Animal Bite

Introduction
Most bites are by cats and dogs.

70-80% of bites are on the limbs, 10-30% on the head and neck.

There is a high risk of infection in patients with asplenia, hepatic cirrhosis, diabetes mellites, immune
deficiency, and implants (prosthetic joint or heart valve)

Infected bites
Signs and symptoms of infection can manifest within hours to days after the initial injury:

 pain, erythema, and swelling of the affected area.

 Purulent drainage may or may not be present
 Lymphadenitis or lymphangitis may occur.
 Cellulitis (streptococci, staphylococci and Pasteurella)
 Osteomyelitis, tenosynovitis, tendinitis, orbital cellulitis, or brain abscess can also be seen.

Clinical manifestation
Classification of severity of bite wounds

Grade 1

 Superficial skin lesion

 Torn skin
 Scratched skin
 Crush injury

Grade 2

 Wound extending from the skin to the fascia, muscle or cartilage.

Grade 3

 Wound with tissue necrosis or tissue loss

Dog bites
Range of injuries

 Scratches
 Deep open cuts
 puncture wounds
 crush injuries
 tearing away of body parts

Dogs because of their rounded teeth and strong jaws, typically cause crush injuries when they bite.

Pasteurella species is the most common organism isolated from both cat and dog breed.
Cat bites:
Common in adult women on the extremities.

Cats can cause wounds with their teeth or claws

Scratches typically occur on the upper extremities or face

Puncture wounds affect the hands or extremities.

Cat bites are more likely to penetrate deeply causing deep abscesses and osteomyelitis, leaving only
a small opening from which fluids can drain.

Human bites:
More serious than bites than bites from domestic animals due to location of the bite, and potential
bacteria inoculated in the wound.

Staphylococcal, streptococcal, gram-negative rods and eikenella corrodens anaerobes are the most
common pathogens; the patient is also at risk of HIV and hepatitis B.

These bites can be categorized as

 Clenched fist injuries (‘fight bites”): result from the impact of the hand against the teeth
during a fight
 Occlusive bite injuries: which are caused by the teeth closing directly on tissue; seen as the
result of sexual crimes, child abuse, self-defence or consensual sexual activity.
Approach to animal bites:

Management:
Wound toilet:
The effected skin surface should be cleaned and the wound should be copiously irrigated with at
least 250ml of normal saline, 20 ml syringe should be used to generate the high pressure required for
adequate cleaning

Cautious debridement:
Should be done.

The wound should be carefully explored for tendon or bone involvement and foreign body.

Investigations:
Obtain a wound culture if there is a infected would with signs of severe cellulitis, abscess, devitalized
tissue or sepsis

Based on clinical suspicion also obtain a radiographic image to rule out a foreign body or fracture.

Early primary closure:

Of the wound of face and neck is advised.

However, allowing a wound to close by secondary closure should be considered if there is high risk of
infection such as wound to the hand.

Antibiotic prophylaxis:
Vaccination:
For all animal bite wounds, rabies and tetanus prophylaxis should be considered.

Rabies vaccination is given at days 0, 3, 7, 14.

Snake bites:
Snake bites are accounted for significant morbidity and mortality especially in south and south east
Asia

Snakes in Pakistan

 Home to 4 types of venomous snakes:

o Cobras
o Kraits
o Soft scaled vipers
o Russell’s viper

Prevalent in Sindh and Punjab province

Snake bites cause tissue destruction and subsequent morbidity by injecting toxic venoms which can
be either locally acting or systemically acting.
Types of toxins:

Management of snake bites:

Immediate:
Immobilization (splint the limb to keep it still)

Quick transport to a hospital

Stabilize the patient with large bore iv access, hydration, tetanus prophylaxis, broad spectrum
antibiotics and compartment pressure monitoring.

Access to an antivenom for systemic symptoms is the most important treatment option for survival
and therefore immediate transfer to a hospital is critically important.

Antivenom:
Primary treatment

Monitoring antivenom response: lack of response indicates inadequate of antivenom injected and
the use of wrong antivenom.

Anti-snake venom serum is a sterile preparation containing purified and concentrated

immunoglobulins against the haemostasis toxins, manufactured by the national institute of health
Islamabad, Pakistan.

Contraindication: previous allergic reaction, patient with asthma, patient received alpha blockers
or ACE inhibitors have a high risk of allergic reaction

Rat bites:
Among all the rodent’s species all over the world, rats are the most troublesome o humans.

Not only do they contaminate food, but they also transmit parasite that cause diseases

Diseases caused by rat bites:

 Tularaemia
 Rat bite fever
 Plague
 Salmonellosis
 Leptospirosis
 Lassa fever

Management:
Wound wash

Tetanus vaccine (rabies vaccine is NOT recommended in rat bite)

Oral antibiotics.

Summary:
Animal bites can have a variable presentation

Cat bites are more likely to penetrate deeply, cause deep abscess and osteomyelitis

Human bites are more serious than animal bites due to risk of serious bacteraemia

Take home:
universal vaccination of pets.