Complaints about the bite wounds are fairly common in outpatient surgical practice. Bite wounds are usually contaminated by various microorganisms, which can lead to infection and, in the absence of medical care, the development of complications such as local abscess, osteomyelitis, septic arthritis, meningitis, abscess and sepsis deleted. Infection is the most difficult in patients with immunodeficiency.

 

The following are the main characteristics of the wounds caused by the bites of various mammals.

 

wounds after being bitten a person can occur when physical violence (eg, damaged skin with his teeth when struck in the jaw), and during sexual contact (so-called "love bites"). The bites are localized mainly on the fingers or hands, at least in the neck, chest and genitals. About 30% of abrasions on the hand caused by a blow on the teeth, accompanied by a deep injury and infection ligaments and bones, especially with late (within 24 h), seeking medical help. Bacteria contaminating the wound, are streptococci, Staphylococcus aureus, Homophiles spp., Fusobacterium spp., Bacteroids and other anaerobes, and Eikenella corrodens. Infection with viruses such as hepatitis B virus, hepatitis C and HIV, there is much less.

 

after dog bite wounds contaminated with oral microflora of these animals, usually including pathogens such as Pasteurella spp., Streptococci, staphylococci, anaerobes, and in 2-30% of cases are accompanied by the emergence of infection. Capnocytophaga canimorsus, gram-negative bacillus, sometimes contaminating the dog (and cat) bites can lead to the rapid development of potentially lethal septic syndrome, especially in immunocompromised individuals. By the bite of a wandering dog must be aware of the possibility of rabies.

 

Cat bites are most often represented stab wounds, making them difficult to process. Lesions are located mainly on the hands and forearms, and two thirds of cases are accompanied by the development of infection. Approximately 75% of infections caused by members of Pasteurella spp., Among other pathogens - a broad spectrum of aerobic and anaerobic microorganisms. Cat scratch disease can occur at the site caused by cat or dog bites or scratches. The infection is caused by Bartonella henselae and manifests the appearance of erythematous papules (usually 3-10 days after injury), and regional lymphadenitis obscheinfektsionnoy symptoms. The disease is allowed after 2 months, however, in some cases may be complicated by pneumonia, encephalitis, or hepatitis, are rarely pathology of the vision.

 

Bites of small rodents such as mice, rats, hamsters and guinea pigs can be contaminated with a variety of microorganisms, including representatives of Pasteurella spp. and Streptobacillus moniliformis (causes "fever Rat bite '). Bite proteins could conceivably lead to infection with fever or tularemia.

 

bites horses, donkeys, pigs and sheep can be infected by representatives Acinetobacillus spp., Pasteurella spp., Staphylococci, streptococci and anaerobic bacteria. Ferret bites contaminated with Staphylococcus aureus. With the bite of bats is transmitted rabies. Camel bites lead to infection with members of Pseudomonas spp., Staphylococci and streptococci, and Clostridium tetani. Bites from infected monkeys mainly bacteroids, fuzobakterii, staphylococcus, streptococcus and E.sorrodens. With the bite of macaques can be transmitted herpes virus B (Herpesvirus simiae), leading to the development of rapidly progressive encephalomyelitis, in which the mortality rate reaches 70%.

 

In the primary treatment is medical history (when they bite and animal species), samples taken for bacteriological examination and initial debridement. In the presence of systemic signs of infection is also carried out blood sampling to detect aerobic and anaerobic pathogens. If contamination of wounds by soil, plant fragments, or water from ponds, lakes, aquariums, as well as in patients with immunodeficiency performed bacteriological tests for mycobacteria and fungi. When a man bites should also be screened for infection with hepatitis B and HIV. Other clinical and instrumental examinations are performed according to indications (such as radiography or ultrasonography for suspected involvement in the process of bones, joints or the presence of a foreign body in the wound).

 

Treatment consists of washing the wound with saline or water at the shallow damage is possible to use an antiseptic (hydrogen peroxide or povidone iodine). Suturing of wounds is recommended for fresh (less than 6 hours), presumably not infected processes, as well as for cosmetic purposes (face). Delayed wound closure (3-5 days) are used for biting a prescription 6-8 hours, localized in the limbs and associated with crushing tissue.

 

Indications for hospitalization include fever, sepsis, progressive cellulitis, edema, or tissue damage, loss of limb function, the patient's immunodeficiency, and infection threatening infections (eg, Herpesvirus simiae), in which patients should be kept in quarantine. [ / bbp]  

Appointment of prophylactic antibiotic therapy is indicated in bites man, cat or dog bite complications, as well as the localization process in the limbs, genitals and face, severe injury, involving in pathological process of bone and joint or localized near the bite prosthetic joint and in patients with immunodeficiency states of various origins.

 

antibiotic selection is conducted on the basis of bacteriological examination. Prior to receiving the results the drug of choice is amoxicillin / clavulanate (625 mg 3 times daily for adults). If you are allergic to penicillin can assign metronidazole in combination with doxycycline bites dogs and cats. Human bites also can be used metronidazole in combination with erythromycin, but preferred is the use of ciprofloxacin in combination with clindamycin. In severe nature of infection antibiotics are administered intravenously, the duration of therapy depends on clinical dynamics.

 

Prophylactic antiviral therapy (hepatitis B, HIV, rabies, and Herpesvirus simiae) is carried out at the possibility of infection is suspected, according to standard schemes. Preventing tetanus (tetanus vaccine and tetanus immune globulin) is conducted in the absence of the patient confirmed the immunological history (ie, data and timing of planned immunization tetanus). If there is risk of contracting hepatitis or HIV patient monitoring should continue for at least 3 months.

 

Managing bites from humans and other mammals.

 

DTB 2004; 42 (9): 67-70.

 

Keywords: bite wounds, antibiotic