Dog Bite Wounds Research Articles

Awareness about rabies and health seeking behavior among animal bite victims attending a tertiary care hospital of Jharkhand

Background: Rabies is an acute fatal disease of central nervous system, caused by Lyssavirus Type 1. Rabies in dogs is the source of 99% of human infection. Awareness about rabies and health seeking behavior are crucial determinants of rabies control. Present study was done to assess awareness regarding animal bite and health seeking behavior among affected population.Methods: A hospital based cross sectional study was conducted in central emergency department of Rajendra Institute of Medical Sciences, Ranchi, Jharkhand for a period of four months. A semi-structured questionnaire was used for data collection. Sample size was 114 using consecutive sampling method. The participants were interviewed after taking informed consent. Data collected were entered in MS Excel and analyzed using SPSS version 20.Results: A total of 114 subjects participated in the study of which 83 (72.8%) were male and 31 (27.2%) female. Most commonly affected age group found was 21-30 years (35.1%). Majority 101 (88.6%) of them resided in urban areas, and only 79 (69.3%) acquired secondary education and above. Most of the animal bite was caused by dogs 102 (89.5%), unprovoked 79 (69.3%) in nature and most common site involved lower limb 70 (61.4%). Majority 68 (59.6%) of the dog bite wound were of category II. Only 55 (48.2%) of animal bite victims washed their wound with soap and water. Majority 58 (50.9%) of the study participants had no knowledge about consequences of dog bite. Median reporting time to tertiary institute was found to be four hours.Conclusions: There was average level of awareness about rabies among animal bite victims attending RIMS, Ranchi

Experiencia en el manejo de heridas por mordedura de perro en un hospital de tercer nivel de cirugía plástica y reconstructiva en México

Dog bite injuries represent an important public health problem, involving all levels of care. They can vary in severity, from superficial wounds (skin and subcutaneous tissue) to devitalization and tissue loss, with the presence of systemic infections, aestethic and functional sequels that require specialized treatment. To describe and share the 7-year experience in the management of dog bite wounds in a plastic and reconstructive surgery referral center in Mexico. A retrospective study was conducted where all patients with dog bite wounds that came to the plastic and reconstructive emergency department were enrolled from July 2010 to August 2017. The collected patient demographic characteristics included age, age group, and sex. The collected injury variables included anatomical location, wound characteristics, antibiotic therapy and therapeutic management. A total of 416 patients were enrolled, 63% of the dog bites occurred in children under 18 years of age. The majority of the wounds were found in an isolated anatomical region 88.2%. The most frequent location was the face in 61.3%. Of all the cases 74.3% were treated only with primary wound closure, 21.4% also required some reconstructive surgical procedure, 2.9% did not require wound closure, and 1.4% were hospitalized. All patients received prophylactic antibiotics. 2% reported infection after the management with primary wound closure. The right management of dog bite wounds in all the health care levels improve the patient prognosis. Complex dog bite wounds must be treated immediately by the plastic and reconstructive surgery department in second or third levels of healthcare. Most of the wounds can be managed by primary closure and other reconstructive techniques with confidence.

Epidemiological and clinical profile of dog bitten children and side effects of anti rabies vaccine

