Clinical manifestations and initial management of animal and human bites
- Marvin Harper, MD
Marvin Harper, MD
- Associate Professor of Pediatrics
- Harvard Medical School
- Section Editor
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The evaluation and initial management of animal and human bites in children and adults will be discussed here.
The microbiology and infectious disease aspects of human, cat, and dog bites are covered in greater detail separately. (See "Soft tissue infections due to dog and cat bites" and "Soft tissue infections due to human bites".)
Animal bites are common worldwide and result in significant morbidity. In low- and middle-income countries, they are a significant source of rabies transmission . In the United States, there is an annual incidence of two to five million occurrences which account for about 1 percent of all visits to emergency departments [2-6]. More than one million victims of bites seek medical attention; medical costs for dog bites alone may be as much as USD $1 billion per year [7-9]. The vast majority of mammalian bites are inflicted by dogs (60 to 90 percent), with the remainder caused by cats (5 to 20 percent), rodents (2 to 3 percent), humans (2 to 3 percent), and rarely, other animals.
Approximately 10 percent of bite wounds presenting for medical attention require suturing and follow-up care, and 1 to 2 percent result in hospitalization [4,10-12]. Animal bites cause 20 to 35 deaths annually in the United States, primarily among infants and small children . Extensive morbidity, including disability and cosmetic damage, can also result from infection.
Epidemiology differs among dog, cat, and human bites:
- Animal bites fact sheet. 2013. World Health Organization http://www.who.int/mediacentre/factsheets/fs373/en/ (Accessed on August 05, 2015).
- Byrington CL, Basow RD. Streptobacillus moniliformis (rat-bite fever). In: Textbook of Pediatric Infectious Diseases, 6th, Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL. (Eds), Saunders, Philadelphia 2009. p.1788.
- Goldstein EJ. New horizons in the bacteriology, antimicrobial susceptibility and therapy of animal bite wounds. J Med Microbiol 1998; 47:95.
- Brook I. Human and animal bite infections. J Fam Pract 1989; 28:713.
- Wiley JF 2nd. Mammalian bites. Review of evaluation and management. Clin Pediatr (Phila) 1990; 29:283.
- Goldstein EJ. Management of human and animal bite wounds. J Am Acad Dermatol 1989; 21:1275.
- Oehler RL, Velez AP, Mizrachi M, et al. Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis 2009; 9:439.
- Quinlan KP, Sacks JJ. Hospitalizations for dog bite injuries. JAMA 1999; 281:232.
- Aziz H, Rhee P, Pandit V, et al. The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. J Trauma Acute Care Surg 2015; 78:641.
- Hodge D, Tecklenburg FW. Bites and stings. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Williams & Wilkins, Philadelphia 2006. p.1045.
- Fleisher GR. The management of bite wounds. N Engl J Med 1999; 340:138.
- Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999; 340:85.
- Schalamon J, Ainoedhofer H, Singer G, et al. Analysis of dog bites in children who are younger than 17 years. Pediatrics 2006; 117:e374.
- Garvey EM, Twitchell DK, Ragar R, et al. Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center. J Pediatr Surg 2015; 50:343.
- Patronek GJ, Slavinski SA. Animal bites. J Am Vet Med Assoc 2009; 234:336.
- Patrick GR, O'Rourke KM. Dog and cat bites: epidemiologic analyses suggest different prevention strategies. Public Health Rep 1998; 113:252.
- Kennedy SA, Stoll LE, Lauder AS. Human and other mammalian bite injuries of the hand: evaluation and management. J Am Acad Orthop Surg 2015; 23:47.
- Daniels DM, Ritzi RB, O'Neil J, Scherer LR. Analysis of nonfatal dog bites in children. J Trauma 2009; 66:S17.
- Goldstein EJ. Bite wounds and infection. Clin Infect Dis 1992; 14:633.
- De Munnynck K, Van de Voorde W. Forensic approach of fatal dog attacks: a case report and literature review. Int J Legal Med 2002; 116:295.
- Brogan TV, Bratton SL, Dowd MD, Hegenbarth MA. Severe dog bites in children. Pediatrics 1995; 96:947.
- Chodakewitz J, Bia FJ. Septic arthritis and osteomyelitis from a cat bite. Yale J Biol Med 1988; 61:513.
- Schweich P, Fleisher G. Human bites in children. Pediatr Emerg Care 1985; 1:51.
