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Pediatric Infectious Diseases Division. Pediatric Residents International Track Seminar. Animal Bites By Hossam M. Al-Tatari, M.D. What are we going to talk about today?. Animal bites in U.S. How to manage an animal bite in general.

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pediatric residents international track seminar

Pediatric Infectious

Diseases Division

Pediatric Residents International Track Seminar

Animal Bites

By

Hossam M. Al-Tatari, M.D.

Hossam M.Al-Tatari, M.D.

what are we going to talk about today
What are we going to talk about today?
  • Animal bites in U.S.
  • How to manage an animal bite in general.
  • Some weared animal bite mainly for the international travelers
  • Actually……even for non travelers!!!

Hossam M.Al-Tatari, M.D.

introduction
Introduction
  • 1% of all visits to pediatric emergency centers
  • 4.7 million dog bites, 400 000 cat bites, and 250 000 human bites occur annually in the United States.
  • The incidence of infection
    • cat bites:50%
    • dog or human bites:15% to 20%

Hossam M.Al-Tatari, M.D.

etiologic agents
Etiologic agents
  • More than 50% are mixed.
  • CatsPasteurella multocida
  • DogsPasteurella Canis
  • HumansEikenella corrodens,Streptococcus pyogenes
  • HorsesActinobacillus species
  • FishHalomonas vensuta, Aeromonas hydrophilia, Psuedomonas species and Vibrio species.

Hossam M.Al-Tatari, M.D.

clinical approach
Clinical approach
  • Questions to be asked
    • Home pet or a wild animal?
    • Would the animal be available for observation over the next 10days?
    • Provoked or not?
    • How long ago was the bite?
    • Assess tetanus immunization status.
    • In case of human bite assess the risk of Hep B and HIV in the offender.
  • Careful exam: e.g.: Clenched-Fist injuries.

Hossam M.Al-Tatari, M.D.

laboratory testing
Laboratory testing
  • Wound cultures:
    • Both aerobic and anaerobic
    • Inform the lab
    • If the wound is contaminated with soil, consider Mycobacteria and fungal cultures
  • Blood cultures
  • Imaging

Hossam M.Al-Tatari, M.D.

management wound
Management, wound

Hossam M.Al-Tatari, M.D.

management wound1
Management, wound

Hossam M.Al-Tatari, M.D.

management wound2
Management, wound

Hossam M.Al-Tatari, M.D.

management wound3
Management, wound

Hossam M.Al-Tatari, M.D.

management wound4
Management, wound

Hossam M.Al-Tatari, M.D.

management antibiotics prophylaxis
Management, antibiotics prophylaxis
  • Indications for antibiotics prophylaxis:
    • Moderate or severe bite wounds, especially if edema or crush injury is present
    • Puncture wounds, especially if bone, tendon sheath, or joint penetration may have occurred
    • Facial bites
    • Hand and foot bites
    • Genital area bites
    • Wounds in immunocompromised and in asplenic persons

Hossam M.Al-Tatari, M.D.

management antibiotics prophylaxis1
Management, antibiotics prophylaxis

Hossam M.Al-Tatari, M.D.

management antibiotics prophylaxis2
Management, antibiotics prophylaxis

Hossam M.Al-Tatari, M.D.

management tetanus
Management, tetanus

Clean, minor wound All other wounds

Hossam M.Al-Tatari, M.D.

management tetanus1
Management, tetanus
  • Tetanus Immune Globulin (human) (TIG) :3000 to 6000 U IM for children and adults.
  • In tetanus neonatorum: smaller doses (as small as 500 U)
  • Some recommend infiltration around the wound. The efficacy has not been proven.
  • Where TIG is not available, equine tetanus antitoxin may be available. It is administered as a single dose of 50 000 to 100 000 U after testing for sensitivity.Part of this dose (20 000 U) should be given intravenously.
  • Intravenous Immune Globulin contains antibodies to tetanus and can be considered for treatment if TIG is not available.

