Mammalian Bites Research Articles

All the Better to Taste You With, My Dear: ED Management of Mammalian Bites.

Mammal bites account for over 5 million visits to Emergency Departments (EDs) annually. Nurse Practitioners (NPs) need to stay abreast of current guidelines, changes to antibiotic regimens that are now most effective, and understand in what circumstances collaboration with other specialists is indicated. It is not enough to care for the wound, itself, but rather understand in what presentations additional care may be needed despite the fact that there is no clear evidence at the time of evaluation of the need for advanced care. Additionally, NPs should understand what resources are available within their community for wound care that may exceed the scope and ability of the facility in which they practice. Health departments may need to be utilized in the care of ED patients who present with wounds that are suspicious for rabies. Finally understanding what constitutes a high, medium, and low risk bite will aide NPs in delivering optimal care within the communities they serve while also minimizing patient morbidity.

Reinterpretation of tuberculate cervical vertebrae of Eocene birds as an exceptional anti-predator adaptation against the mammalian craniocervical killing bite.

We report avian cervical vertebrae from the Quercy fissure fillings in France, which are densely covered with villi-like tubercles. Two of these vertebrae stem from a late Eocene site, another lacks exact stratigraphic data. Similar cervical vertebrae occur in avian species from Eocene fossils sites in Germany and the United Kingdom, but the new fossils are the only three-dimensionally preserved vertebrae with pronounced surface sculpturing. So far, the evolutionary significance of this highly bizarre morphology, which is unknown from extant birds, remained elusive, and even a pathological origin was considered. We note the occurrence of similar structures on the skull of the extant African rodent Lophiomys and detail that the tubercles represent true osteological features and characterize a distinctive clade of Eocene birds (Perplexicervicidae). Micro-computed tomography (μCT) shows the tubercles to be associated with osteosclerosis of the cervical vertebrae, which have a very thick cortex and much fewer trabecles and pneumatic spaces than the cervicals of most extant birds aside from some specialized divers. This unusual morphology is likely to have served for strengthening the vertebral spine in the neck region, and we hypothesize that it represents an anti-predator adaptation against the craniocervical killing bite ("neck bite") that evolved in some groups of mammalian predators. Tuberculate vertebrae are only known from the Eocene of Central Europe, which featured a low predation pressure on birds during that geological epoch, as is evidenced by high numbers of flightless avian species. Strengthening of the cranialmost neck vertebrae would have mitigated attacks by smaller predators with weak bite forces, and we interpret these vertebral specializations as the first evidence of "internal bony armor" in birds.

The Food-Crushing Reflex and Its Inhibition

Anterior tooth (ANT) contacts induce a short-latency reflex inhibition of the human jaw-closing muscles. The jaw is a rigid class 1 lever for pinpoint targeting muscle force into a single bite point, the pivoting food particle. Seesaw reflex movements around the food particle fulcrum multiply the food-crushing force. Unpredictable jolts of reaction force caused by food crushing are subjected to the rostral ANT and caudally to the two articulate ends of the jaw triangle. The compression/distraction strains of food crushing must be monitored and inhibited by withdrawal reflexes. The mesencephalic ganglion (Vmes), neural myelin sheath, and muscle stretch receptors evolved subsequently to the advent of jaws to improve the velocity of proprioceptive and withdrawal reflexes. In mammalians, the spindles of the taut motor units, stretched by the food fulcrum, send excitatory monosynaptic feedback for the efferent neurons of the respective ipsilateral muscle units via the Vmes. In the Vmes, the spindle-input-mediating afferent neurons are coupled with another source of afferent feedback, which is also excitatory, from the back tooth (BAT) mechanoreceptors. The two sources of excitatory pulses are summated and targeted for the efferent neurons to boost the stretched and taut motor units. Likewise, the afferent feedback from the ANT mechanoreceptors is also coupled in the Vmes with concomitant feedback from spindles. The ANT output, however, is inhibitory to negate the excitatory feedback from the stretched jaw muscle units. The inhibitory feed from the anterior teeth temporarily blocks the excitatory potential of the masticatory motor efferent neurons to protect the anterior teeth and jaw joints from inadvertent strains. The inhibitory inputs from the anterior teeth alternate with the excitatory inputs from the BAT to determine which jaw-closing muscle units are activated or inhibited at any given instant of food crushing. The Vmes exists in all jawed vertebrates, and its evolution was probably motivated by demands for the control of bite force. The monosynaptic unilateral food-crushing excitatory and inhibitory reflexes (UFCRs) override the coexisting bilaterally executed feed for the jaw muscles from the central nervous system. The hypothesis proposed in this study is that the Vmes-mediated UFCRs combine neural inputs from tooth contacts with concomitant feedback from the muscle stretch receptors for the control of the mammalian food-crushing bite force.

