Complications
Bite wounds do not usually allow visualisation by simple inspection to determine damage to deeper structures. Suspicion merits referral for exploration (e.g., pain on resisted movement may indicate partial tendon rupture).
Complicated or extensive wounds identified by physical examination with or without radiography need surgical specialist management.
Complications from these complex wounds are specific to the type of injury and subsequent management.
Inoculation of organisms can cause local infection and abscess formation. These may be deep and difficult to determine clinically. Ultrasound can be a useful modality if there is clinical doubt.
Hospital admission for parenteral therapy should be considered especially for patients with severe underlying illnesses or immunocompromising conditions. Empirical antibiotic choice is based on bacteriology of bite wounds and should be active against Pasteurella, Streptococcus, and Staphylococcus as well as anaerobes. No single agent covers all possible organisms. Antibiotics are started once prophylaxis is deemed necessary, or on clinical diagnosis after wound cultures have been obtained and the wound has been debrided.
No standard guidelines exist for length of therapy. In general, prophylactic therapy is given for 5 to 7 days and treatment of established uncomplicated infection is usually 7 to 15 days.
Infection may spread locally from soft tissue to a bone, leading to osteomyelitis.
Hospital admission for parenteral therapy should be considered for patients with severe underlying illnesses or immunocompromising conditions. Empirical antibiotic choice is based on bacteriology of bite wounds and should be active against Pasteurella, Streptococcus, and Staphylococcus as well as anaerobes. No single agent covers all possible organisms. Antibiotics are started once prophylaxis is deemed necessary, or on clinical diagnosis after wound cultures have been obtained and the wound has been debrided.
Full blood count and blood cultures should be obtained. No standard guidelines exist for length of therapy. Treatment may need to continue for 4 to 6 weeks.
In susceptible individuals, infection may spread to another site and act as a nidus of infection (e.g., endocarditis).
Hospital admission for parenteral therapy is recommended. Empirical antibiotic choice is based on bacteriology of bite wounds and should be active against Pasteurella, Streptococcus, and Staphylococcus as well as anaerobes. No single agent covers all possible organisms. Antibiotics are started once prophylaxis is deemed necessary, or on clinical diagnosis after wound cultures have been obtained and the wound has been debrided.
Full blood count and blood cultures should be obtained. No standard guidelines exist for length of therapy. Treatment may need to be continued for 4 to 6 weeks.
Infection may spread locally from soft tissue to affect a joint, causing septic arthritis.
Hospital admission for parenteral therapy is recommended. Empirical antibiotic choice is based on bacteriology of bite wounds and should be active against Pasteurella, Streptococcus, and Staphylococcus as well as anaerobes. No single agent covers all possible organisms. Antibiotics are started once prophylaxis is deemed necessary, or on clinical diagnosis after wound cultures have been obtained and the wound has been debrided.
Full blood count and blood cultures should be obtained. No standard guidelines exist for length of therapy. Treatment may need to be continued for 4 to 6 weeks.
Infection occurring as a consequence of a bite may spread and a more generalised sepsis develop, depending on the virulence of the organism and immune status of the host.
Sepsis can progress rapidly to multi-organ failure and shock, and is often fatal. Survival is dependent on early recognition and immediate intervention with empiric broad-spectrum antibiotic therapy, which should be administered within one hour of recognition of suspected sepsis.
Individuals with bite wounds caused by attacks, particularly by dogs or humans, can develop post-traumatic stress disorder (PTSD).[1] Around 5% of paediatric patients develop PTSD after an attack by an animal, and there is an association between wound severity and PTSD development.[63]
The symptoms of PTSD are varied and include re-experiencing, emotional numbing or dysregulation and negative alterations in mood and thinking.[64] Symptoms may present differently in paediatric patients under 6 years old.[65]
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