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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.