Mammalian Bites: Infection Prevention and Management

Mammalian Bites: Infection Prevention and Management

“The role of antibiotics in revision amputation: A single institution 10 Year experience”

Revision amputation remains an important consideration in the management of severely crushed or contaminated finger injuries. The duration and type of antibiotic usage in revision amputations vary greatly among providers. This study sought to elucidate the role of antibiotics in revision amputations performed in the emergency department. A retrospective review of all patients who underwent revision amputations by the plastic surgery division in the emergency department was performed. 150 patients with 190 digit amputations met the inclusion criteria. 136 patients (91%) received antibiotics at the time of revision amputation. 61 (41%) received a single dose of IV antibiotics alone, 24 (16%) received a course of outpatient oral (PO) antibiotics, and 51 (34%) patients received a combination of a single dose IV and a course of outpatient PO antibiotics. There was an 12% complication rate and a 4% infection rate. There was no significant difference found in the rates of infection across antibiotic groups. For performing revision amputation in the Emergency Room setting, the best treatment would be meticulous debridement, irrigation, and closure of the wound. We recommend a single dose of IV antibiotic for prophylaxis, except for cases involving mammalian bite wounds. • Antibiotic use in digit revision amputation is varied. • Extended regimens of antibiotics may not be needed. • A single dose of IV antibiotic may be sufficient in preventing infection.

Management of mammalian bites to the external genitalia: a scoping review

To review existing publications to determine the approaches for the medical and operative management of mammalian bites to the external genitalia. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Review guidelines were followed. Four databases were searched. Articles were independently screened and analysed by two reviewers. Publications were included if detailed summaries of genitalia bites and management were documented. Discrepancies were resolved by a third reviewer. Data were extracted from the final article cohort. A total of 42 articles were included in this scoping review with 67 cases of mammalian bites to the genitalia reported in the cohort. The most common injury site was the penis (44.9%). Dog and human bites were the most common type of mammalian bites (61.2% and 26.9%, respectively). In all, 13.4% of cases were managed with medical therapy while 86.6% of cases required surgical intervention. The most common intervention was wound irrigation, debridement, and primary closure (32.8%). Although uncommon, other operative approaches included skin flaps (7.5%) and grafts (4.5%), re-implantation (4.5%), urethroplasty/repair (7.5%), penectomy (3.0%), scrotoplasty (3.0%), and perineal urethrostomy (1.5%). The reported complication rate was 19.4%. The mean follow-up time was 39.9 months. Trauma related to mammalian bites is associated with high utilisation of healthcare resources and cost. Although management of such bites to the genitalia is controversial, surgical intervention is often warranted ranging from simple debridement of devitalised tissue to complex reconstructive surgery. This review underscores the need for further investigation of mammalian bites to the genitalia to improve surgical options and monitor for long-term complication rates.

Two-Screen Virtual Board Game Didactic for Teaching Wilderness and Environmental Medicine Topics to Emergency Medicine Residents.

