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Infectious Complications
of
Bite
By Arash Nematollahi
HARRISON 19th Edition
CHAPTER 167e
Contents
• Dog Bites
• Cat Bites
• Other Animals
• Human Bites
• Treatment
Introduction
Skin’s Nonspecific Immunity
An Immunocompromise
Inoculation
300 bites per 100’000 population
Few may be life threatening
Mostly the Oropharyngeal flora
Dog Bites
80% of All Animal Bites
15 to 20% become Infected
More Prevalent in Children
8 to 24 Hour After
Pain & Cellulitis
by
purulent
and sometimes
foul-smelling discharge
Septic Arthritis & Osteomyelitis
Systemic Manifestations:
• Fever
• Lymphadenopahty
• Lymphangitis
Systemic Infections
like Bactremeia, meningitis, Brain Abscess
Or Endocarditis & Chorioamnionitis
Edema or reduced Lymphatic Drainage
Immunocompromised
Capnocytophaga canimorsus
Fulminant Sepsis, Disseminated Intravascular Coagulation
& Renal Failure
Diagnonsis:
Peripheral Blood
Culture in Liquid Media
Thin gram-negative rod
Cat Bites
Bites & Scratches
50% Infectious
Teeth Penetrate Deeply
Over or Near a Joint
Pasteurella multocida
Pasteurealla Infections
Advance Rapidly
Within hours
Severe Inflammation
Purulent Discharge
Repiratory Droplets
Bartonella henselae
Cat-scratch Disease
swollen lymph nodes, fever
headache, fatigue, and loss of appetite
Rabies
Tularemia
Tetanus
Other Animal Bites
Occupational :
• Farmers, Laboratory Workers, Veterinarians
Recreational :
• Hunters, Trappers, Wilderness Campers &…
Oral Flora of the Biting Animal
Aquatic Animals
Alligators
Aeromonas hydrophila
Venomous SnakeBites
Severe inflammatory response
Tissue Necrosis
Prone to Infection
Many aerobes & Anaerobes
As Pseudomonas
Small Rodents
Rats, Mice & Gerbils
Streptobacillus
moniliformis
 Microaerophil, gram-negative rod
 Common in United States
 3-10 days Incubation period
 Severe migratory arthralgias,
 Fever, Chills, Myalgias &
Headache
 Maculopapular Rash
 Complications
Spirillum minor
 Spirochete
 more Common in Asia
 Both cause Rat-bite Fever
 Initial Infection has healed
 Pain & Purple Swelling
 1-4 Weeks Incubation period
 Fever, Chills, Headache
Human Bites
Self-inflicted, Medical Personnel, Fights, Domestic
Abuse or Sexual Activity
More frequently become Infected
Diverse Microflora of humans
Multiple Aerobic & Anaerobic
E. Corrodens Clenched-fist Injury
Many Produce beta-lactamase
Occlusional vs Clenched-fist
• Fight Bites result in
Serious Infection
• Deep spaces including
Bone, tendons, joints
frequently inoculated
• Tendons Retraction
• Medical attention
sought late
TREATMENT
Wound Closure is
Controversial
Irrigation
Removing Foregin body
Debride dead tissue
Approximate wound edges
Puncture Wounds Must not
Be Sutured
Suture Facial wounds
Antibiotic Therapy
• Dog and Cat Bites:
• S. aureus, Pasteurella species, c. canimorsus, streptococci, and Oral
anaerobes
• Human Bites:
• S. aureus, H. influenzae, beta-lactamase positive oral anaerobes
• Most reliable coverage:
• An extended-spectrum penicillin with a beta-lactamase Inhibitor
• Second Generation Cephalosporins as Cefuroxime
• Hypersensitivity: Clindamycin plus TMP-SMX or a fluoroquinolone
• For a period of generally 10-14 days
The End

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Infectious complications of bites