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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Bite Wounds

 - Discussion: (see: necrotizing fascitis )
      - human bite wounds
      - snake bite
             -  Bacteriology of rattlesnake venom and implications for therapy.
      - cat bite: (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;
             - prophylactic treatment: augmentin / amoxicillin or with allergy (cipro + clindamycin)
             - w/ estabilished infection: unasyn or with allergy  (cipro + clindamycin) or ceftriaxone 
             - references:
                    - Preliminary Communication: Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir.
                    - Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group.
                    - Bacteriology of human and animal bite wounds
                    - 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 trial of amoxicillin/clavulanic vs penicillin +/- dicloxacillin
                    - Case records of the Massachusetts General Hospital. Case 31-2010. A 29-year-old woman with fever after a cat bite.
                    - The management of bite wounds in children--A retrospective analysis at a level I trauma centre

       - dog bite: 
            - consider viridans strep, pasteurella multocida, bacteroides, fusobacterium, capnocytophaga; 
            - prophylactic treatment: augmentin / amoxicillin or with allergy (cipro + clindamycin)
            - w/ estabilished infection: unasyn or with allergy  (cipro + clindamycin) or ceftriaxone 
            - consider antirabies rx; rabies immune globin + vaccine; 
            - primary closure vs immediate closure:
                   - references:
                          - Dog-bite lacerations: a controlled trial of primary wound closure
                          - Primary closure versus non-closure of dog bite wounds. A randomised controlled trial
                          - Comparison of primary and delayed wound closure of dog-bite wounds
            - references:
                   - Dog bite wounds and infection: a prospective clinical study.
                   - Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group.
                   - Surgical-Wound Infection with Pasteurella multocida from Pet Dogs 
                   - Bacteriology of human and animal bite wounds
                   - 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 trial of amoxicillin/clavulanic versus penicillin +/- dicloxacillin
                   - The management of bite wounds in children-A retrospective analysis at a level I trauma centre

     - Brown Recluse Spider Bites
             - brown recluse spider is also know as loxoscelism;
             - can be up to 5 cm in length / 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. 

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

- 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)


Management of human and animal bite wounds.

Bacteriology of human and animal bite wounds.




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 19, 2013 5:05 pm