This game is appropriate for medical students, interns, junior and senior residents. The COVID-19 pandemic has forced a transition from in-person to virtual learning, and educators must innovate and adapt to keep learners engaged. One way to achieve this is through gamification.1 The authors employed a novel approach to gamification of virtual learning which engaged not only learners' computers but also their mobile phones. Learners worked in teams communicating by text message to answer ABEM board-style questions and occupy sites on the virtual board. By the end of this didactic, the learner will:1. Describe the basics of the presentation of each topic listed above2. Recall the basics of management of each topic listed above3. Improve learners' preparedness for the Emergency Medicine Inservice Exam and Written Board Examination. Wilderness and environmental medicine topics were selected from the list of topics covered on the ABEM boards. Questions were then written by the authors teaching these concepts. Learners were surveyed immediately following the session using an evaluation tool containing both Likert-scale questions on quality and applicability as well as open-ended questions on strengths and areas for improvement. The response rate to this survey was 100%. Feedback was overwhelmingly positive, with 19/20 respondents rating the sessions 5/5 for effectiveness and value of teaching compared with other sessions, and 1/20 rating the session 4/5. Nineteen out of twenty respondents rated the content as "highly relevant"; 1/20 rated it as "mostly relevant." Nineteen out of twenty respondents rated the session 5/5 for being engaging and holding their attention; 1/20 rated it as somewhat engaging. Learners rated the session as highly relevant and engaging. We hypothesize that by engaging two screens and forcing learners to work together by text message, we were able to turn what would normally be a distraction (texting co-residents during resident conference) into a tool for learning. Electrical injury, lightning strike, thermal burns, inhalational injury, chemical burns, acute radiation syndrome, snake bites, scorpion envenomation, stingray envenomation, jellyfish stings, black widow spider bites, mammalian bites, rabies, murine typhus, bear encounters, decompression sickness, arterial gas embolism, drowning, dehydration, heat stroke, exercise-associated hyponatremia, frostbite, hypothermia, CO poisoning, hydrogen sulfide poisoning, giardia.

Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families.

This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk. We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/poisoning, psychiatric/behavioral complaints, or any complaint triaged as "least urgent"). Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0-3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5-7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9-2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4-1.9) were predictive of a high SRS. Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.

Animal Bites Presenting to the Emergency Department

Context: Animal bites including insect, reptile, and mammalian bites are common presentations to the emergency department (ED). Although profile and outcome of individual bites are described in detail, the literature on comprehensive overall clinical spectrum and seasonal variation of all animal bites is scant. Aims: To describe the spectrum, seasonal variation, clinical features, and outcomes of all patients presenting as emergencies due to animal bites. Methods: All the patients who presented to the ED of a large tertiary care hospital in South India with bites from January 2017 to December 2018 were retrospectively included in the analysis. Results: During the 2-year study period, animal bites constituted 0.83% of all ED admissions with 1145 incidents included in our analysis. The various animal bites/stings were classified as follows: mammal bites (480: 41.9%), arthropod bites (275: 24%), reptile bites (290: 25.3%), and unknown bites (100: 8.6%). We found an increase in the incidence of bites during the monsoon months of July to September (average: 58 cases per month) in our geographical locality. More than half (46: 58%) of scorpion stings had features of envenomation while a quarter (19: 24%) had the signs of autonomic storm. Snake bites constituted a quarter (25.2%: 289/1145) of all animal bites with 66% (191/289) showing features of envenomation. Dog bites constituted the majority of mammalian bites with 73% (352/480), followed by rat bites (14%: 68/480), cat bites (7.5%: 37/480), human bites (2.5%: 12/480), and monkey bites (1.9%: 9/480). The World Health Organization rabies exposure Category 3 bites were seen in 48%, 12%, and 27% of dog, rat, and cat bites, respectively. Conclusion: Snake and dog bites comprised the majority of all animal bites. There was a clear seasonal pattern with increased prevalence of bites during the rainy season.

How does primary closure compare with delayed or no closure for people with traumatic wounds due to mammalian bite?

How does primary closure compare with delayed or no closure for people with traumatic wounds due to mammalian bite?

Crocodylus acutus (American crocodile) bite marks on a nest data logger.

Several data loggers deployed to monitor temperature and humidity of Crocodylus acutus (American crocodile) nests in South Florida could not be located after hatching. One badly damaged data logger was retrieved, providing insight into the possible fate of the others. Using a taphonomic approach, we identified numerous indentations, consistent with crocodylian bite marks, and inconsistent with potential mammalian or squamate bites. It seems most likely that the data logger was damaged by the nesting C. acutus rather than during attempted nest predation. Estimated bite forces for reproductive age, female C. acutus exceed the predicted material properties of the data logger’s housing, suggesting that the bites were exploratory in nature. We suggest that data loggers be removed prior to hatching or permit remote data storage.

