Bite Cases Research Articles

Exploration of circumstances surrounding bites from potentially rabid dogs on rampage, and the coping strategies of victims and communities in Central Uganda

Free-roaming dogs (FRDs) cause 86% of the 14,865 dog bites recorded annually and 20 rabies-related deaths in Uganda. Unfortunately, there is a lack of data on the circumstances surrounding the bites, which undermines the development of effective mitigation measures. To address this gap, we actively tracked reports involving aggressive dogs in the Kampala metropolitan area in Central Uganda. Our approach included tracing the responsible dogs to rule out rabies and conducting interviews with victims and community members. We investigated seven incidents, including two rampages, two instances of aggressive behaviour in dogs, two cases of livestock predation, and one incident where a dog strayed into a residence. In three of the seven incidents, the dogs managed to escape due to factors such as nighttime cover, easy access to hideouts in slums, and limited community support. Of the four dogs that were traced, three were confirmed positive for rabies using the fluorescent antibody test. In total, 53 bite cases were recorded, affecting 29 humans—predominantly children (72.4%)—and 24 animals, including cattle, sheep, goats, pigs, pet dogs, and poultry. Notably, the two rampages accounted for 47 bite cases (88.7%), with the highest dog-to-bite incident ratio of 1:37 occurring in Matugga, Wakiso District. Despite 96.6% of the human victims being eligible for rabies post-exposure prophylaxis (PEP) due to sustaining deep wounds, 58.6% sought treatment from traditional healers, 13.8% self-medicated with local herbs, and 3.4% did not take any intervention. The community’s response to the rampages was to kill the responsible dogs. However, in one instance where the dog could not be traced, the community resorted to indiscriminately killing roaming dogs in the area, using sticks and stones in a mob. Our study underscores the significant threat that FRDs pose in the transmission of rabies. To achieve the global target of eliminating dog-mediated rabies by 2030, it is essential to enhance rabies vaccination coverage for dogs to meet the WHO-recommended threshold of 70%. Additionally, mass education efforts should be prioritized at both the community level and in schools, particularly in areas where rabies is endemic and dogs roam freely.

Hemodynamic Effects of Viperidae and Elapidae Snake Bites: A Comprehensive Review

Snakebite is a health issue frequently overlooked in tropical and subtropical countries. Despite snake bites from the families of Viperidae and Elapidae have been reported, there is limited information on the range of clinical manifestations on hemodynamics in adults. This study aims to describe the clinical manifestations of hemodynamic disorders in adults due to snake bites from the Viperidae and Elapidae families. The data for the literature review on hemodynamic disorders caused by Viperidae and Elapidae snake bites in adults was collected through a systematic search on Sciencedirect and PubMed from 2018 to 2023, along with manual searches on Google Scholar. This literature review was conducted using a systematic search on ScienceDirect and PubMed from 2018 to 2023 and a manual search on Google Scholar. The findings were 21,431 snakebite cases from 47 published research studies successfully acquired in this study. There are 36% of coagulopathy cases worldwide, 2% of internal bleeding cases, 25% of arrhythmia cases, and 21% of cardiomyopathy cases. The majority of the cases (70%) were Viperidae bite cases, with some (20%) being Viperidae and Elapidae bite cases and a tiny number (10%) being Elapidae bite cases. The study underscores the importance of a comprehensive approach to snakebite management based on a thorough understanding of the hemodynamic effects induced by these snake families.

Machine learning to improve the understanding of rabies epidemiology in low surveillance settings

In low and middle-income countries, a large proportion of animal rabies investigations end without a conclusive diagnosis leading to epidemiologic interpretations informed by clinical, rather than laboratory data. We compared Extreme Gradient Boosting (XGB) with Logistic Regression (LR) for their ability to estimate the probability of rabies in animals investigated as part of an Integrated Bite Case Management program (IBCM). To balance our training data, we used Random Oversampling (ROS) and Synthetic Minority Oversampling Technique. We developed a risk stratification framework based on predicted rabies probabilities. XGB performed better at predicting rabies cases than LR. Oversampling strategies enhanced the model sensitivity making them the preferred technique to predict rare events like rabies in a biting animal. XGB-ROS classified most of the confirmed rabies cases and only a small proportion of non-cases as either high (confirmed cases = 85.2%, non-cases = 0.01%) or moderate (confirmed cases = 8.4%, non-cases = 4.0%) risk. Model-based risk stratification led to a 3.2-fold increase in epidemiologically useful data compared to a routine surveillance strategy using IBCM case definitions. Our study demonstrates the application of machine learning to strengthen zoonotic disease surveillance under resource-limited settings.