Background: Rabies is one of the commonest zoonotic diseases due to Lyssa virus. Rabies is a 100% fatal disease. Understanding the epidemiological and clinical profile of the victims helps in the prevention of dog bite. But rabies is 100% preventable by pre and post exposure prophylaxis vaccination. Evaluation of side effects of anti-rabies vaccine (ARV) is helpful in the pre and post exposure prophylaxis.Methods: Authors did a descriptive study of 1450 dog-bitten children. Using the pro-forma, authors interviewed the parents, examined the children. Using W.H.O classification, authors classified the dog bite wounds. Anti-rabies vaccination was administered to category 2 dog bite wounded children. Side effects of vaccination are recorded.Results: Out of 1450 children, significantly more number of boys (67%) in the age group of 10-12 years (31%), from class IV socioeconomic category (52%), nuclear families (80%), sustained category III dog bite (52%) in the lower limb (48%) by unvaccinated (82%) stray dogs (60%) while playing or walking (52%) in the street (60%) during night (72%). Purified Vero cell culture rabies vaccine is having rare mild local side effects (2%), rare mild systemic side effects (4.16%) and very rare systemic allergic reaction (0.14%) but no major side effects.Conclusions: Dog bites can be prevented by not allowing the children to play or walk alone in the street especially during night. The severity of wound can be minimized by wearing fully covered extremities. Vaccination of dogs and population control of stray dogs will reduce rabies. There were no major side-effects or adverse events following vaccination (AEFI) with anti-rabies vaccination. Rare mild local side effects and very rare mild systemic side effects may happen.

Epidemiology, Socioeconomic Analysis, and Specialist Involvement in Dog Bite Wounds in Adults.

Dog bites have been well described and characterized in the pediatric population. Comparatively, dog-bite injuries in adults and the settings in which surgeons become involved are less studied. An electronic hospital database identified all patients 18 years or older who were treated for dog bites from 2010 to 2014. Demographics, injury information, intervention type, and payer source were collected. Socioeconomic analysis was performed using Geographic Information Systems mapping. A total of 189 adults presented to the emergency department with dog-bite-related injuries. The most common injury location was the hand (n = 62, 32.8%), followed by the head and neck (n = 36, 19.1%). Of the 189 patients, 33 adults (17.5%) were forwarded to a surgical subspecialist for repair. A head and neck injury was significantly more likely to be repaired by a surgical specialist (P = 0.011). The most common breed of dog identified was pit bull (n = 29, 47.5%). The majority of pit bull attacks involved the extremities (65.5%) compared to other breeds of dogs. Pit bull victims were noted to have a lower average annual income compared to other breed victims ($64,708 versus $75,004; P = 0.16). Annual income between intervention group and no intervention group was not significantly different (P = 0.26). This study is the 1st to perform a socioeconomic analysis in the adult dog-bite population and encourages the use of a surgical specialist in the setting of a head and neck bite.

Thoracic dog bite wounds in cats: a retrospective study of 22 cases (2005-2015).

The aim of this study was to describe a series of cats suffering from thoracic dog bite wounds, in order to detail the clinical, radiographic and surgical findings, and evaluate outcomes and factors associated with mortality. The medical records of cats with thoracic dog bite wounds presenting to a single institution between 2005 and 2015 were retrospectively reviewed. Data relating to clinical presentation, wound depth and management, radiographic findings, surgical findings and mortality were collected. Wound depth was defined as no external wound, superficial, deep or penetrating, and wound management was defined as conservative, exploratory or thoracic exploration. Statistical analyses were performed using Fisher's exact test, the Mann-Whitney U-test and the χ2 test. Twenty-two cats were included, of which two were euthanased on presentation. In cats where wound depth could be assessed (21/22), six had no external wounds, four had superficial wounds, three had deep wounds and eight suffered penetrating wounds. Sixteen cats also suffered wounds elsewhere, most commonly to the abdomen. Neither an abdominal wound nor abdominal surgery were associated with mortality. Pneumothorax was the most common radiographic finding (11/18). Individual radiographic lesions were not significantly associated with respiratory pattern, presence of pseudo-flail, need for thoracotomy or lung lobectomy, or survival. The presence of ⩾3 radiographic lesions was associated with the presence of a penetrating wound (P = 0.025) and with having thoracic exploration (P = 0.025). Local exploration was performed in 7/20 cats, while 8/20 underwent thoracic exploration. Wound management type was not significantly associated with mortality. Overall mortality rate was 27%. Presence of ⩾3 radiographic lesions should raise suspicion of a penetrating injury and may be suggestive of injury requiring a greater level of intervention. The treating veterinarian should have a high index of suspicion for penetrating injury and be prepared in case thoracic exploratory surgery is necessary, particularly in the presence of pseudo-flail chest, pneumothorax or ⩾3 radiographic lesions.