A Descriptive Analysis of the Patients Presenting with Mammalian Bites in the Emergency Department of the Lady Reading Hospital, Khyber Pakhtunkhwa, Pakistan

Background: Animal and rodent bites are a common occurrence in Pakistan, but little is known about the characteristics of the injuries incurred and the patient pattern in the Khyber Pakhtunkhwa province of Pakistan. This study aims to describe the injuries caused by the animal and rodent bites and characteristics of the patients presenting at the Emergency Department of the Lady Reading Hospital, Peshawar, Pakistan. Methods: This cross-sectional study is based on a retrospective analysis of the records of patients presenting at the animal bite clinic from Jan- June, 2018 at the Emergency Department, Lady Reading Hospital using R statistical software. All patients presenting to the clinic during this period with a history of mammalian bite were included in the study. Findings: A total of 5054 presented during the reporting period of whom 83% belonged to Peshawar district. Dog bite cases were mostly from multiple areas in the outskirts of Peshawar and Yakatoot. Majority of rat bite cases from Peshawar inner city areas, Nothia Cantt and suburbs. Four out of 5 patients were males and the mean age of the patients at 20 years (SD=15.26). More than 80% of bite cases were less than 30 years old in both genders. The prevalence of dog bites was highest at 78.40%, in the patients included in the study, followed by rat bites at 16.30%, and 5.30% by other animals. 52% of bites were caused by stray animals. Upper and lower extremities were predominant sites of bites in contrast to back, head and chest regions. Most frequent exposure category was Category II i.e. nibbling of uncovered skin and abrasions for 3 out of 4 cases (77.20%), followed by Category III i.e. single or multiple transdermal bites and/or contamination of mucous membranes (4.10%). Category I was the least frequent i.e. touching or feeding of animal or human cases and licks on intact skin (2.30%). Around 79.40% patients were treated with antirabies vaccine (ARV) + tetanus toxoid (TT) + antibiotics (Category II patients by dogs and other animals), 16.40% with TT + antibiotic (mostly rat bite patients) and 4.20% with ARV + TT + Immunoglobulin + antibiotics (all category III patients by dogs and other animals). Conclusions: Bites by dogs and rats constitute the vast majority of cases presenting at the Lady Reading Hospital, Peshawar and signify the enormity of this public health problem at population level. A coordinated and targeted response with multi-sectoral interventions is direly needed to decrease the burden of disease and mortality due to animal bites in Khyber Pakhtunkhwa.

​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite.

Mammalian bites are a common presentation in emergency and primary healthcare facilities across the world. The World Health Organization recommends postponing the suturing of a bite wound but this has not been evaluated through a systematic review. To assess the effects of primary closure compared with delayed closure or no closure for mammalian bite wounds. In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We included randomised controlled trials which compared primary closure with delayed or no closure for traumatic wounds due to mammalian bite. Two review authors independently screened titles, abstracts and full-text publications, applied the inclusion criteria, and extracted data. We pooled data using a random-effects model, as appropriate. We used the Cochrane 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We found three trials (878 participants) that compared primary closure with no closure for dog bites and one trial (120 participants) that compared primary closure with delayed closure. No other mammalian bite studies were identified. The trials were from the UK (one trial), Greece (one trial) and China (two trials). Overall, participants from both sexes and all age groups were represented. We are uncertain whether primary closure improves the proportion of wounds which are infection-free compared with no closure, as the certainty of evidence for this outcome was judged to be very low (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.05; 2 studies, 782 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. There is no clinically important difference in cosmesis (acceptable physical/cosmetic appearance) of dog bite wounds when primary closure is compared with no closure (mean difference (MD) -1.31, 95% CI -2.03 to -0.59; 1 study, 182 participants). The certainty of evidence for this outcome was judged to be moderate (we downgraded our assessment by one level for imprecision). We are uncertain whether primary closure improves the proportion of dog bite wounds that are infection-free compared with delayed closure, as the evidence for this outcome was judged to be very low (RR 0.98, 95% CI 0.90 to 1.07; 1 study, 120 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. None of the four trials reported any adverse outcomes such as death or rabies but they were, in any case, unlikely to have been large enough to have satisfactory power to provide precise estimates for these. Important outcomes like time to complete wound healing, proportion of wounds healed, and length of hospital stay were not evaluated. All the studies we identified concerned dog bites. There is no high-certainty evidence to support or refute existing recommendations concerning primary closure for dog bites. The potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain and more robust trials are needed.

