Bites of man and animals

In the United States, as a result of animal and insect bites, about 100 people die each year, in addition,> 90,000 cases of poisoning centers are registered, and many cases are not registered at all. All affected by insect and animal bites need tetanus prophylaxis.

The most common bites of humans and mammals (mainly bites of dogs and cats, also possible bites of squirrels, gerbils, guinea pigs and monkeys), they can cause serious functional disorders. The brush, limb and face are most often affected by bites, sometimes the chest and external genitalia suffer.

In addition to the actual injury of tissues, it is very dangerous for them to become infected with the microflora of the oral cavity biting. Human bites can theoretically transmit viral hepatitis and human immunodeficiency virus (HIV). Brush bites are associated with a higher risk of infections, especially cellulite, tenosynovitis, septic arthritis and osteomyelitis, compared to other parts of the body. This risk is especially high with human bites, resulting from a direct blow with a clenched fist in the mouth ("combat bite"). Bites of a person in other parts of the body carry less risk of infection than bites of other mammals.

Rabies is considered in the relevant article.

[1], [2], [3], [4]

Diagnosis of human and animal bites

Bite wounds are examined to exclude damage to nearby structures (for example, nerves, vessels, tendons, bones) and detection of foreign bodies. The wound inspection should be focused on a careful determination of the dysfunction and prevalence of the bite. Wounds over the joints or near the joints should be examined at the extreme positions of the joint movements (for example, with a clenched fist) and under sterile conditions to detect damage to the tendons, bones, structural elements of the joint and foreign bodies. Sowing a fresh wound is not important for the selection of antibacterial therapy, but seeding from an infected wound is necessary. A screening study of a person who has been bitten by a person on viral hepatitis and HIV is appropriate only if it is known that the attacker is seropositive or if there are grounds for suspicion.

[5], [6], [7], [8], [9], [10]

Treatment of human and animal bites

Hospitalization is indicated if infection or ugrata functions at admission are obvious, with deep wounds or the threat of damage to nearby structures and when the probability of self-closure of the wound is questionable. Priorities for treatment include cleansing, treatment, wound closure and infection prevention.

Wound care

First of all, the wound should be washed with a mild antibacterial soap and water (allowable washing with unsterile water), then sprinkle a large amount of 0.9% sodium chloride solution with a syringe and an intravenous catheter. You can also use a diluted solution of povidone-iodine (10: 1 with 0.9% saline), but irrigation with 0.9% sodium chloride solution cleans the wound better. If necessary, you can use a local anesthetic. Dead and nonviable tissues are removed.

Ways to close wounds are diverse. Many wounds are best left open at first, including the following:

• point wounds;
• wounds of the hand, foot, perineum, or genitals;
• wounds inflicted more than a few hours ago;
• heavily soiled, obviously swollen, with signs of inflammation or damage to nearby structures (eg, tendon, cartilage, bone);
• wounds from a man bite;
• Wounds that had contact with the polluting environment (for example, seawater, field, sewage system).

In addition, wound healing in immunocompromised patients is better at late closure. Other wounds (for example, fresh, torn) can usually be closed after appropriate treatment. If there are doubts, it should be borne in mind that the results of delayed primary closure are slightly different from those in the initial closure, which means that leaving the wound open, we do not lose anything.

When biting the brush should be applied a sterile gauze bandage, immobilize in a functional position (easy extension of the wrist, flexion in the metacarpophalangeal and interphalangeal joints) and constantly keep in an elevated position. With bites of cosmetically significant and inclined to the scarring of the face, a recovery operation may be required.

Prevention of infection

To prevent infection in most cases, a careful wound toilet is enough. Regarding the indications for antibiotic therapy, there is no consensus. Drugs do not prevent the occurrence of infection in highly contaminated or improperly treated wounds, but many doctors prescribe antibiotics prophylactically with hand bites and with some other localizations. When bitten by dogs and a person for prevention and treatment, amoxicillin-lin + [clavulanic acid] is preferred 500-875 mg orally 2 times a day for 3 days (prophylaxis) or 5-7 days (treatment) for outpatients. For stationary patients, a valid empirical choice is ampicillin + [sulbactam] 1.5-3 g every 6 hours; it covers a-haemolytic streptococci, Staphylococcus aureus Eikenella corrodens, microorganisms most frequently sown by human bites, and various species of Pasteurella (P. Canis P. Multocida) and Capnocytophaga canimorsus, which are found when bitten by dogs. In the case of bites, cats are recommended for prevention and treatment of fluoroquinolones (eg, ciprofloxacin 500 mg orally for 5-7 days) due to the presence of P. Multocida. (Bartonella henselae is also transmitted through the bites of cats.) Alternative medications for patients with penicillin allergy may be clarithromycin 500 mg orally for 7-10 days or clindamycin 150-300 mg orally for 7-10 days. Bites of squirrels, gerbils, rabbits and guinea pigs lead to infection less often, but are subject to treatment similar to biting of cats.

The testimony to the prevention of viral hepatitis and HIV depends on the serological status of the victim and the attacker.

Infected Wounds

In case of infection, antibiotics are first prescribed empirically, depending on the characteristics of the bite, see above. Further treatment is based on the results of sowing from the wound. Wound sanitation, suturing, wetting and intravenous administration of antibiotics depend on the specificity of the infection and the clinical picture. Joint infection and osteomyelitis may require prolonged intravenous administration of antibiotics and orthopedic consultation.

Bites of monkeys (in the USA are found mainly among the employees of the vivariums) are associated with a low probability of a viral infection of the herpesvirus simiae, which causes vesicular lesions of the skin on the side of the bite. However, with these bites, the development of encephalitis is possible, often with a fatal outcome. Treatment is carried out by intravenous injection of acyclovir.