Animals bite

1. Animals bite Inson Lou

2. Overview About half of all persons will incur an animal bite sometime in their life. Not all bite wounds need medical attention, but severe bite wounds and those at high risk of infection are frequent reasons for emergency department visits.

3. Epidemiology Common bacteria Management

4. Epidemiology - Dog Dogs are responsible for more than 80% of animal bite wounds The peak incidence is between 5 and 9 years of age Their own pet Most often on the extremities. Facial bites

5. Epidemiology - Dog 4% to 25% of dog bite wounds become infected The median time from bite to appearance of first symptoms of infection is 24 hours

6. Epidemiology Cat bites more commonly in women, 30% to 50% of cat bite injuries become infected, appearance of first symptoms of infection is 12 hours Human bites occur during fights command become infected Other animal bites

7. Common bacteria- cat & dog Aerobic?? and anaerobic?? bacteria Pasteurella species - facultatively?? anaerobic, gram-negative coccoobacilli??? rods??, 50% to 75% of cat bites and 20% to 50% of dog bites Streptococci, staphylococci, and Moraxella, Corynebacterium, and Neisseria species, Bergeyella zoohelcum, Capnocytophaga species Fusobacterium???, Porphyromonas??

8. Common bacteria - human S aureus, Staphylococcus epidermidis, viridans streptococci, Eikenella corrodens, Haemophilus influenzae, and beta-lactamase-producing anaerobic bacteria

9. Management Irrigation?? and debridement?? -initially cleaned with soap and water Irrigated with normal saline under high pressure Necrotic tissue should be debrided.

10. Management - antibiotic moderate to severe wounds high risk of infection � on the hand, head, neck, or genital region puncture wounds, crush injuries injuries in which a deeper structure -bone or joint patients with specific conditions (eg, diabetes, liver disease) bite wounds that require surgical repair from a human or cat. immunocompromising immunocompromising

11. Management - antibiotic Cat/dog should be directed against Pasteurella, Streptococcus, Staphylococcus and anaerobes For human bites, antibiotic coverage should be directed against Streptococcus and Staphylococcus species, anaerobes, and E corrodens.

12. Management - antibiotic Augmentin 875/125 mg PO bid or 500/125 mg PO tid Doxycycline in patients allergic to penicillin

13. Management Rabies and tetanus consideration of tetanus and rabies prophylaxis Rabies - not common in macau Tetanus - dependent on the wound classification and immunization status of the patient

14. Summary Animal and human bites are common. Basic bite wound care should be performed, including cleansing and irrigation of the wound. A good understanding of bite wound bacteriology and the situations in which antibiotics may be indicated is important. Rabies and tetanus prophylaxis should be considered and appropriate follow-up care ensured.