Comparison of polyhexanide, cold atmospheric plasma and saline in the treatment of canine bite wounds.

To compare the efficacy of polyhexanide, cold argon plasma and saline in reducing bacterial bio-burden in dog bite wounds. Prospective blinded randomised clinical trial. Dogs were randomly assigned to one of the treatment groups by lottery and bacterial cultures obtained before and after treatment were compared. Bite wounds were surgically debrided and treated with polyhexanide, cold argon plasma or saline lavage. All wounds were cultured three times: directly after debridement, directly after prelavage with 2 mL/cm2 (saline in the saline and cold argon plasma group, or polyhexanide) and following the definitive lavage. Data were analysed using a generalised linear model for ordinal data. A total of 85 dogs were enrolled in this study (polyhexanide n=29, cold argon plasma n=28, saline n=28). Positive bacterial culture results after debridement were obtained in 53/85 (62.3%) wounds. Polyhexanide and saline lavage significantly reduced the bio-burden, while cold argon plasma treatment did not. This effect was evident after prelavage when polyhexanide performed significantly better than saline and cold argon plasma as well as after final treatment. No significant differences were detected after prelavage or main treatment between saline and cold argon plasma. Polyhexanide lavage achieved the best immediate and ultimate decontamination of bite wounds.

Knowledge, attitudes and practices towards dog-bite related rabies in para-medical staff at rural primary health centres in Baramati, western India.

The lack of awareness regarding rabies amongst rural primary care health staff and their adverse practices towards the management of dog-bite wounds is a major contributor to the high incidence of rabies infection and subsequent human mortality in India. A Knowledge, Attitudes and Practices survey was carried out involving 54 nursing and non-nursing staff working in 18 rural Primary Health centres and sub-centres around Baramati town of Pune district in Western India. Multivariable logistic regression models were constructed to assess factors that influenced knowledge of rabies and practices towards management of dog-bite related wounds. The more experienced and better-educated workers were found to have a good awareness of rabies (OR 3.4, 95%CI 1.0–12.1) and good practices towards dog-bite wound management (OR 5.6, 95%CI 1.2–27.0). Surprisingly, non-nursing staff were significantly more knowledgeable about rabies (OR 3.5, 95%CI 1.0–12.3), but their practices towards dog-bite wound management were inadequate (OR 0.18, 95%CI 0.04–0.8) compared to the nursing staff. It is recommended that a mandatory training module for primary care health staff be developed and implemented to improve their knowledge regarding rabies and management of dog-bite wounds to reduce the incidence of human rabies in rural India.

Surgical management of enterocutaneous fistula secondary to dog bite wound in a malabari goat

Enterocutaneous fistula is a rare case reported in animals. The underlying cause for the development of enterocutaneous fistula varies with every case. The goat was presented with the history of passing greenish fluid via a wound in the right lateral abdominal wall which occurred before one week due to dog bite. Clinical examination revealed normal physical parameters. The animal was having a normal feed intake with normal defecation and urination. Pain evinced on palpation of the wound followed by passing of greenish fluid through the wound. From the history and clinical examination the condition was tentatively diagnosed as a case of enterocutaneous fistula and decided to perform an emergency exploratory coeliotomy to correct the condition. A right flank coeliotomy was performed by making an incision across the wound. The necrosed ends of the intestine was resected along with the accompanying mesentery. The ends of the resected intestine was anastomosed. The abdominal wall muscles were closed in the standard surgical protocol. Post-operatively animal was treated with antibiotics and non-steroidal anti-inflammatory drugs. Animal made an uneventful recovery after the course of antibiotics along with supportive therapy.

Septic monoarthritis with isolation of P dagmatis as a monoculture in the stifle joint of a dog

A seven-month-old male cane corso was presented to our emergency clinic, with severe left hind lameness. The combination of history, physical examination, radiographs and cytology of the left stifle raised...

