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Flashcards in Bite Injuries Deck (10):

With bite injuries, what are the patient risk factors?

What are the associated infections?

Splenectomy, asplenic, cirrhosis - increased risk of Capnocytophaga (DF2)
Alcoholism, steroids, immunosuppression, RA, diabetes - increased risk of Pasteurella infection

Mastectomy, recent course of antibiotics


With bite injuries, what are the wound risk factors?

More than 6 hours old
Involvement of tendons, ligaments, joints
Hand bite


Which organisms are most commonly implicated with human bite wound infections?

What is the appropriate management?

Staph aureus
Strep viridans
Eikenella corrodens

I&D, IV antibiotics - eg ampicillin
5-7/7 PO Abx on discharge eg co-amoxiclav


What structures are most likely to be involved with dog bites, and cat bites?

Dog bites - most common bite
Crush and puncture injuries - structural damage to nerves, vessels, joints
Cat bites are the second most common bite injury, more likely to cause infection than dog bites
Penetrate joints and bones leading to septic arthritis or osteomyelitis


Pasteurella is most commonly implicated with cat and dog bites. What is its histological appearance?

What is the appropriate treatment?

Gram stain: gram negative, anaerobic, coccobacillus
With m. Blue - bipolar staining with safety pin appearance

Nb. Inform the lab of the potential of Pasteurella - 1 week to grow

Pasteurella canis, Pasteurella multocida, Pasteurella septica


When should rabies infection be considered?

What is the appropriate management?

Caused by a rhabdovirus
Rabies prophylaxis indicated with suspicion for rabid animal, strange behaviour, unprovoked

Human diploid cell vaccine and human rabies immunoglobulin


What is the initial management of any bite injury?

- irrigate with water/normal saline - if high risk of rabies, use povidone iodine solution
- remove foreign objects
- wound debridement
- delay closure of the wound
- if swelling, raise and immobilise
- consider prophylactic antibiotics
- if infected, wound swabs
- review in 24-48hours
- consider tetanus prophylaxis
- consider formal surgical debridement


What are the stages of the tetanus vaccination schedule?

8, 12 and 16 weeks - primary immunisation
3years and 4 months - booster
14 years - booster


In a bite injury, what tetanus treatment is needed, if any, if the patient has full immunisation, with or without complete boosters?

As long as up-to-date, no further treatment needed
Consider toxoid if high risk tetanus prone wound


In a bite injury, what tetanus treatment is needed, if any, if the patient has incomplete immunisation, with or without up-to-date boosters?

Single dose vaccine initially with further vaccinations to complete recommended schedule

If tetanus prone wound, single dose of human tetanus immunoglobulin to separate site (prophylactic dose IM 250IU, or 500IU if heavy contamination, burns or more than 24 hour delay to presentation)