These thorns can kill

By KATHERINE HOBY

John Davies has a claw where he once had a healthy left hand. The cause - a tiny splinter.

He is not alone.

Research by a doctor at Middlemore Hospital reveals that a small but significant number of people have died or been maimed by serious infections from garden rose thorns and other splinters.

TVNZ newsreader Liz Gunn underwent surgery after getting a rose thorn embedded in her hand at the end of last year.

Only a doubling of her antibiotic dose saved her from losing a finger.

The Middlemore study followed a rash of cases in Auckland about April last year.

Orthopaedic registrar Dr Fiona Timms, who carried out the audit, said: "There are always one or two cases a year, but the fact that there had been three or four by April - and all of those serious - was alarming."

Two people have died in the past 12 months and at least five others had fingers and thumbs amputated.

The cause is a common bug, streptococcus pyogenes, which is present in the soil and even the human mouth and can prove fatal when toxins enter the bloodstream.

Middlemore hand surgeon Tim Tasman-Jones said he had seen six people develop serious infections.

Two were from rose thorns and one was from a tiny metal splinter. The rest were caused by other tiny slivers embedded in the hand.

Dr Timms said the bug could be very aggressive.

"It spreads through the tendon sheaths very quickly.

"The hand is so sensitive that once you get some swelling in there it can shut down very fast."

Mr Davies, a 34-year-old Pukekohe truck mechanic, had had wounds from metal splinters become infected many times.

He thought he had removed most of the tiny metal fleck he got in the base of his thumb in early April last year.

The wound started to swell and after a week he decided to have it checked at hospital.

"I was told it was infected and that I might have to stay the night," he said.

"I was there for nine weeks."

By the time of his first operation the aggressive bug - which is the same organism that causes the flesh-eating disease necrotising fasciitis - had spread through his hand and was advancing up his arm.

The surgeon's report notes that he went into septic shock and was barely able to hold a conversation as the bug reasserted its hold on his forearm.

He was rushed to intensive care and his little finger was amputated.

He needed four days in intensive care to keep him alive.

Mr Tasman-Jones' report says: "John now has a severe claw hand which nearly cost him his life."

Once the streptococcus pyogenes toxins are in the bloodstream, they can spread quickly. If they are not treated, renal and respiratory failure can follow.

Mr Davies has had to accept that he will almost certainly not be able to return to his job as a mechanic.

"It's all because of a splinter. It's so hard to believe."

He faces the possibility of three operations this year - the second of which might restore some movement to his ravaged tendons.

Mr Tasman-Jones said any fine splinter - even one just 1mm long - could carry the bug into the body.

He stressed that most of those who got a splinter embedded in their hand and contracted minor infections could be treated with antibiotics and were fine within 24 hours.

Mr Tasman-Jones said the patient he lost had had a small metal splinter in his hand.

A serious infection developed and his arm was amputated. Unfortunately, the bug had spread and he went into renal failure and died.

"All the six had serious infections which at the time were life-threatening. Everyone lost something: a digit, a thumb or in one case, their life."

A Clarks Beach great-grand-mother, who did not want to be named, lost her middle finger after a tiny cut sustained while gardening became infected in April.

Within two days the woman was in hospital, where she remained for four and a half weeks, including a spell in intensive care.

"It moves very fast," she said.

"If I had left it another day before I went in, I don't know what would have happened."