Diverse spectrum of facial dog bite presentation and their management

Background: Dog bite patients are frequently encountered in our hospital seeking immediate as well as delayed reconstruction. More than two third of dog bite injuries involve head, neck and scalp region. Facial dog bites present a challenge for the surgeon, as they lead to cosmetic disfigurement and psychological trauma to the patient. Following thorough washout and debridement, we have used various reconstructive techniques for definitive management of wounds like- primary repair, V-Y advancement flap, nasolabial flap, SSG, FTG and Karapandzic flap. Purpose of the present study is to share our experiences in management of dog bite wounds on the face in both adult and paediatric patients with available reconstructive options to maximize the functional and cosmetic outcomes by using basic principles of surgery.Methods: Present study was a single centre retrospective study conducted in a tertiary care centre from February 2013 to January 2018. Total 497 patients of dog bite who presented in the emergency department were enrolled. Out of them 310 patients had involvement of head, neck and scalp requiring surgical intervention in any form.Results: In last five years, we have encountered mid face predilection in face, head and neck cases. Out of 310 cases, lip (25.16%) and cheek (24.51%) were involved in majority of the patients. Flap cover surgery is required in majority of the scalp and nose group of patients, as there is less mobility of tissue present in surrounding region, while cheek and lip were managed with primary closure in most of the patients.Conclusions: Although most of the dog bites are preventable, but cases of dog bite are increasing continuously. Child should never be left alone with dogs and, if they are fear of dogs, it’s better not to obtain dogs. As far now, it’s a major concern for treating physician or surgeon to provide optimal cosmetic as well as functional outcome. Early surgical intervention for wound management gives better results with the use of basic principles of plastic surgery.

Comparative Study of Primary Closure Versus Non-Closure in Dog Bite Wounds

Introduction: Dog bites are common in India accounting to 1-2% of patients presenting to Emergency department. There is long drawn controversy regarding the treatment protocol for dog bites. Several studies have shown comparable amount of wound infection in both these techniques with better aesthetic appearance following Primary closure. We conducted a study to compare the rate of infection, aesthetic outcome & the wound healing time between Primary closure and Non-closure technique. Materials & Methods: After Ethical committee clearance,120 consecutive patients with Dog bite wounds were included in this Experimental control trial. The patients were divided into two groups based on computer-based randomization.All dog bite wounds received initial wound care. One group underwent Primary suturing of wound and in other group wounds were dressed without suturing. Prophylactic antibiotics were given to all patients. Human immunoglobulin was administered according to WHO guidelines. Infection rates, cosmetic appearance and healing time were compared. Results: The infection rate in primary closure was 8.3% as compared to 11.7% in Non-closure. However, it was not statistically significant (P=0.543). Primarily closed wounds had 86.7% good scars as compared to 11.7% in Non-closure which was statistically significant (p=0.001). We also found that the Mean healing time was 23.65 days in Primary closure and 49.05 in Non-closure. Conclusion: Primary suturing of dog bite wounds leads to faster healing rate with no significant change in the infection rate & yields a good cosmetic scar. Local infiltration of wound with immunoglobulin showed no change in the rate of infection.

Comparative In Vitro Activity of Omadacycline against Dog and Cat Bite Wound Isolates.

Omadacycline was tested against 125 isolates recovered from infected cat and dog bites in humans. Its activity was similar to that of other compounds in the tetracycline class, and it was active against strains exhibiting tetracycline resistance. Against anaerobic isolates, resistance to tetracyclines was more prominent and omadacycline was the most active of the group. All isolates had omadacycline MICs of <1 μg/ml, with the exception of Eikenella corrodens, which showed reduced susceptibility to the entire tetracycline group.

Characterization of a CC1153 PVL-producing community-acquired methicillin-resistant Staphylococcus aureus from a dog bite wound.

