0071643192.pdf

BITES AND STINGS

A 31-year-old male presents to the ED for evaluation of hand pain after

an altercation outside a bar. On examination there is pain, swelling,

and a laceration present at the fifth metacarpal joint. The extensor ten-

don sheath is visible through the wound. What is the risk if this injury is left

untreated?

This patient has sustained a “fight bite” or closed-fist injury from striking a

person’s tooth with a closed fist. If left untreated, tenosynovitis, osteomyelitis,

and septic arthritis can occur, requiring surgical intervention.

Mammalian Bites

The vast majority of mammalian bite wounds seen in the ED are due to domes-
ticated animals. Infecting organisms vary with species (see Table 13.1).

WOUNDSWITHINCREASEDRISK OFINFECTION(HIGH-RISKWOUNDS):

■ Puncture wounds
■ Intraoral, hand, below knee, or joint area bites
■ Cat bites > human bites > dog bites
■ Immunocompromised (eg, asplenic, alcoholic) or elderly patient
■ Presence of peripheral vascular disease or prosthetic valve
■ Delayed presentations

ENVIRONMENTAL EMERGENCIES

TABLE 13.1. Common Infecting Organisms in Mammalian Bites

Cat Pasteurella multocida

Staphylococcus aureus

Dog S. aureus

P. multocida

Bacteroidessp.

Fusobacteriumsp.

Capnocytophaga canimorsus

Human Polymicrobial

Viridans streptococcus

Staphylococcus

Bacteroidessp.

Corynebacteriumsp.

Eikenella corrodens

Rodent Streptobacillus moniliformis

Spirillum minus

Other transmitted diseases:

Leptospirosis

Tularemia

Sporotrichosis

Plague