Evaluating and treating mammalian bites.

Mammalian bites, typically from dogs, cats, or humans, are a common presentation in EDs and family practice settings, and patients present with varying degrees of complexity. Injuries can range from local to systemic, including aggressive bacterial infections and permanent limb impairment. Using a systematic approach to initial wound assessment, followed by appropriate diagnostic testing and treatment, is critical to improved long-term patient outcomes.

Emergency department presentations with mammalian bite injuries: risk factors for admission and surgery.

The incidence of animal bite injuries in Australia is high. There is currently no established method for reliably predicting whether a patient with a bite injury will require admission to hospital or surgery. A retrospective audit of mammalian bite injuries at seven major hospitals in Melbourne, Victoria, over a 2-year period. The associations between each predictor and outcome of interest were analysed with univariate and multiple regression analyses. Seven major hospitals in Melbourne, Victoria: the Alfred Hospital, Austin Hospital, Frankston Hospital, Monash Medical Centre, Royal Melbourne Hospital, St Vincent's Hospital and Western Hospital. Patients presenting to emergency departments with mammalian bite injuries. Hospital admission, intravenous antibiotic therapy, surgery, reoperation, readmission. We identified 717 mammalian bite injuries. The mean age of the patients was 36.5 years (median, 34 years; range, 0-88 years), with an equal number of males and females. The overall rate of hospital admission was 50.8%, and the mean length of stay was 2.7 days. Intravenous antibiotics were administered in 46% of cases; surgery was undertaken in 43.1% of cases. The re-operation rate was 4.5%, the re-admission rate was 3%. Our study provides a detailed epidemiological analysis of animal bite injuries at seven major hospitals in Victoria. Risk factors for hospitalisation and surgery may assist in identifying patients who require admission and surgical intervention.

Treatment and outcome of unusual animal bite injuries in young children.

Animal bites are a major cause of preventable traumatic injuries. To provide more epidemiological information on animal bites, and assist in increasing awareness of the problem. A retrospective chart review was performed including children aged >13 years presenting with bite injuries (excluding dog and human bites) to the trauma unit at Red Cross War Memorial Children's Hospital, Cape Town, South Africa, over a 25-year period. Two hundred and thirteen children were eligible to be entered into the study. The median age was 2.9 years (range 1.2 - 6.5), with boys slightly predominating (54.9%). Most (74.6%) of the bite injuries were inflicted by mammals, the majority (64.8) of mammalian bites being rat bites. The proportions of boys and girls in the age group 0 - 4 years bitten by rats significantly differed from the proportions in the age group >4 years (p=0.039). In the age group 0 - 4 years more girls suffered rat bites, while more boys were bitten in the age group >4 years. Of 91 rat bites, 81 (89.0%) occurred inside the house. The hands (43.9%) and the head/face/neck region (39.0%) were most affected. The underdeveloped suburbs of Philippi, Gugulethu and Khayelitsha in Cape Town represented a disproportionate number (41.6%) of rat bites. There is a relationship between poverty, unemployment, poor housing, informal settlements and rodent infestation. These high-risk populations need to be the target for government rat eradication programmes.

Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department

IntroductionEmergency department presentations after mammalian bites may be associated with injection of bacteria into broken skin and may require prophylactic antibiotics to prevent subsequent infection. We aim to describe the epidemiology of patients presenting with a mammalian bite injury and antibiotic choice to an Australian adult tertiary centre. MethodsA retrospective cohort study was performed capturing all presentations after mammalian bite wounds between 01 Jan 2014 and 31 Dec 2014. An explicit chart review was conducted to determine management of each case. Cases were subgrouped into high- and low-risk groups as defined by the Australian Therapeutic Guidelines for animal bites. ResultsThere were 160 cases of mammalian bite wounds included, with 143 (89.4%) patients grouped as high-risk and 17 (10.6%) patients identified as low-risk. High-risk features were delayed presentation > 8 hours (57 patients, 35.6%), bites to the head, hand or face (113 patients, 70.6%), and puncture wounds unable to be adequately debrided (74 patients, 46.3%). There was a significant association with delayed presentation of more than eight hours and clinically established infection [OR 36.2; 95% CI: 12.6–103.6; P < 0.001]. Prescriptions for antibiotics that adhered to current guidelines occurred in 99 (61.9%) cases. ConclusionsThis study highlights variability in antibiotic prescription practice among clinicians and the need for ongoing education on antibiotic stewardship. Intervention strategies, including ongoing education, are indicated to improve adherence to antibiotic guidelines.

Immunogenicity and Serological Cross-Reactivity of Saliva Proteins among Different Tsetse Species

Tsetse are vectors of pathogenic trypanosomes, agents of human and animal trypanosomiasis in Africa. Components of tsetse saliva (sialome) are introduced into the mammalian host bite site during the blood feeding process and are important for tsetse’s ability to feed efficiently, but can also influence disease transmission and serve as biomarkers for host exposure. We compared the sialome components from four tsetse species in two subgenera: subgenus Morsitans: Glossina morsitans morsitans (Gmm) and Glossina pallidipes (Gpd), and subgenus Palpalis: Glossina palpalis gambiensis (Gpg) and Glossina fuscipes fuscipes (Gff), and evaluated their immunogenicity and serological cross reactivity by an immunoblot approach utilizing antibodies from experimental mice challenged with uninfected flies. The protein and immune profiles of sialome components varied with fly species in the same subgenus displaying greater similarity and cross reactivity. Sera obtained from cattle from disease endemic areas of Africa displayed an immunogenicity profile reflective of tsetse species distribution. We analyzed the sialome fractions of Gmm by LC-MS/MS, and identified TAg5, Tsal1/Tsal2, and Sgp3 as major immunogenic proteins, and the 5'-nucleotidase family as well as four members of the Adenosine Deaminase Growth Factor (ADGF) family as the major non-immunogenic proteins. Within the ADGF family, we identified four closely related proteins (TSGF-1, TSGF-2, ADGF-3 and ADGF-4), all of which are expressed in tsetse salivary glands. We describe the tsetse species-specific expression profiles and genomic localization of these proteins. Using a passive-immunity approach, we evaluated the effects of rec-TSGF (TSGF-1 and TSGF-2) polyclonal antibodies on tsetse fitness parameters. Limited exposure of tsetse to mice with circulating anti-TSGF antibodies resulted in a slight detriment to their blood feeding ability as reflected by compromised digestion, lower weight gain and less total lipid reserves although these results were not statistically significant. Long-term exposure studies of tsetse flies to antibodies corresponding to the ADGF family of proteins are warranted to evaluate the role of this conserved family in fly biology.

​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite

​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite

Human and other mammalian bite injuries of the hand: evaluation and management.

The hand is the most common site for bite injuries. Because of specific characteristics of hand anatomy, bite mechanics, and organisms found in human and animal saliva, even small wounds can lead to aggressive infections. Failure to recognize and treat hand bites can result in significant morbidity. Human and animal bites most commonly lead to polymicrobial bacterial infections with a mixture of aerobic and anaerobic organisms. Pasteurella species are commonly found in dog and cat bite wounds, and Eikenella is characteristic of human wounds. Staphylococcus, Streptococcus, and anaerobic bacterial species are common to all mammals. Although public health measures in developed countries have been highly effective at reducing rabies transmission, dog bites remain the most common source of rabies infection worldwide. Human bites can transmit HIV, hepatitis B, or hepatitis C, especially when contaminated blood is exposed to an open wound. Appropriate management of any mammal bite requires recognition, early wound cleansing, evaluation of injured structures, and infection prophylaxis. Structural repair is performed as indicated by the severity and contamination of the injury, and wounds may require delayed closure. Wound infections typically require débridement, empiric antibiotics, and delayed repair or reconstruction.