The isolation of a rare community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strain from an infected dog bite wound is here reported. A 27-year old man presented with a deep open wound on his right hand caused by his dog's bite at the outpatient clinic of Infectious Disease Hospital (IDH), Kuwait. A wound swab was obtained for bacteriological culture and susceptibility testing. The wound culture yielded pure heavy growth of an MRSA isolate, designated IDH70, which was susceptible to vancomycin, teicoplanin, erythromycin, clindamycin, trimethoprim, fusidic acid and rifampicin. The patient was successfully treated with a combination of rifampicin and cotrimoxazole twice daily for 10 days. Molecular characterization revealed that IDH70 was positive for genes encoding Panton-Valentine leucocidin. IDH70 also carried the SCCmec V genetic element, belonged to coagulase type XIIIa, spa type t903, and was assigned to clonal complex 1153 and sequence type ST1153 (ST1153-V-t903). The report highlights the increasing burden of CA-MRSA in the community and the risk of its acquisition from bites of companion animals.

Examining evidence on dog bite injuries and their management in children.

Dog bites are common injuries in children. The effects of such injuries can be devastating for the children concerned and their families. It is therefore important to provide holistic care and to consider psychological well-being as well as physical recovery. There should be clear guidelines for professionals about reporting dog bites and safeguarding. The literature recommends primary closure of the dog bite wound unless an infection is present. Literature also suggests that prophylactic antibiotics are ineffective in preventing infection except in hand injuries, although they are still routinely used in practice. This article recommends further research, support and education on dog bites in children, as well as national guidelines.

Retrospective analysis on emergency management of dog-bite wounds in 10 children

目的 探讨儿童犬咬伤急诊治疗的方法和疗效。 方法 回顾我院急诊科2011年5月至2013年8月收入的10例犬咬伤患儿的一般资料，评价伤口感染率及伤口愈合情况。 结果 10例犬咬伤患儿均收入院手术并行抗生素治疗，伤口均呈甲级愈合。术后随访15 d～26个月，家属对术后创口瘢痕愈合外观较为满意。 结论 儿童犬咬伤处理越早效果越好，伤后10 h以上行一期缝合会增大感染概率。考虑到患者对伤口美观的要求，伤口较大或面部重伤影响面容时，在做完清创消毒后可行Ⅰ期缝合和包扎，感染概率无明显增加。

Cave canem: HBO₂ therapy efficacy on Capnocytophaga canimorsus infections: a case series.

Dog bites are a frequent injury, but the incidence and type of lesions vary across countries. Although only few patients develop complications, the treatment of advanced injuries has a considerable medical, social and economic impact. A frequently isolated pathogen in dog bite wounds is Capnocytophaga canimorsus, a bacterium that can cause sepsis or meningitis. Hyperbaric oxygen (HBO₂) therapy has been shown to be useful in treating anaerobic infections, most likely because it creates an inhospitable environment for the bacterium and enhances the patient's immune response. We present a case series of C. canimorsus infections treated with HBO₂ in adjunction to antibiotic therapy. Furthermore, we tested the in vitro activity of ceftaroline against C. canimorsus, alone and in association with hyperbaric oxygen therapy. We included nine (9) patients admitted to the surgery department of "A. Cardarelli" Hospital (Naples) after dog bite, from 2010 to 2016. All were initially treated with antibiotics and required transfer to the intensive care unit due to worsening conditions. C. canimorsus was isolated from wounds, and HBO₂ therapy was administered in adjunction to antibiotics, until clinical improvement and microbiological test negativity. We tested the activity of hyperbaric oxygen therapy in adjunction to ceftaroline on cultured plates with C. canimorsus versus ceftaroline alone. Minimal inhibitory concentration was evaluated. Our findings confirm the utility of HBO₂ therapy after biting injuries. Indeed, increased oxygen supply to the wound (as well as in vitro) may be toxic for bacteria, can improve healing and may improve the effectiveness of antibiotics.

