History and exam

Key diagnostic factors

common

circumstances of animal bite

Useful for determining rabies risk and for public health reporting.[18]

Information about the type of animal, domestic or feral status, circumstance of injury, current location, ownership, and vaccination status is essential.[10]​ The likelihood of capturing the animal for quarantine should be established; quarantine allows for the animal to be assessed for the risk of rabies.

wound description

Precise location and dimensions should be recorded. Full documentation of the size and depth of the wound is important, as well as the proximity to bone and neurovascular structures. Neurovascular functional assessment and a check for avulsed tissue are also essential.

Photographs are sometimes helpful. Given the circumstance of the injury (i.e., suspicion of crime, violence, or potential litigation), forensic documentation may be necessary.

erythema

A sign of superficial infection that, when present, should elicit evaluation and documentation of involvement of deeper structures.

induration

A sign of superficial infection that, when present, should elicit evaluation and documentation of involvement of deeper structures.

fluctuance

A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.

purulent drainage

A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.

regional adenopathy

A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.

necrotic tissue

A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.

uncommon

vital signs unstable

Vital signs may be unstable in the setting of severe trauma and/or sepsis.

Risk factors

strong

age <14 years

Children have the highest incidence of dog bites treated in emergency departments, with admissions peaking in 5 to 9 year olds.[2][25]​ In one US emergency department between 2013 and 2018, children 1 to 5 years old were most frequently bitten by dogs (53%), and the risk for dog bite injury decreased with ages up to 14 years.[26] Some factors may encourage a dog to act aggressively towards a child, including small size and play activity. In addition, children may lack judgment about how to interact safely with dogs, and are less likely to be able to fend off an attack.[27]

pet ownership

People are bitten most frequently by a dog living in their own home, followed by pets belonging to family and friends.[2][26] Owners with multiple dogs are more than three times more likely to be bitten than nondog owners.[3]

high-risk groups (for rabies infection)

Includes veterinarians and their staff, animal handlers, workers in rabies laboratories, wildlife personnel, cave explorers (spelunkers), hikers, and field military or nongovernmental organization personnel in rabies-endemic countries. Also includes international travelers likely to come into contact with animals in areas where rabies is enzootic (and access to medical care may be limited), and children living in, or visiting, rabies-affected areas. Individuals in high-risk groups are eligible for rabies pre-exposure prophylaxis.[18][28][29]

weak

previous medical procedures (increased risk of infection if bitten)

Procedures that compromise the immune system, such as splenectomy or lymph node removal (e.g., during mastectomy) may predispose patients to rapidly spreading or severe infections.[30]​​[31]

underlying medical conditions (increased risk of infection if bitten)

Immunosuppression or underlying medical conditions such as diabetes mellitus or liver disease can increase an individual’s susceptibility to infections when bitten.[31]

A small number of case reports document severe infection in patients with diabetes mellitus following dog bites.[32][33][34]​​

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