Bite Wounds

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- See: Necrotizing Fascitis

- Human Bite Wounds:
    - clenched fist injury:
    - infections of the hand
          - bacteriology of hand infections:
          - bites distal to the wrist are at higher risk for malignant infections due to the proximity of superficial spaces, flexor tendons, and joints; 
          - besides considering tetatnus also consider Hep B.

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- Snake Bite:

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Cat: (see cat scratch disease)
   - consider pasteurella multocida;
   - note P. multocida infection develops within 24hrs;
   - with bites on the finger observe for osteomyelitis;
   - may transmit tularemia and rabies;
   - rx: penicillin V (DOC); or try ceftriaxone or tetracycline;
   - references:
          - Preliminary Communication: Rochalimaea henselae Infection: A New Zoonosis With the Domestic Cat as Reservoir.
          - Bacteriologic Analysis of Infected Dog and Cat Bites

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- Dog Bite:
    - consider viridans strep, pasteurella multocida, bacteroides, fusobacterium, capnocytophaga;
    - penicillin V or ampillin: or trytetracycline or amoxicillin clavulanate, or ceftriaxone;
    - consider antirabies rx; rabies immune globin + vaccine;
    - references:
          - Dog-bite lacerations: a controlled trial of primary wound closure.
          - Dog bite wounds and infection: a prospective clinical study.
          - Bacteriologic Analysis of Infected Dog and Cat Bites
          - Surgical-Wound Infection with Pasteurella multocida from Pet Dogs

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-Brown Recluse Spider Bites
     - brown recluse spider is also know as loxoscelism;
     - can be upto 5 cm in length;
     - has 3 pairs of eyes as opposed to 4 pairs of eyes;
     - characteristically has a violin shaped mark on its cephalothorax;
     - bite often results in full thickness skin loss;
           - magnitude of tissue injury depends on the amount of venom injected and on the patient's immune status;
     - surrounding erythema may spread quickly (adjacent pallor and cyanosis is common);
           - non healing ulcer with red, white, and blue phenomenon (erythema, ischemia, and cyanosis)
     - untreated, lesion can take more than one month to heal;
     - diff dx: pyoderma gangrensum:
     - treatment:
           - treatment with dapsone and antibiotics may reduced the prevalence of secondary infections as well as the need for surgery;
     - references:
           - Brown recluse spider bites. A comparison of early surgical excision versus dapsone and delayed surgical excision.
           - The diagnosis and treatment of brown recluse spider bites.
           - Spider bites
           - The brown recluse spider bite.

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- Rat:
     - streptobacillus moniliformis;
     - try ampicillin or tetracycline; antirabies Rx not indicated;

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- Bat, Racoon, Skunk:
     - rx ampicillin or tetracycline;
     - in americas, antirabies Rx indicated, rabies immune globin + vaccine;

- Rabies:
    - animals at high risk for rabies: bats, cats, cattle, coyotes, dogs, foxes, skunks, racoons;
    - CDC web site (888 CDC FACTS)

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Management of human and animal bite wounds.

Hand infections. Bacteriology and treatment: a prospective study.

Human bites in children. A six-year experience.

A comparative double blind study of amoxycillin/clavulanate vs placebo in the prevention of infection after animal bites.

Outpatient therapy of bite wounds. Demographic data, bacteriology, and a prospective, randomized trial of amoxicillin/clavulanic acid versus penicillin +/- dicloxacillin.

Bacteriology of rattlesnake venom and implications for therapy.

Bacteriology of human and animal bite wounds.

Human bites of the hand: twenty years of experience.

Osteomyelitis of the hand after a human bite.

A functional treatment method for IP pyogenic arthritis.
    N Wittels et al.   J. Hand Surgery. Vol 9-A. 1984. p 894-898.

Bacteriologic Analysis of Infected Dog and Cat Bites.