A Case of Snake Bite in a One-Year-Old Cross-Breed Cow – A Case Report

This clinical article reports a case of snake bite in a -year-old Friesian and white Fulani cross-breed cow at the Livestock Investigation Division of the National Veterinary Research Institute, Vom, Nigeria. The clinical signs observed during the physical examination are as follows: swollen brisket region and left forelimbs, anorexia, fever (39.2°C), and difficulty walking. The whole blood clotting time was positive (Absence of clotting for more than 2 h). The affected cow was treated using antibiotics, diuretics, and anti-inflammatory agents without the administration of anti-venom. The recovery was uneventful within 3 days following treatment.

Individual variation in Macrovipera lebetinus obtusa (blunt-nosed viper) venom from a limited area in Southeastern Anatolia (Türkiye)

Intraspecific variation in snake venom composition has been the subject of many studies, revealing the differences in venom proteomes according to age, diet, sex, and geographic region. Previous research on M. lebetinus venom mainly focused on protein purification, proteomic characterization, and biological activities. Although venom proteomes of its subspecies from different geographical areas were compared, it is a widespread species and there is limited knowledge regarding the individual venom variation of M. lebetinus in the same area. In this study, individual variation in M. lebetinus obtusa venom was investigated in terms of protein profiles, protease, phospholipase A2, ʟ-amino acid oxidase, hyaluronidase and phosphodiesterase, and hemolytic activities based on nine individuals collected in the province of Şanlıurfa (southeastern Türkiye). HPLC analysis indicated more striking differences compared to SDS-PAGE. Phosphodiesterase activity varied most between the individuals, followed by hyaluronidase and phospholipase A2. Hemolytic activity did not show significant alteration based on the blood agar method. The results of this initial study revealed that M. lebetinus venom shows variation between the individuals inhabiting the same habitat, which should be taken into account in the development of antivenoms and the clinical assessment of the bite cases.

Unravelling the enigma: Autopsy challenges in alleged snakebite deaths

Snakebites account for a substantial public health burden in India, contributing to 80 % of global snakebite fatalities. This case series explores the intricacies of two alleged neurotoxic snakebite deaths, delving into the complexities of diagnosing neurotoxic snakebite deaths in India through meticulous medico-legal autopsies. Despite initial suspicions and circumstantial evidence suggesting snakebite involvement, the autopsies revealed surprising causes of death. The article discusses challenges in accurately attributing deaths to snakebites, and the potential for false claims, and underscores the crucial role of Forensic pathologists in dispelling enigmas. Forensic pathologists are urged to maintain an unbiased approach, allowing postmortem findings to guide conclusions amidst deliberate attempts to mislead. The cases described highlight that ruling out snake bites in cases with positive history is as challenging as opining a case of neurotoxic snake bite as they are mainly the diagnosis of exclusion in autopsy.

Epidemiological Profile and Awareness Regarding Animal Bite Management in an Urban Area.

The most common way for people to contract the deadly zoonotic disease rabies is through animal bites. This study was designed because there is a shortage of community-based data to determine the true extent of rabies infection and a lack of understanding regarding patient misconceptions in urban areas. The objective was to determine the scope of the issue and the epidemiological features of animal bite incidents. This was a facility-based cross-sectional study conducted at the field practice area (Urban Health Training Centre) under the Department of Community Medicine, Government Medical College. The study duration was one year (May 2023 to April 2024). Consecutive patients (accompanied by an attendant) attending the Urban Health Training Centre were included in the study. A purposive sampling technique was used, and around 400 animal bite cases were recorded in one year at the Urban Health Training Centre. Out of 1503 male cases at the Urban Health Training Centre, around 255 were dog bite cases (50.6%), whereas out of 1302 females visiting the Urban Health Training Centre, around 145 were dog bite cases (48%). The majority (35%) belonged to the age group of 11 to 20 years for both males and females. The mean age of the cases was 19.4 ± 3.4 years. The study found a male preponderance (64%), with females constituting 36%. The right lower limb (49.5%), left lower limb (39%), and upper limb were the most frequently bitten sites. Fifty-one percent of the cases fell into Category II. According to local data, the most popular home management practices were ghee oil and cold treatments. Although Category III is the most severe bite, only 35% had taken the anti-rabies vaccine (ARV), and 8.75% had received rabies immunoglobulin. The public and medical community need to be made aware of the importance of wound care and the prudent use of the anti-rabies vaccine.

A cross-sectional epidemiological study of animal bite victims in district hospital Alwar, Rajasthan, India

Background: Rabies, an invariably fatal viral disease, transmitted to humans through animal bites, mostly dogs. According to WHO, each year, 23000-25000 people die in the SEA region due to rabies. These accounts for approximately 45% human deaths due to rabies worldwide. Objective was to study epidemiological trend of animal bite in Alwar district hospital. Methods: A retrospective, record-based study was conducted in 200 animal bite victims presenting to district hospital Alwar, Rajasthan wherein information on monthly number of animal bite cases was collected from records section of the hospital. Information on annual number of animal bite cases was available from the annual report of the hospital from 2018 onwards, this data was used for studying the monthly variation in animal bite cases. Data were compiled and analyzed using Microsoft Excel. Results: Among 200 victims 76.3% were males, 56.7% belongs to 15-45 years, 61.6% were living in urban area, 31.3% and 21.7% of the victims were agriculture worker and laborers respectively. Among 95.8% victims bitten by dog, 89% of them were stray. 89.4% had category III bite, lower extremity affected in 60.8%, fate of animal was unknown in 78.6% and 46% of the victims were bitten during evening hours. Conclusions: Majority of bites were by stray dogs, unprovoked and category III bites. This indicates the need of large amount of anti-rabies serum or HRIG thereby increasing the cost of management of animal bite cases. There is a need to control stray dog population and immunize pet dogs.

Adherence to the post-exposure prophylaxis among animal bite patients attending rabies clinic at tertiary care hospital – A cross-sectional study

Background: Rabies is an acute and 100% fatal viral disease transmitted to humans through the bite or lick of an infected animal. It can be successfully prevented if a complete course of anti-rabies vaccine (ARV) is taken following an animal bite. The present study reveals the compliance of animal bite victims to post-exposure prophylaxis (PEP). Aims and Objectives: The objectives of the study are as follows:(1) To determine the adherence to PEP among animal bite victims and factors influencing it. Materials and Methods: A retrospective record-based cross-sectional study was conducted at the anti-rabies clinic of VIMS Hospital Ballari. Information regarding sociodemographic variables, animal bite history, category of bite, treatment received, and completion of ARV schedule of all the animal bite cases were collected from the animal bite register and treatment card during the period from July 2023 to December 2023. Results: Out of the total 350 animal bite victims, all of them received the first dose of vaccine, 86.28% completed two doses, 72% completed three doses, and only 51.14% completed the schedule by taking all four doses, 37% of them completed the schedule without any delay, 14% delayed one or more doses, and the rest 49% did not complete the schedule. Conclusion: Adherence to PEP is a dire necessity as rabies is a fatal disease. Counseling the animal bite victims about the importance of adhering to the complete PEP schedule at the time of administering the first dose of vaccine is crucial.

Rabies surveillance and prevention in Guinea: Epidemiological data and postexposure prophylaxis challenges.

Canine rabies is an endemic form of zoonosis and represents a major public health threat in Guinea, similar to other African countries. However, few investigations on the epidemiology of rabies in animals and humans have been conducted, and evidence-based data required to inform health policies remain inadequate. This study was conducted to update our knowledge of human dog-mediated rabies epidemiology and post-exposure prophylaxis (PEP) accessibility-related factors in Guinea. This retrospective study, conducted from January 2018 to December 2020, collected data on animal bite cases, veterinary observations, rabies diagnoses through fluorescent antibody test, and PEP delivery from three veterinary and medical entities. Statistical analysis utilized Chi-square test and Fisher's exact test to evaluate relationships between variables. An average of 775 bites was recorded annually, and dogs were responsible for 98% of bites. However, only 64% of the biting dogs were under veterinary observation as required for integrated bite case management. Regarding the geographical distribution of bite cases, the entire country was affected, with the highest number of bites recorded in the prefectures of Nzérékoré and the special zone of Conakry. In addition, the laboratory diagnosis of brain samples from biting dogs indicated that 72% of the samples were rabies-positive. However, regarding prevention, only 58% of the bitten individuals received full PEP. Improving disease surveillance and PEP provision for dog-transmitted rabies is crucial to preventing human cases and deaths. Increasing community awareness is essential for enhancing dog vaccination and PEP utilization. A national action plan integrating stakeholders for controlling canine rabies should be developed for effective One Health collaboration.

Does Invisalign Outperform Fixed Appliance in Treating Vertical Discrepancies?

Aligners became popular among adult patients for their superior aesthetics and comfort in comparison to conventional fixedappliances. It has undergone numerous enhancements over time, allowing it to address more complex malocclusions. Many researchers argued that managing vertical discrepancies is more challenging than addressing anteroposterior issues. This complexity arose from the mechanical requirements for treatment and the required mechanics to prevent relapse. Studies assessing the treatment outcome of anterior open bite closure using clear aligners have yielded conflicting results regarding the mechanisms of bite closure. Proposed mechanisms included extrusion of upper or lower incisors, lingual tipping of upper or lower incisors, intrusion of upper or lower molars, counterclockwise rotation of the mandible, or various combinations of these mechanisms. The research highlighted the biomechanical challenges associated with using aligners for the treatment of deep bites as mandibular incisor intrusion and leveling the curve of Spee remain among the least predictable movements. Given the widespread use of aligners, it is imperative to rigorously assess the effectiveness of clear aligners in achieving overbite correction to ensure they deliver the desired outcome. This review aimed to assess the performance of Invisalign in the management of vertical discrepancies. It sought to identify the dentoskeletal effects of clear aligners in addressing deep bite and anterior open bite cases, understand the mechanisms behind overbite correction, and provide a comprehensive overview of the existing research on this topic.

Rabies Realities: Navigating Barriers to Rabies Control in Rural Zambia-A Case Study of Manyinga and Mwansabombwe Districts.

Rabies persists as a longstanding issue in Zambia, despite being preventable. The current control measures, including dog vaccination, population control, and movement restriction, guided by 'The Control of Dogs Act Chapter 247 of the Laws of Zambia', have not yielded the desired impact in many areas of the country including Manyinga and Mwansabombwe districts. These two districts continue to report low dog vaccination rates, unrestricted dog movements, and escalating cases of animal and human rabies, along with dog bites. Aligned with global aspirations to achieve zero human rabies cases by 2030, this study scrutinizes the determinants and obstacles hampering the execution of rabies control initiatives in Manyinga and Mwansabombwe. Spanning approximately 11 months, this cross-sectional study gathered pre- and post-vaccination data from 301 households in Manyinga and 100 households in Mwansabombwe. Questionnaires probed knowledge, attitudes, and practices related to rabies prevention and control. A transect survey, key informant interviews, and assessment of rabies vaccination and dog bite records complemented the data collection. Findings revealed that 88.0% of respondents from both districts possessed knowledge about rabies, confirming affected species and transmission. Moreover, 76.8% in Manyinga and 88.6% in Mwansabombwe were acquainted with rabies prevention and control methods. Concerning dog owners, 89.0% were aware of rabies, 66.0% understood its prevention and control, and the majority identified bites as the primary mode of transmission. Despite the high level of knowledge recorded during the survey, the implementation of preventive measures was low, which was attributed to low levels of law enforcement by the local government authority, inadequate staffing in the veterinary department, unwillingness to pay for dog vaccinations, and unavailability of rabies vaccine at the veterinary office in both districts. Vaccination coverage stood at 64.0% in Manyinga and 21.0% in Mwansabombwe. Notably, education and occupation exhibited a positive significant association with rabies knowledge. In terms of dog bite cases, Manyinga recorded 538 dog bite cases from 2017 to June 2022, while Mwansabombwe recorded 81 dog bite and 23 jackal bite cases from 2021 to June 2022. The study underscores critical knowledge gaps in rural areas and emphasizes the imperative for enhanced public education and awareness programs, improved rabies surveillance, free mass vaccination campaigns, and community engagement to augment vaccination coverage and knowledge about rabies.

Rabies in rural northeast India: A case report emphasising the urgency of the One Health approach

Dog-mediated rabies is endemic in India. The country records the highest mortality due to dog-bite-related rabies despite the availability of interventions to prevent deaths. We present a case study of the death of a 59-year-old man in a suburban town of Northeast India after a dog bite from an owned pup. Through this case study, we investigate various omissions and commissions in communities and health professionals that make rabies rampant in India. The circumstances surrounding the death were investigated by interviewing the wife, relatives, neighbour, the hospital/nursing home where the bite case was reported, the district Rapid Response Team (RRT), and the Veterinary and Animal Health Department Officer and through the information recorded in the disease outbreak report. While the biting animal was not vaccinated and had no restriction over its movement imposed by the owners, the response of the hospital staff and public authorities was delayed and inadequate. A poignant reminder of the complexities surrounding dog-mediated rabies in India, this case study calls for a holistic protocol to address dog bites through ensuring the One Health approach encompassing education, provision of post-exposure prophylaxis (PEP) and canine rabies vaccines for dogs, promotion of responsible dog ownership, and intersectoral collaboration. Moreover, strengthening communication channels through effective data exchange and encouraging synergy among healthcare, veterinary, and public health sectors is indispensable to maximize the impact of rabies prevention and control interventions.

1033 A Rare Case of a Dog Bite Leading to Bilateral Lower Limb Amputation

1033 A Rare Case of a Dog Bite Leading to Bilateral Lower Limb Amputation

The use of therapeutic plasma exchange in systemic loxoscelism induced treatment resistant hemolytic anemia: A case report

Brown recluse spider bites can lead to severe reactions such as skin necrosis,hemolytic anemia, and multiorgan failure, which can be life-threatening. Therapeutic plasma exchange has been reported to provide clinical benefit for such cases. In thisreport, we present a case of a brown recluse spider bite that was successfully treated with therapeutic plasma exchange and compare it with previous case reports.

Prevalence Study and Overview of Rabies in the Province of Ouarzazate-Morocco

Background: Rabies is a cosmopolitan anthropozoonosis for which humans are accidental victims. In Morocco, rabies is an endemic disease, with new cases of human rabies reported every year. The aim of our study is to analyze the epidemiological aspects of rabies in the province of Ouarzazate. Materials and Methods: This is a retrospective study using records available at the Ouarzazate Municipal Hygiene Office. It includes 1,759 cases of exposure to animal bites between 2016 and 2019. Results: We identified 1,759 cases of animal bites during the period of 4 years of study, representing an average annual exposure rate of 190/100,000 inhabitants. Most cases were rural (65%). The median age of bitten cases was 28 years, with people under 15 years of age exposed in 32% of cases. Males predominate, with 61.3% of cases. Dogs are the main animal aggressors at 47.8%, followed by cats at 33%. The upper limbs are the preferred sites of aggression (89.2%). Exposure was grade III in 76.8% of cases. Lesions were multiple in 52.1% and superficial in 62.6%. No cases of human rabies have been recorded since 2001, despite 20 cases being exposed to a biologically confirmed rabid animal during our study. Conclusion: Rabies remains a public health concern in the province of Ouarzazate, despite the presence of a national rabies control program. Effective control of this zoonosis requires strengthening education and community engagement, as well as close collaboration between animal health and human health sectors for integrated management of bite cases.

Morphological state of lungs of rats under the influence of Vipera berus berus venom

About 5.4 million snake bite cases are registered worldwide every year. About half of them cause 81,000-138,000 deaths or disabled 400,000 people. Despite this, this problem is neglected in many countries in Asia, Africa and Latin America. It is believed that death from snakebites is associated with poverty since the lack of proper access to medical facilities in such sections of the population causes the development of fatal complications. The purpose of the study is to study the morphological state of rats' lungs under exposure to Vipera berus berus venom. Experimental studies were carried out on white, non-linear male rats. Animals were conditionally divided into control and experimental groups, ten individuals each. Experimental rats were injected intraperitoneally with a semi-lethal dose (LD50) (1.576 mg/g-1) of Vipera berus berus venom in a physiological solution. Animals of the control group were injected intraperitoneally with only a physiological solution. Rats were removed from the experiment 24 hours after exposure to the poison and anaesthetized by cervical dislocation. Lung tissue samples were taken for microscopic examination. Fixation of the material and preparation of paraffin blocks were carried out according to generally accepted methods. Staining of histological preparations of the lungs was carried out with hematoxylin and eosin, according to Masson, and the PAS+"Hale" reaction was carried out according to the Mowry method. Histological preparations were studied using an SEO SСAN light microscope. The toxic effect of Vipera berus berus venom caused significant changes in the vascular, stromal and parenchymal components, which was confirmed by histological, histochemical and morphometric data. In the lungs of experimental animals, the vascular bed is primarily restructured, forming coagulopathies and thrombosis. The development of DIC syndrome and haemorrhages accompanies an increase in the permeability of the vessel wall. Inflammatory phenomena are found in the bronchi and respiratory departments' walls. There is a remodelling of the respiratory department components, with the formation of significant areas of dis- and atelectasis and zones of emphysema, which is confirmed morphometrically.

Dog bites are increasing in frequency and severity – a sustained effect following the COVID-19 pandemic

The COVID-19 pandemic and subsequent lockdown measures have changed various aspects of society, including patterns of human-animal interactions. This audit investigates the incidence and severity of dog bites admitted under the plastic surgery department at a major trauma centre before and after COVID-19 lockdowns. We assessed trends in dog bite cases over the course of one year (2018) prior to the COVID-19 lockdown and one year after (2022). A time period during COVID-19 lockdown itself was not included to avoid confounding factors due to changes in healthcare provision during the pandemic. Our analysis reveals a 47 % increase in dog bites after lockdowns ended compared to before. We also demonstrate statistically significant increases in the need for operative management (90 % of patients compared to 78 %) and length of inpatient hospital stay (average 63 h compared to 51). Moreover we show that dog bites have increased in severity, with a clear increase in patients presenting with deeper tissue injuries, tissue loss and muscle, nerve, vascular or bone involvement. This represents a significant functional, cosmetic and psychological impact for patients as well as financial impact on the NHS and increased workload for plastic surgery departments. This is the first paper to examine the severity of dog bite injuries and to demonstrate a sustained effect even after the easing of lockdown measures. Our findings shed light on the potential impact of lockdown measures on human-dog interactions and highlight the importance of public awareness and prevention strategies in mitigating dog bites. Lay summaryOur study demonstrates that dog bite injuries increased in frequency by 47 % following COVID-19 lockdowns. Patients with dog bites are also being admitted for longer than before, requiring more operations and have more severe injuries, with some requiring skin grafting, nerve repair or more complex plastic surgery reconstruction.

Three-dimensional evaluation of two intrusive modalities in treatment of deep bite cases accompanied with gummy smile (randomized controlled trial)

Three-dimensional evaluation of two intrusive modalities in treatment of deep bite cases accompanied with gummy smile (randomized controlled trial)

An 8-year-old child with Encephalitis Rabies due to delayed case finding, proper Post Exposure Prophylaxis for Rabies infection a case report

Background and Purpose: Until April 2023, it has been documented about 31.113 case of animal rabies-borne bite, which 23.211 cases are given Post Exposure Prophylaxis Anti Rabies Vaccine and 11 death cases in Indonesia and 95% of them are caused by dog bite. This case report was conducted to describe a rare case of an 8 years old child presenting with late complication of encephalitis in Borong General Hospital due to the delayed case finding, management and proper prophylaxis for Rabies infection. Case: One day prior to admission, an 8-year-old girl with irritability, aggressive behavior, and severe speech abnormalities reported to the emergency room. These symptoms quickly escalated to confusion and disturbed mental status. One month before to presentation, the patient's parents stated that his right arm had been bitten by a stray dog. Because there were no obvious bite marks and the family was not aware of the dog bite, PEP was not requested. In the previous five days, her parents described experiences of hydrophobia, photophobia, and aerophobia. The patient's health deteriorated two hours after admission, and palpating the carotid artery revealed that there was no pulse. Despite performing cardiopulmonary resuscitation, ROSC was not reached. Conclusion: Animal rabies control and surveillance are essential, particularly in locations where the disease is endemic. PEP is extremely effective and ought to be given as soon as possible following an exposure to reduce the high fatality rate. Keywords: aware, PEP, mortality, irritability