Hossam M.Al-Tatari, M.D.

management rabies
Management, rabies

Hossam M.Al-Tatari, M.D.

management rabies1
Management, rabies
  • Passive post-exposure prophylaxis
    • Human RIG should be used concomitantly with the first dose of vaccine.
    • Dose of RIG is 20 IU/kg of body weight.
    • As much of the dose as possible should be used to infiltrate the wound(s). Dilute if needed for large wounds.
    • The remainder is given intramuscularly using a separate syringe and needle.
    • Vaccine should be administered in a different site.
  • Purified equine RIG or antisera containing rabies antibodies is available outside the United States

Hossam M.Al-Tatari, M.D.

management rabies2
Management, rabies
  • Active Immunization (Postexposure).
    • A 1.0-mL dose of any of the 3 vaccines is given intramuscularly in the deltoid area or anterolateral aspect of the thigh on the first day of post-exposure prophylaxis, and repeated doses are given on days 3, 7, 14, and 28 after the first dose.
    • An immunization series should be initiated and completed with 1 vaccine product.
    • Serologic testing to document seroconversion after administration is advised occasionally only for recipients who may be immunocompromised.

Hossam M.Al-Tatari, M.D.

complications
Complications
  • Cellulitis and soft tissue necrosis.
  • Pyogenic arthritis.
  • Osteomyelitis.
  • Septicemia.
  • Meningitis.
  • Brain abscess.

Hossam M.Al-Tatari, M.D.

slide21
Weared Bites

Hossam M.Al-Tatari, M.D.

snake bites
Snake bites
  • 45000 reported annually in US
  • Only 8000 are venomous
  • Toxins are species specific
    • Nuerotoxic: Death results from respiratory suppression
    • Cytolytic: Death results from hemorrhagic shock, adult respiratory distress syndrome or renal failure.
  • Antivenins should be administered within <4 hours when indicated and before the presence of any symptoms.
  • They pose a small but significant risk of immediate hypersensitivity reaction.

Hossam M.Al-Tatari, M.D.

alligator bites
Alligator bites

Hossam M.Al-Tatari, M.D.

alligator bites1
Alligator bites
  • Open thumb fracture resulting from an alligator bite became infected with Aeromonas hydrophila, Enterobacter agglomerans, and Citrobacter diversus.
  • Cultures obtained from the mouth of ten alligators !!!
  • Initial empiric therapy after alligator bites should be directed at gram-negative species,

Initial antibiotic therapy for alligator bites: characterization of the oral flora of Alligator mississippiensis.Flandry F, et alDepartment of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, La.

Hossam M.Al-Tatari, M.D.

alligator bites2
Alligator bites
  • 16 reported crocodile attacks in Northern Australia (1981-1991)
  • Four of these were fatal.
  • Most attacks resulted from swimming or wading in shallow water (13/16)
  • Half the victims were known to be affected by alcohol.
  • The majority of attacks occurred in failing light or at night (10/16).
  • Injuries in survivors ranged from minor lacerations and puncture wounds to major abdominal, chest and limb trauma.
  • Death in fatal attacks was caused by transection of the torso or decapitation.
  • Microorganisms isolated from wound swabs included Pseudomonas, Enterococcus, Aeromonas and Clostridium species.

Hossam M.Al-Tatari, M.D.

camel bites
Camel bites
  • In western countries are mostly inflicted by zoo or circus camels.
  • Highest risk during the mating season between December and March
  • Cause significant injuries by biting, throwing the victim, kicking in any direction (forward, sideways, and backwards), trampling, or squeezing with their whole body (weight, 450–690 kg) .
  • Nigeria: 32 patients with facial animal bites
    • Cows (n=14)
    • Camels (n=9)
    • Donkeys (n=6)
    • Dog (n=3)

Hossam M.Al-Tatari, M.D.

lion bites
Lion bites
  • Big cats attack at the nape of the neck. By Loefler IJ. in journal of trauma 1996.
    • Reviewed 20 cases of lion bites
    • “Wild cats” bite the neck
    • “Domestic large animals” bite the peripheral limbs
    • Main organisms are Pasteurella multocida and septica
  • In a case report from Kansas: the arm was found to be unsuitable for reimplantation because of the near complete soft tissue loss while in possession of the lion.

Hossam M.Al-Tatari, M.D.

lion bites1
Lion bites

Hossam M.Al-Tatari, M.D.