Bites
are extremely common and can cause significant pain and other
problems, especially when associated with an infection. Early
recognition of warning signs and appropriate treatment are key
in minimizing potential problems from the bite.
When
an animal bites, bacteria from its mouth can contaminate the
wound. These bacteria may grow within the wound and cause an
infection. The consequences of infection range from mild discomfort
to life-threatening complications.
Factors
that contribute to the infection of an animal bites:
-
Type
and location of the wound
-
Pre-existing
health conditions in the bitten person that impair immunity,
such as HIV, Diabetes, etc.
-
The
extent of delay before treatment
-
The
presence of a foreign body in the wound; and
-
The
animal causing the bite
Animal Bites
Animal
bites to the hand most frequently occur on the fingers of the
dominant hand of children between the ages of 5 and 14. Women
are bitten more frequently by cats, and men by dogs. Infections
occur more frequently in cat bites because cats have extremely
sharp, pointed teeth that can cause deep puncture wounds. The
skin usually flaps over the bite, thereby sealing off the puncture
wound, precluding open drainage and allowing an infection to
develop.
The
major concern of all bite wounds is subsequent infection. In
fact, a very small percentage of dog and cat bites requires
hospitalization. With swift and proper care, the prognosis is
usually very good for recovery from these injuries.
Rabies
is an extremely rare but fatal infection which may result from
an animal bite. The good thing you may do is to report animal
bites to your public health department. They may ask your assistance
in locating the animal so that it can be confined and observed
for symptoms of rabies.
Human Bites
Human
bite wounds contain very high concentrations of bacteria so
the risk of infection is high. These infections can progress
quickly and result in substantial complications, so early treatment
is necessary. Often, human bites occur when a person’s
fist is driven into another’s mouth, such as during a
fistfight. After the skin is broken, bacteria are seeded into
the soft tissue and the ‘knuckle’ joint, which if
left untreated often results in deep infection in the joint
which may ultimately destroy the joint. These problems can be
effectively treated by early diagnosis, intravenous antibiotics,
and surgery to drain the infection out of the joint and wash
it out.
Symptoms of Concern with Animal Bites to the Hand
If
the bite results in swelling, redness, warmth, continued pain
beyond 24 hours, pus draining from the bite wound, red streaks
extending up the arm or forearm, swollen lymph nodes (“glands”)
around the elbow or in the armpit, loss of mobility, loss of
sensation in the hand or fingertip, fever, malaise, night sweats,
or rigors, emergency treatment should be sought either in your
physician’s office or the emergency room.
Treatment
Your
doctor will examine the wound and ask about contributing factors
to the injury. A complete history of the bite, including the
type of animal and its status (general health, rabies vaccine,
behavior), the time and location of the event, circumstances
of the bite, whereabouts of the animal, and pre-hospital treatment
will be reviewed.
It
is crucial to update your tetanus status if you have not had
a booster shot within the past ten years.
X-rays
may be used to identify any damage to the bones and joints or
tooth fragments that may have broken off. If an infected bite
to the hand goes untreated for too long, x-rays may reveal evidence
of osteomyelitis, or the spread of infection to the bone.
Animal
bites to the hand require meticulous cleansing. Your doctor
or other medical personnel will wash the wound and might trim
away any devitalized (dead) tissue, damaged skin, blood clots,
or other particles that could be a source of infection. It is
important to look for signs of lymphangitis, indicated by the
presence of red streaks on the forearm. Your doctor will feel
the inner side of the elbow for evidence of enlarged lymph nodes.
When the wound is infected, a culture is obtained to identify
the type of bacteria that is causing the infection and thus
help determine the antibiotic that is most effective for treatment.
The
use of antibiotics for animal bites depends on the particular
circumstances of the injury, patient health and sensitivity
to various medications, and the appearance of the wound. Some
bites require the use of IV antibiotics, while others may be
treated with oral medication. The presence of an underlying
fracture usually dictates inpatient antibiotic treatment. If
you are diagnosed as having an infection of a flexor tendon
sheath or a joint, you will need hand surgery, which will need
to be performed as soon as possible.
Follow-up
care is crucial in the case of animal bite wounds, to ensure
that infection is diminishing or has not developed, and to restore
the hand as much as possible to its former condition.
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