it was caught this way but we'll never know for sure. Either way, it is a very dangerous disease and Paul would need to remain on antibiotics for six months along with regular appointments for blood tests and check-ups.

Thankfully Paul made a full recovery from his ordeal and was back at work within a matter of weeks. Fast forward one year and his elbow is barely recognisable as the one on the photos.

The wound one year on

One year later and the wound has healed remarkably well.
One year later and the wound has healed remarkably well. | Source

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