Prevalence, treatment and management of health conditions in pet rabbits presented to the Veterinary Teaching Hospital (VTH), University of Peradeniya

Forty five pet rabbits of different breeds with various clinical conditions were presented to the VTH from January 2014 to March 2016 reflecting an emerging trend in companion animal ownership and health concerns. Of these cases, Psoroptic mange was the commonest disease condition while traumatic injuries (26.7%) including dog bite wounds, fractures, eye conditions were regularly encountered. Chemical trauma and infectious diseases (17.8%) namely, ulcerative pododermatitis, respiratory tract and urinary tract infections; miscellaneous cases such as floppy rabbit syndrome, heat stress, nutritional deficiency and prolapsed vagina were also presented. The objective of this communication is to make the veterinary practitioners aware of the common health conditions encountered in pet rabbits and how those were treated and managed.

Complete Genome Sequence of Neisseria weaveri Strain NCTC13585.

Neisseria weaveri is a commensal organism of the canine oral cavity and an occasional opportunistic human pathogen which is associated with dog bite wounds. Here we report the first complete genomic sequence of the N. weaveri NCTC13585 (CCUG30381) strain, which was originally isolated from a patient with a canine bite wound.

APPLICATION OF DOUBLE PEDICLED FLAP AND TECHNIQUE OF GEOMETRIC BROKEN LINE FOR PRIMARY REPAIR OF SERIOUS DOG BITE WOUNDS

To evaluate the effectiveness of double pedicled flap and technique of geometric broken line (GBL) for primary repair of serious dog bite wound. Between October 2006 and December 2014, 9 patients with serious dog bite wound were treated. There were 3 males and 6 females with an average age of 34.5 years (range, 8-68 years), and with a mean disease duration of 4 hours (range, 30 minutes to 24 hours). The defect ranged from 1.7 cm×0.5 cm to 15.0 cm×8.0 cm, with the mean depth of 0.5 cm (range, 0.3-0.8 cm). Deep tissue exposure was observed. After routine debridement, a vacuum sealing drainage (VSD) was equipped to suck and irrigate for 1 day, then wound was repaired. The superomedial edge of defect was trimmed, then a GBL shape mainly with square and rectangular was designed. According to defect size, a double pedicled flap was designed at the lateroinferior edge of defect, which size ranged from 1.7 cm×1.5 cm to 18.0 cm×15.0 cm. The donor site was sutured directly. VSD was used for 3 days after operation. All flaps survived and wound healed, and donor site incision healed well, with invisible scar. All patients were followed up 6 months to 8 years (mean, 4 years). The wounds were repaired well, and the patients had good facial appearance. No rabies attack was observed during follow-up. It is an ideal repair method to chose double pedicled flap and technique of GBL for primary repair of dog bite wounds. Satisfactory cosmetic appearance can be obtained.

Whole genome sequencing identifies a novel species of the genus Capnocytophaga isolated from dog and cat bite wounds in humans.

C. canimorsus and C. cynodegmi are dog and cat commensals which can be transmitted to humans via bites or scratches and can cause sepsis, meningitis, endocarditis, and eye- or wound infections. Recently an additional Capnocytophaga species was identified as part of the oral flora of healthy dogs and was given the name “C. canis”. We previously identified a Capnocytophaga isolate that could not be typed with available diagnostic tests including MALDI-TOF, 16S rRNA sequencing or species-specific PCR. This strain and 21 other Capnocytophaga spp isolated in Sweden from clinical blood- or wound-cultures were subjected to whole genome sequencing using the Illumina platform. Phylogenetic analysis revealed that the previously non-typable isolate belongs to the putative new species “C. canis”. Since this strain was isolated from a wound it also shows that members of “C. canis” have the potential to be pathogenic. In addition, our phylogenetic analysis uncovered an additional species of Capnocytophaga, which can be transmitted from dogs and cats to humans, suggesting a speciation within the Capnocytophaga family that has not been observed before. We propose the name of “C. stomatis” for this putative novel species.