Approach
Thorough evaluation of an animal bite is necessary in order to assess for infection and other potential complications.
History
Information regarding the type of animal and its characteristics will help in assessing the extent of injuries as well as in determining whether prophylactic or therapeutic antibiotics are needed. Ask about the mechanism of attack (scratch, single bite, multiple bites, clenched jaw with shaking), timing of the injury, and circumstances of the attack.[10] Host factors need to be elucidated, such as immunosuppression, history of diabetes mellitus, prosthetic valves or joints, liver disease, and previous mastectomy or splenectomy, which can predispose patients to rapidly spreading or severe infections.[10][31]
Tetanus and rabies immunisation status should be established and documented in order to determine the need for immunisation.[10] Pre-exposure rabies immunisation is reserved for people at increased risk of contracting rabies.[18][28][29][38]
Local health authorities or animal control authorities should be contacted.
For human bites, an assessment of risk of hepatitis B and human immunodeficiency virus (HIV) should be done. In children with bites, child abuse or neglect should be considered (e.g., leaving children with dangerous animals). Human bites in adults may be the result of physical or sexual abuse.
Examination
Vital signs should be monitored, especially if there is extreme trauma and/or sepsis ensuing after the bite. Vital signs may be unstable in these settings.
Wounds may be large and cosmetically disfiguring or small and deceptively shallow. Thorough but careful exploration and complete evaluation of deep structure and function are necessary. Examination of lymph nodes should be performed. Neurovascular function and range of motion should be assessed.[10] Some wounds may be avulsions (skin is missing), and the patient should be referred to the appropriate surgeon, most commonly a plastic or orthopaedic surgeon. Flexor tenosynovitis of the hand is a surgical emergency. Necrotic tissue, purulent drainage, erythema, induration, and fluctuance may be present, indicating infection.
Clear documentation of examination findings is critical, as animal bite cases may involve litigation.
Laboratory evaluation
If signs of infection are present, wound cultures should be obtained. The results will help to guide therapy, as atypical organisms are sometimes present. If systemic infection is suspected, a full blood count and blood cultures should be obtained. A DNA swab may be required as part of a forensic evaluation (e.g., in suspected child abuse).
Radiographic evaluation
X-rays may be required if injuries are located near a joint or bone, or to evaluate for retained foreign bodies (e.g., teeth), fractures, or air in soft tissues or joints.[10] Photography of the wound may be required as part of a forensic evaluation. Angiography may be necessary to assess for vascular injury from penetrating injuries to the chest, neck, and thoracic outlet.
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