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Martin Williams’ left leg doubled in size and turned purple after he contracted cellulitis, likely the result of stepping on a small sea creature at Cheung Sha beach on Lantau Island in Hong Kong. Photo: Martin Williams

My cellulitis scare: how a serious bacterial infection was sparked by one wrong step on a Hong Kong beach

  • Martin Williams was playing frisbee with his son on Cheung Sha beach when he felt a prick to the bottom of his left foot, from which he caught cellulitis
  • As his leg doubled in size and turned purple, and he heard his doctor mention flesh-eating disease, his worries grew. But after six days he was able to walk out

A recent run-in with something rather sharp and likely putrid triggered a short staycation in a hospital near my Hong Kong home on Cheung Chau island. I had developed cellulitis.

No, not cellulite – the condition that causes lumpy, dimpled flesh on the thighs, hips, buttocks and stomach (that many people have) – but a bacterial infection deep in the inner layers of the skin.

It started simply enough, as I played frisbee with my son in the shallow, sandy waters at Cheung Sha beach on Lantau Island. I felt a quick pricking in the bottom of my left foot when treading on the sand. Briefly, I wondered if it was a marine creature, but felt nothing more: no pain indicating venom from a stone fish, for instance.

Arriving home on Cheung Chau that evening, I was feeling unwell, but thought it must be dehydration. Drinking water and sports drinks was little help. The next day, I had a minor fever. Though I slept well, I awoke sweating, then had a spell of intense shivering, and tremors.

Williams’ swollen and infected left leg. Photo: Martin Williams

Wondering if dehydration had led to a sinus infection, to which I’m prone, I saw a doctor. He found nothing wrong – though he was surprised my temperature was high.

Arriving home, I noticed my lower left leg was swollen, reddish, with a couple of angry looking rashes. Checking online, I found this fitted the description for cellulitis, “a common, potentially serious bacterial skin infection”, according to the Mayo Clinic website. “Left untreated, the infection can spread to your lymph nodes and bloodstream and rapidly become life-threatening.”

Viruses vs bacterial infections: how can you tell the difference?

I quickly set off for the accident and emergency department in nearby Cheung Chau hospital, telling my son, “I’m just going out for a few minutes.” I figured I’d be prescribed antibiotics and sent home. Instead, a doctor confirmed it was cellulitis. Would I like to be admitted there for four or five days, or on Hong Kong Island? he asked. I chose to stay close to home. It was Tuesday.

Nurses fitted me with a catheter leading to a vein in the back of my left hand to give the first of three daily injections of antibiotics. I was issued pyjamas, and taken to an isolation ward, since my fever made me a potential Covid-19 patient. My wife dropped off a bag with supplies including my laptop, allowing some communication with the outside world.

After a couple of nights, my Covid-19 test came back negative, and I was moved to a general ward. I was advised to walk, and took to pacing up and down a corridor that afforded wonderful views over Tung Wan beach to Hong Kong Island.

Williams spent six days in Cheung Chau hospital. Photo: Martin Williiams
A course of intravenous antibiotics helped reduce the infection in Williams’ left leg. Photo: Martin Williiams

Each morning, the on-duty doctor visited. One asked if I’d had any contact with marine creatures, reminding me of the pricking sensation at Cheung Sha. I didn’t think there were sea urchins in the area, but maybe the spine of a fish hidden in the sand? The doctor named three potential species.

I later learned from nurses that the Cheung Chau hospital quite often treats cellulitis arising from encounters with sea creatures. Sometimes, people arrive with cases that are too advanced, and are sent to larger hospitals.

Cellulitis is common worldwide, with around 14 million cases in the United States annually. The risk is around twice as high in diabetics, and a study of a Hong Kong diabetes database revealed 45,470 hospital admissions for cellulitis from 2001-2016.

The pain that accompanied standing after bed rest decreased; a doctor was able to squeeze affected areas of my leg without me yelling in agony
Martin Williams on recovering from cellulitis
While more serious complications are rare, they can be deadly: I was struck by a report of an 83-year-old woman who suffered a puncture wound from a tilapia fish, and within two days developed an infection akin to cellulitis. In her case, this became “flesh-eating disease”, known as necrotising fasciitis. Despite intensive treatment, she died 17 days after being admitted to hospital.

On overhearing a doctor briefing nurses about my case mention “necrotising fasciitis”, I was quick to check that I didn’t have this. At one point, I rolled down a compression sock I was wearing to limit the swelling, and saw my leg looking huge and purple as a beetroot. I wondered if it would soon be a case of “bye-bye leg”.

The intravenous antibiotics I was getting began to counter the infection, however. After three days, my fever subsided. The pain that accompanied standing after bed rest decreased; a doctor was able to squeeze affected areas of my leg without me yelling in agony.

The view over Tung Wan beach from Cheung Chau hospital where Williams was being treated. Photo: Martin Williiams

They removed my IV drip and gave me antibiotics in pill form. After another overnight stay for observations, I was sent home with enough antibiotics to last a few days.

I arrived home on a Monday morning – a six-day absence – feeling grateful to have both legs intact, and to have caught this infection in time, with treatment by an experienced team.