Bites

Question 1

Main Considerations

Answer 1

• Penetrating injuries often involving vulnerable structures (i.e. hands)
• Altered microbiology of wounds

Question 2

Aetiology

Answer 2

• Staphylococci and streptococci still common
• Anaerobic organisms also common
• Pasteurella and capnocytophagia from mammal bites

Question 3

Signs & Symptoms

Answer 3

• Signs/symptoms include circumstances of animal bite, wound description, erythema, induration, fluctuance, purulent drainage, regional adenopathy and necrotic tissue.
• Risk factors include age <14 years, pet ownership and high-risk occupations.

Question 4

Investigations

Answer 4

• Wound cultures
  o Growth of pathogenic organisms
• X-ray
  o Bony injury

Question 5

Treatment

Answer 5

• Antibiotic treatment:
  o 1st line – Co-amoxiclav
  o 2nd line – Doxycycline and metronidazole
• Surgical treatment:
  o Need to consider early exploration and debridement of complications, i.e. tendon sheath infection
• Prophylactic treatment:
  o Antibiotics for high risk injuries
  o Consideration of tetanus prophylaxis
  o Rabies prophylaxis if rabies cannot be excluded – bat scratches/bites only in the UK

Question 6

Complications

Answer 6

• Deep structure damage
• Abscess formation
• Osteomyelitis
• Endocarditis
• Septic arthritis
• Sepsis

Question 7

Prevention & Prognosis

Answer 7

• Primary prevention
  o Animal control
  o Bite reporting
  o Public and owner never education (i.e. approach unfamiliar dogs)
• Prognosis
  o Dependent on wounds – minor have excellent recovery, more complicated can have higher morbidity although mortality is uncommon.