Fingertip And Distal Phalanx Necrosis After Self-Inoculation With The Johne’s Disease Vaccine: A Case Report And Review Of The Literature.

摘要

In 2002, the Australian government gave approval for the use of the GudairTM vaccine (CZ Veterinaria, Porrino, Spain)1 to prevent the spread of Ovine Johne’s Disease (OJD). The vaccine’s introduction has failed to prevent the spread of OJD and currently vaccination programs are active in most Australian states. OJD is a mycobacterial infection affecting sheep, deer and goats. It is an animal wasting disease resulting in chronic diarrhoea, decreased wool production and stock loss. Accidental human injection of the vaccine can have serious and long lasting consequences. We report on a case of self-inoculation resulting in the amputation of a fingertip and distal phalanx. Introduction In 2002, the Australian government gave approval for the use of the GudairTM vaccine (CZ Veterinaria, Porrino, Spain)1 to prevent the spread of Ovine Johne’s Disease (OJD). The vaccine’s introduction has failed to prevent the spread of OJD and currently vaccination programs are active in most Australian states. OJD is a mycobacterial infection affecting sheep, deer and goats. It is an animal wasting disease resulting in chronic diarrhoea, decreased wool production and stock loss. Accidental human injection of the vaccine can have serious and long lasting consequences. We report on a case of self-inoculation resulting in the amputation of a fingertip and distal phalanx. Case Presentation A 63 year old farmer from regional New South Wales accidentally injected himself with the GudairTM vaccine into his left middle fingertip. The needle passed through the neck tissue of a lamb and penetrated the pulp of his fingertip. The vaccination dose was delivered but, the exact quantity of vaccine injected was unknown. The patient immediately irrigated the region with water and attempted to express the vaccine from the pulp. No vaccine was seen to emerge from the needle puncture site. He presented to our hospital 60 hours post inoculation and underwent incision, irrigation and debridement early the next morning. The patient reported pain in the entire fingertip and felt that it had started to swell. The finger pulp looked relatively benign with a small puncture wound from the needle and minor fingertip erythema. A direct midline volar approach to the pulp was used for debridement. No vaccine was visible. After copious irrigation the incision was left open and dressed. A repeat washout and nylon closure was undertaken two days later. There was no necrotic tissue evident on this occasion. Whilst an inpatient he received intravenous antibiotic coverage with cephazolin and was subsequently discharged with a 10 day course of oral antibiotics.The patient was reviewed 2 weeks later in clinic. He reported no pain and despite no decrease in the size of the swelling felt that his finger was improving. The wound had healed with no discharge.