Mammalian bites

2017-01-25T05:13:07Z

Awertheimer:

==Background==
*5% of untreated dog bites will become infected (similar to rate of non-bite wounds)
*80% of untreated cat bites will become infected
*Human Bite - (Also see [[Closed fist infection]])

===High-Risk Wounds===
*Cat, human, livestock, or monkey bites
*Deep puncture wounds
*Hand or foot wounds
*Bites in immunosuppressed patients

==Clinical Features==
*Depends on source of bite - bite marks or puncture wounds.

==Differential Diagnosis==
{{Bites and stings DDX}}

==Evaluation==
*Clinical diagnosis, based on history and physical exam
*Consider X-ray
**If concern for retained foreign body (e.g. tooth)
**To rule out fracture (adult dogs may exert >200 lbs force bite)
*Consider Ultrasound
**If concern for abscess or foreign body
*CT Angio if concern for vascular injury
*Wounds overlying a joint should be examined through complete range of motion to assess for tendon injury

==Management==
===Indications for Primary Closure of Mammalian Bites===
*Consider primary closure in face bites <ref> Rui-feng C, Li-song Huang, Ji-bo Z, Li-qiu Wang. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: a prospective randomized trial study. BMC Emergency Medicine. 2013;13(Suppl 1):S2. doi:10.1186/1471-227X-13-S1-S2. </ref> <ref> Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. 2014 Jul 15;59(2):e10-52, executive summary can be found in Clin Infect Dis 2014 Jul 15;59(2):147 </ref> if all of the following are true:
**Repair can occur within 6hr of injury (time dependent upon individual judgment)
**Repair only requires single-layer closure; no devitalized tissue
**No underlying fracture
**No systemic immunocompromising conditions
*Consider antibiotics in patients who are primarily closed
*A mnemonic to remember the management: '''HELICOPTER'''
**'''H'''istory, '''E'''xamination, '''L'''iberal cleansing, '''I'''rrigation, '''C'''losure & Culture consideration, '''O'''perative cleansing & closure, '''P'''rophylactic antibiotics, '''T'''etanus immunization, '''E'''levation, '''R'''abies risk

===[[Antibiotics]]===
{{Animal bite antibiotics}}

===[[Antivirals]]===
*Monkey Bites: [[Acyclovir]] or [[Valacyclovir]]
**Monkeys are carriers of Cercopithecine herpesvirus 1 aka Herpesvirus simiae aka B virus.
**Valacylovir — 1g PO q8hrs for 14 days or Acyclovir —800mg PO 5 times daily for 14 days

===[[Rabies]] prophylaxis===
*[[Rabies]] immune globulin should be inidividualized<ref>Human rabies—Washington, D.C., 1995. MMWR Morb Mortal Wkly Rep. 1995;44:625–7.</ref>
**Indicated for bites from bats, monkeys, skunks, raccoons, foxes. In the U.S. rare for dog and cat bites to contain rabies (however different rules apply for stray animal in areas with higher rabies incidence)
**CDC recommends that if possible, the animal be tested, or quarantined for 10 days monitoring to help with the decision to provide rabies prophylaxis

===[[Tetanus]] Prophylaxis===
IDSA suggests considering Tetanus Vaccination in patients whose last Vx was 10 years or more <ref> Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. 2014 Jul 15;59(2):e10-52, executive summary can be found in Clin Infect Dis 2014 Jul 15;59(2):147 </ref>

===Hand Bites===
*Consider hand surgeon consultation early for hand bite infections (see [[closed fist infection]])

===Extremity Wounds===
Keep involved extremity elevated.

==See Also==
*[[Laceration Repair]]
*[[Closed fist infection]]
*[[Herpes B virus]]
*[[EBQ:Antibiotic prophylaxis for mammalian bites]]

==Video==
{{#widget:YouTube|id=CJVh5_7nVwo}}

==References==
<references/>

[[Category:ID]]

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Mammalian bites