- Tsokos M. Diagnostic criteria for cutaneous injuries in child abuse: classification, findings, and interpretation. Forensic Sci Med Pathol 2015; 11:235.
- Moran GJ, Talan DA. Hand infections. Emerg Med Clin North Am 1993; 11:601.
- Phair IC, Quinton DN. Clenched fist human bite injuries. J Hand Surg Br 1989; 14:86.
- Jaindl M, Grünauer J, Platzer P, et al. The management of bite wounds in children--a retrospective analysis at a level I trauma centre. Injury 2012; 43:2117.
- Boenning DA, Fleisher GR, Campos JM. Dog bites in children: epidemiology, microbiology, and penicillin prophylactic therapy. Am J Emerg Med 1983; 1:17.
- Callaham M. Prophylactic antibiotics in common dog bite wounds: a controlled study. Ann Emerg Med 1980; 9:410.
- Sutton LN, Alpert G. Brain abscess following cranial dog bite. Clin Pediatr (Phila) 1984; 23:580.
- Klein DM, Cohen ME. Pasteurella multocida brain abscess following perforating cranial dog bite. J Pediatr 1978; 92:588.
- Iannelli A, Lupi G. Penetrating brain injuries from a dog bite in an infant. Pediatr Neurosurg 2005; 41:41.
- Faciszewski T, Coleman DA. Human bite wounds. Hand Clin 1989; 5:561.
- Kannikeswaran N, Kamat D. Mammalian bites. Clin Pediatr (Phila) 2009; 48:145.
- Maimaris C, Quinton DN. Dog-bite lacerations: a controlled trial of primary wound closure. Arch Emerg Med 1988; 5:156.
- Chen E, Hornig S, Shepherd SM, Hollander JE. Primary closure of mammalian bites. Acad Emerg Med 2000; 7:157.
- Wu PS, Beres A, Tashjian DB, Moriarty KP. Primary repair of facial dog bite injuries in children. Pediatr Emerg Care 2011; 27:801.
- Muguti GI, Dixon MS. Tetanus following human bite. Br J Plast Surg 1992; 45:614.
- Rabies. Epidemiology and burden of disease. World Health Organization. http://www.who.int/rabies/epidemiology/en/ (Accessed on February 07, 2017).
- Havens PL, American Academy of Pediatrics Committee on Pediatric AIDS. Postexposure prophylaxis in children and adolescents for nonoccupational exposure to human immunodeficiency virus. Pediatrics 2003; 111:1475.
- Lohiya GS, Tan-Figueroa L, Lohiya S, Lohiya S. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm. J Natl Med Assoc 2013; 105:92.
- Snyder CC. Animal bite wounds. Hand Clin 1989; 5:571.
- Freer L. Bites and injuries inflicted by wild and domestic animals. In: Wildnerness Medicine, 5th, Auerbach PS. (Ed), Mosby Elsevier, Philadelphia 2007. p.1133.
- Flandry F, Lisecki EJ, Domingue GJ, et al. Initial antibiotic therapy for alligator bites: characterization of the oral flora of Alligator mississippiensis. South Med J 1989; 82:262.
- Kelsey J, Ehrlich M, Henderson SO. Exotic reptile bites. Am J Emerg Med 1997; 15:536.
- Pavia AT, Bryan JA, Maher KL, et al. Vibrio carchariae infection after a shark bite. Ann Intern Med 1989; 111:85.
- Peters V, Sottiaux M, Appelboom J, Kahn A. Posttraumatic stress disorder after dog bites in children. J Pediatr 2004; 144:121.
- Richman KM, Rickman LS. The potential for transmission of human immunodeficiency virus through human bites. J Acquir Immune Defic Syndr 1993; 6:402.
- CLINICAL MANIFESTATIONS
- Dog bites
- Cat bites
- Human bites
- Infected wound
- ANCILLARY STUDIES
- Laboratory studies
- Wound culture
- Plain radiographs and ultrasound
- Head computed tomography
- INITIAL MANAGEMENT
- Wound preparation
- - Puncture wounds
- Primary closure
- - Risk of infection
- - Delayed primary closure
- - Surgical consultation
- Antibiotic prophylaxis
- Tetanus and rabies prophylaxis
- Viral prophylaxis after human bites
- INFECTED BITES
- UNUSUAL ANIMAL BITES
- FOLLOW-UP CARE
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS