Bite Cases Research Articles

Anaphylaxis as probable cause of death in a rare case of fatal Vipera berus bite.

This case report describes the death of a 52-year-old male who was bitten by a venomous snake, Vipera berus (common European adder), on his left wrist. Despite experiencing symptoms, the patient refused medical care and self-medicated with alcohol instead. He was later found dead in his residence. Autopsy and histological examination revealed evidence of an anaphylactic reaction in response to the snake bite, with additional findings of alcohol intoxication and other underlying medical conditions.

Effect of Different Mini Implant Assisted Rapid Palatal Expansion (MARPE) Designs on Maxillary Protraction in Skeletal Class III malocclusion: An FEM Study.

Four different designs of mini-implant-assisted rapid palatal expansion (MARPE) and protraction in nasomaxillary complex and mid-palatal sutures in late adolescent skeletal Class III malocclusion were compared using a three-dimensional finite element analysis. A finite element model of skull and related sutures was constructed using the computed tomography scan of a 16-year-old female patient with skeletal Class III and ANB of -2°. Four appliance designs: Type I: MARPE with palatal force, Type II: MARPE with buccal force, Type III: Hybrid hyrax with palatal force, and Type IV: Hybrid hyrax with buccal force. Protraction vectors were and analyzed using Ansys software (ANSYS 2021 R2). The displacement pattern of the nasomaxillary structures and the stress distribution in the sutures were examined in all four appliance designs. All the appliance designs resulted in a forward movement of the maxilla, while Type I and III, which used palatal protraction force, caused the greatest forward displacement. In Type I, II, and III, along with forward movement, a clockwise rotation of maxilla was observed, while in Type IV, an anticlockwise rotation of maxilla was observed. Type I, II, and III resulted in higher stress distribution around the superior structures, while Type IV resulted in less stress distribution around the superior structures of maxilla. The forward displacement was enhanced when palatal plates were used to protract the maxilla. The effective appliance design for skeletal class III with open bite case was Type I, II, and III and Type IV for deep bite cases.

A rare case of a dog bite leading to bilateral lower limb amputations

Capnocytophaga canimorsus is a rare cause of bacteraemia, occurring usually after dog bites, and can have devastating consequences for patients. This report describes the case of a 65-year-old woman who presented acutely unwell 6 days after being bitten on the hand by a dog. She suffered consequences of overwhelming sepsis, disseminated intravascular coagulation and bilateral acute limb ischaemia requiring bilateral major lower limb amputations. C. canimorsus-associated sepsis is extremely rare, but early (prophylactic) antibiotic treatment after a dog or cat bite could prevent serious complications associated with this bacterium.

Epidemiological characteristics and surveillance of animal bite injuries, in Kerman city, Iran.

Animal bites are a major threat to human health. The present study was designed to determine the incidence and epidemiological factors and to investigate the process of referral and treatment of animal bite cases in Kerman city. This was a cross-sectional (descriptive-analytical) study. All the cases of animal bites that were referred to rabies treatment and prevention centers under the coverage of Kerman health center during 2019 and 2021 were investigated. The data were collected from the health center of Kerman city in Excel form that was registered in the portal of the Ministry of Health. The Chi-square test and Fisher's exact test were used in SPSS24 software to analyze the data. In this study, 5407 people (4076 men and 1331 women) were bitten by animals. The average incidence of animal bites was 313 per hundred thousand people. The mean ± SD age of the injured was 31.38 ± 17.72 years. 73.2% of cases of attacking animals were dogs, and half of those dogs had owners. 58.6% of cases were injured in the hand, and 94.2% referred to rabies treatment and prevention centers in the first 48 h after the bite. No cases of animal-bitten deaths were reported during this period. Between gender (P = 0.006), age (P = 0.013), place of residence (P = 0.003), occupation (P < 0.000), history of previous bites and vaccinations (P = 0.001), and injured limb (P < 0.000) and not going to receive the next round of vaccinations, there was a statistically significant correlation. Animal bites are a major health problem in Kerman, and due to creating health problems and economic losses, it is necessary to take serious action to control and prevent this health threat.

Compliance of Post-Exposure Prophylaxis of Anti-rabies Vaccine amongst Animal Bite Cases Attending Secondary Healthcare Hospital in Thiruvallur District, Tamil Nadu, India: A Cross-sectional Study

Compliance of Post-Exposure Prophylaxis of Anti-rabies Vaccine amongst Animal Bite Cases Attending Secondary Healthcare Hospital in Thiruvallur District, Tamil Nadu, India: A Cross-sectional Study

PREVALENCE OF DOG BITE CASES IN HUMANS AND VACCINATION COVERAGE AGAINST RABIES IN SELECTED PARTS OF LAGOS STATE, NIGERIA

Aim: Lagos State has a long history of rabies control efforts. However, the success of such efforts and the goal to eliminate rabies is yet to be realized. This study was carried out to evaluate dog bite cases in humans presented to the Lagos State Teaching Hospital Ikeja and to evaluate anti-rabies vaccination coverage in dogs presented for dog consultation at the State Animal Hospital Agege and a private Veterinary Clinic Ikeja between the years of 2012 to 2018. Methods: Factors such as age, sex and season of dog bites in humans as well as the age and sex of dogs presented for anti-rabies vaccination were obtained for the years under review. Also, a cross-sectional survey was conducted using structured questionnaires to assess knowledge on rabies and factors affecting routine anti-rabies dog vaccination amongst consenting residents and dog owners of selected households in Ikeja and Agege Local Government Areas of Lagos state. Results: From the retrospective data on dog bites in humans, a total of 347 dog bites was reported with 59.7% (207) occurring in females and 40.3% (140) in males, all of whom were adults aged between 25 to 40 years. Seasonal distribution of bites indicates a higher frequency in the months of April, July and October. A total of 300 (13.2%) dogs were vaccinated out of 2,275 cases presented to the State Animal Hospital Agege, 48% (144) of which were females and 52% (156) males. 62.7% (188) of the dogs were aged between 3 to 12 months, 23.3% (70) aged between 12 to 36 months and 14% (42) aged above 36 months. A total of 295 (28.1%) dogs were vaccinated out of the 1,048 cases presented to the private Veterinary Clinic at Ikeja. On the cross-sectional study, 422 consenting households were issued a questionnaire across the two local government areas. Overall, 330 (78.2%) had satisfactory knowledge on rabies, while 92 (21.8%) had a non-satisfactory knowledge on rabies, 287 (68%) knew what to do when bitten by a dog while 135 (32%) gave a non-satisfactory response, 302 (71.6%) had reasonable response to perceived threats of rabies whereas 120 (28.4%) respondents were not quite knowledgeable on the perceived threats of rabies. Factors affecting routine anti-rabies vaccination in dogs such as breed, cost, distance and ease of handling were assessed among 196 dog owners out of the 422 selected households, with no statistical significance as factors associated with or affecting dog rabies vaccination coverage. Conclusions: The result of this study indicates that dog bite as a threat to spread of rabies is still a menace and anti-rabies vaccination coverage of dogs falls below the recommended standard by the World Health Organization despite various existing control programs. Despite majority of respondents having satisfactory knowledge on rabies, their attitudes towards rabies prevention were inadequate.

Clinical case of treatment of anterior open bite malocclusion in a pediatric patient using a tongue trap

Anterior open bite is a complex and multifactorial malocclusion that affects both dental function and aesthetics. The objective of the study was to present a clinical case of anterior open bite (AOB) treatment in a pediatric patient using a lingual trap. A case study was conducted on a 7-year-old girl with AOB, employing a removable orthopedic appliance. The treatment consisted of using a lingual trap to correct the open bite and promote proper mandibular growth, with monthly check-ups and a total duration of 12 months. The results showed a significant improvement in occlusion and dental alignment, as well as in the facial profile. It is concluded that the lingual trap is an effective tool in the treatment of anterior open bite in pediatric patients, highlighting the importance of an integral and personalized approach to achieve successful results

An 8-year-old child with encephalitis rabies due to delayed case finding, proper post-exposure prophylaxis for rabies infection: a case report

Background: Until April 2023, it has been documented about 31,113 cases of animal rabies-borne bites, of which 23,211 cases were given Post Exposure Prophylaxis (PEP) Anti Rabies Vaccine and 11 death cases in Indonesia, and 95% of them were caused by dog bite. This case report was conducted to describe a rare case of an 8-year-old child presenting with the late complication of encephalitis in Borong General Hospital due to the delayed case finding, management, and proper prophylaxis for Rabies infection. Case Presentation: One day before admission, an 8-year-old girl with irritability, aggressive behavior, and severe speech abnormalities was 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 exposure to reduce the high fatality rate.

Sociodemographic Profile of Animal Bite Cases Attending at a Tertiary Care Center, Rewa (M.P.)

Abstract Objective: The study’s objectives were to learn about the sociodemographic profile of animal bite cases in Madhya Pradesh’s Vindhya region while attending the Medicine Outpatient Department (OPD) at Shyam Shah Medical College in Rewa (M. P.). Materials and Methods: Between January 1, 2018, and December 31, 2018, this study was conducted in the Medicine OPD, Department of Medicine, at Shyam Shah Medical College in Rewa, Madhya Pradesh, India. A cross-sectional study was conducted. A total of 1440 cases of animal bites were included in the sample, and for each patient, a sociodemographic profile was obtained along with a comprehensive history of the animal’s category and type, bite type and site, duration of exposure, and category of exposure. Results: The majority of the 1440 animal bite cases were bitten by dogs 1198 (76.94%). There are 763 (52.98%) Category II bites, 605 (42.01%) Category III bites, and 72 (5%) Category I bite. Lower limbs were bitten 914 (63.47%), upper limbs 389 (27.01%), head and neck 67 (4.65%), and trunk 70 (4.86%). Conclusion: This study found that rural areas have a high number of dog bite cases, and adult males have a higher incidence of animal bites than adult females. The most common biting animal is the dog, and the most common site of bite in adults is the lower limbs.

Epidemiological characteristics and trends of animal bites in Neyshabur, Iran: A cross-sectional study

Objective: To investigate the trend of animal bites between 2015-2021 in Neyshabur, Iran. Methods: In this cross-sectional descriptive study, data were retrieved from the vice-chancellery of the Neyshabur University of Medical Sciences. The data included person variables, place and time variables, and animal variables. Results: There were 13190 cases of animal bites and the trend was increasing during 2015-2020. Most injuries were caused by dogs (86%), most animal bites (76.6%) occurred in males, and 28.1% of all cases were farmers. The most common bitten parts were the lower limbs (64.8%), often reported as a scratch (83.4%). Most of the biting animals (67.9%) were not strays, and 83.3% of them had bitten their owners. No rabies death was reported during the study period. Conclusions: The incidence of animal bites increases and is higher than the national statistics in Neyshabur, Iran. Serious attention and intervention should be given to control and prevent this health threat.

Developing Prototype of the Nasu Suwoho Application for Rabies Case Reporting in Endemic Areas, North Sumatera, Indonesia

&lt;p&gt;&lt;em&gt;Delays in the handling of cases including rabies will affect the severity level caused by the inaccurate handling and detection of cases and tends to be slow. Considering that the era of digital technology is now developing so rapidly, almost all information can be accessed easily today. The purpose of this activity is to provide knowledge or socialization of the plan for a rabies self-reporting program by the community through the Nasu Suwoho application. Community service activities are carried out using a Participatory Action Research approach where the community as the subject and object of this community service activity plays an active role in planning to implement the use of the rabies reporting application. A qualitative approach with in-depth interviews was conducted to the respondents by the research team. Service activities consist of opening, giving material, delivering videos and testing applications. With the Nasu Sowoho application, it is hoped that the signals of rabies cases, humans and animals infected with rabies in the community, health center staff and animal health centers can be properly monitored. This application displays questions in the form of self-diagnosis of the general public about the clinical symptoms of bite cases of rabies-transmitting animals. These clinical symptoms are adapted to general and typical signs that are easily recognized by the public so they can be reported easily.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;strong&gt;&lt;em&gt;Keyword: Rabies, Digital Health, Qualitative Study&lt;/em&gt;&lt;/strong&gt;

A retrospective study of clinical profile of viper bite cases in selected hospitals in central kerala

Viper bite is a commonly occurring occupational health hazard to people involved mainly in agricultural sector in tropical and sub-tropical areas. The aim of the study was to assess the clinical pattern of poisonous snakebites from four selected hospitals in central Kerala. Study site: Carithas Hospital (Kottayam), Little Flower Hospital and Research Centre (Angamaly), Paalana Institute of Medical Sciences (Palakkad) and Charis Medical Mission (Muvattupuzha). Percentage of cases collected from Carithas hospital, Little Flower hospital, Paalana hospital and Charis hospital were 51. The various clinical profile was assessed such as Hb level , symptoms, total leukocyte count, platelet count prothrombin time etc. Conclusion: Practice of locally developed treatment protocol for optimised treatment of viper bite is required.

Epidemiological study of animal bite cases attending a tertiary care hospital in Tripura: North-East India

Background: This research article presents an epidemiological study in Tripura, North-east India, investigating animal bite cases at a tertiary care hospital. Animal bites pose significant public health concerns, including potential zoonotic disease transmission. The study aims to assess animal bite incidence, envenoming, and treatment-seeking behaviours among victims. Data from individuals over one year old will reveal the burden of animal bites on healthcare facilities, guiding effective prevention and management strategies for this pressing health issue. Methods: A cross-sectional study at AGMC and GBP Hospital, Tripura, assessed animal bite patterns referred to the ARV centre (2018–2021). Included animal-related bites and excluded incomplete data. Collected age, gender, socio-economic status, biting animal, and bite category. Staff ensured nationwide surveillance. Categorised subjects by age. Results: The cross-sectional study investigated animal bite patterns at AGMC and GBP Hospital, Agartala, Tripura, from 2018 to 2021. Analysis revealed male adults (20-39 years, 41.7%) were most affected, predominantly by dogs (57.58%). The APL category showed the highest frequency (70.79%). Missing category bites decreased, while third category bites increased over time. The winter months had higher frequencies of animal bites. Continued surveillance and targeted interventions are vital for effective prevention. Conclusions: This study highlights male adults (20–39 years old) as being most affected, predominantly by dog bites. The APL category showed higher susceptibility. Continued surveillance and targeted interventions are crucial for effective prevention.

Stability of anterior open bite cases treated with upper and lower extrusion arches in adults: a follow-up study.

To investigate the post-treatment stability of anterior open bite (AOB) cases treated with upper and lower extrusion arches in adults. 23 patients with AOB were treated with extrusion arches and evaluated for dentoskeletal changes using lateral cephalometric radiographs before treatment (T0), after treatment (T1), and 12 months post-treatment (T2). Patients received bondable tongue spurs and vacuum-formed retainers as post-treatment retention/stability measures for 12 months. Post-treatment stability was further assessed qualitatively by the Photographic Openbite Severity Index. All the cases showed positive overlap between the anterior teeth at the end of orthodontic treatment, and 20 of 23 treated patients attended the recall visit after 12 months. A total of 85% of the cases maintained positive overlap at least 1 year post-treatment, 10% showed edge-to-edge bite, and only 5% showed no overbite. Treatment of AOB in adults with extrusion arches proved to be stable 1 year post-treatment. Changes in the overbite after 1 year of follow-up were not significant.

Exploring the spatial pattern of animal bites in Iran (2021–2022)

ObjectiveKnowledge of the spatial pattern of animal bites can be helpful for targeted resource allocation and to develop and deliver effective intervention programs. The aim of this study was to explore the spatial pattern of the animal bites in Iran during 2021–2022. MethodsAnimal bite cases from all provinces and counties in Iran were obtained from a nationally based registry. Global Moran's I was applied to check spatial autocorrelation. The spatially adjusted standardized incidence ratios (SIRs) were estimated using the Besag, York, and Mollie (BYM) model. Spatial clusters were identified by local indicators of spatial association (LISA) and purely spatial scan statistic. ResultsA total of 260,470 animal bites were registered during the study period. There was a positive spatial autocorrelation (global Moran's I=0.27, p-value=0.001). The majority of SIRs greater than 1.00 was found in counties in the northern belt of Iran (e.g., observed greater than expected animal bites). LISA found that approximately 7% of counties in the north and northeast, 18% in the west and south, and 3% in the central part of Iran were significant hot spots, cold spots, and spatial outliers (p-value≤0.05). Spatial scan statistic detected primary hot spot cluster in the counties in the Mazandaran and Alborz provinces (Relative Risk=2.56, p-value<0.001), while primary cold spot cluster involved counties in Kurdistan and Kermanshah province (0.37, <0.001). ConclusionAnimal bites were unevenly distributed in Iran. Further prevention and control programs as well as appropriately resource allocation are needed in order to reduce the observed animal bites spatial disparity.

Measuring the impact of an integrated bite case management program on the detection of canine rabies cases in Vietnam.

Dog-mediated rabies is enzootic in Vietnam, resulting in at least 70 reported human deaths and 500,000 human rabies exposures annually. In 2016, an integrated bite cases management (IBCM) based surveillance program was developed to improve knowledge of the dog-mediated rabies burden in Phu Tho Province of Vietnam. The Vietnam Animal Rabies Surveillance Program (VARSP) was established in four stages: (1) Laboratory development, (2) Training of community One Health workers, (3) Paper-based-reporting (VARSP 1.0), and (4) Electronic case reporting (VARSP 2.0). Investigation and diagnostic data collected from March 2016 to December 2019 were compared with historical records of animal rabies cases dating back to January 2012. A risk analysis was conducted to evaluate the probability of a rabies exposure resulting in death after a dog bite, based on data collected over the course of an IBCM investigation. Prior to the implementation of VARSP, between 2012 and 2015, there was an average of one rabies investigation per year, resulting in two confirmed and two probable animal rabies cases. During the 46 months that VARSP was operational (2016 - 2019), 1048 animal investigations were conducted, which identified 79 (8%) laboratory-confirmed rabies cases and 233 (22%) clinically-confirmed(probable) cases. VARSP produced a 78-fold increase in annual animal rabies case detection (one cases detected per year pre-VARSP vs 78 cases per year under VARSP). The risk of succumbing to rabies for bite victims of apparently healthy dogs available for home quarantine, was three deaths for every 10,000 untreated exposures. A pilot IBCM model used in Phu Tho Province showed promising results for improving rabies surveillance, with a 26-fold increase in annual case detection after implementation of a One Health model. The risk for a person bitten by an apparently healthy dog to develop rabies in the absence of rabies PEP was very low, which supports the WHO recommendations to delay PEP for this category of bite victims, when trained animal assessors are available and routinely communicate with the medical sector. Recent adoption of an electronic IBCM system is likely to expedite adoption of VARSP 2.0 to other Provinces and improve accuracy of field decisions and data collection.

Snake Bites in The Arabian Peninsula: A Scoping Review

INTRODUCTIONThe aim of this study is to provide a comprehensive review of snake bites in the Arabian Peninsula. METHODS A scoping review was conducted from October to December 2022, and included sources from PubMed, Ovid, the Cochrane Database, reference lists of relevant articles, and grey literature sources such as ClinicalTrials.gov and the World Health Organization’s International Clinical Trials Registry Platform. The keywords used were “Arabian Peninsula”, “Saudi Arabia”, “Qatar”, “Kuwait”, “Oman”, “United Arab Emirates”, “Bahrain”, “Yemen”, “snake venom”, “snake bite”, and “envenomation”. The inclusion criteria for selecting studies were those that explored snake bites in various regions of the Arabian Peninsula. RESULTS 28 studies were included, with a total of 16,602 snake bite cases. In 78.57% of cases, the initial presentation was a local injury. Haematological manifestations were seen in several of the reported cases, while some cases showed neurological symptoms and cardiac manifestation. Leucocytosis, thrombocytopenia/thrombocytosis, and acute kidney injury and proteinuria were also observed. The administered dose of antivenom varied, and post-antivenom complications were seen in less than one third of the reported cases. CONCLUSIONThe current body of literature does not provide a concise management plan for snake bite in the Arabian Peninsula. We provide a proposed plan for treating and monitoring such cases.

Factors Associated with Risk Exposure to Human Rabies among Mammal Bite Cases in Mukah Division, Sarawak, East Malaysia

INTRODUCTION: Rabies is a neglected disease. Before the epidemic of rabies in Sarawak in July 2017, surveillance of mammal bites was not well implemented throughout the state. Our objective was to determine the prevalence of mammal bites in the Mukah Division and the factors that are associated with the risk of exposure to human rabies. MATERIALS AND METHODS: This is a cross-sectional study that used data from reported cases of mammal bites in Mukah Division, Sarawak, from 2018–2019. A universal sampling method was used, and 457 cases of mammal bites were included in the analysis. Data was analysed using single logistic regression and multiple logistic regression. RESULTS: The prevalence of mammal bites in Mukah Division was 0.35% with a cumulative incidence of 354 per 100 000 population. Age group 0-14 years old (AOR 6.49, 95%CI 1.26-33.53), free-roaming pet (AOR 2.93, 95% 1.36-6.28) and stray mammals (AOR 10.88, 95% CI 5.05-23.48) were found to be significantly associated with risk exposure to human rabies in Mukah Division in the final model. CONCLUSION: Health awareness and education should be emphasized to the community and medical personnel on the identified risk factors so that rabies infection can be prevented.

Rabies and its prevention: are our medical students well informed?

Background: Rabies is a vaccine-preventable, viral disease. However, once clinical symptoms appear, rabies is 100% fatal. Significantly, India accounts for 36% of the world’s rabies deaths. Recently, in Kerala, a surge in dog bite cases and a consequent rise in the incidence of rabies deaths has been noted, which is a serious public health medical concern. The present study was done to assess the level of knowledge of rabies and its prevention among medical students of Government T D Medical College, Alappuzha to identify lacunae in knowledge if any and to provide sessions on rabies prevention and control. Methods: A cross-sectional study was conducted among the medical students of Government T. D. Medical College, Alappuzha in 2022. Convenient sampling was done, and data was collected using a pre-tested questionnaire which was analysed using SPSS software. Results: Out of the 261 students who took part in the study, 88.13% of the study participants were observed to have medium to sufficient level of knowledge regarding rabies and its prevention, while 11.87% had low level of knowledge. In general, the level of knowledge was noted to be roughly proportional to the year of study of MBBS. Conclusions: The level of knowledge of the participants with regards to the schedule of vaccination and knowledge of symptoms of rabies, was observed to be less than what would be desirable. Structured training and education of medical students can rectify this lacuna, and thereby bring about significant reduction in fatality rates.

Animal Bites in ENT

Introduction:&#x0D; Animal bites can range from abrasions to laceration injury and are notorious for causing infectious diseases like rabies. Four such animal bite cases presented to ENT emergency, two of them assaulted by the Royal Bengal Tiger and the remaining two were bitten by their pet dogs. The management protocol has been discussed for the four cases.&#x0D; &#x0D; Case reports:&#x0D; The first two case reports deal with tiger attack and the other two involve bites by the pet dogs. The primary management of the cases has been described, followed by definite treatment.&#x0D; &#x0D; Conclusion:&#x0D; Primary management of the case involves washing the wounds with normal saline. Anti-rabies vaccination followed by regular antiseptic dressing was done and the definite repair was done in the second sitting.