Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten
18 august 2004

BITE WOUNDS

     It was about 1:00 o’clock in the morning and the cowboy who subsequently became a patient probably shouldn’t have been where he was.  He was in a bar having had enough to drink to remove many of his inhibitions.  Somebody said something that he wished they hadn’t said and the fight was on.  The cowboy landed a punch square on the other person’s mouth and the fight was over.  The cowboy had a slight cut on his knuckle where he hit the other person’s tooth but that was o.k.  He had won the fight.

     Four days later, he came to the clinic because his hand was quite swollen and had become very painful.  There was a red streak going up his arm and a pus-like discharge was coming from the small cut on his knuckle.

He was hospitalized at this point and extensive surgery was required to drain the infection from his hand along with 10 days of intravenous antibiotics.  About $20,000 later, he was able to get back to work and about two months later, his hand was pretty much back to normal. 

The morale of the story is:
 1.  It is not good to hit other people no matter what they say.

 2.  If there is an absolutely irresistible need to strike another individual, don’t hit him in the mouth.

     Ever since insects began to sting, fish began to eat, vipers began to bite, and lions began to rip and tear with their mouth, biting has been both an offensive and defensive weapon.  Of all the emergency room visits that occur, about 1 in 100 are related to somebody being bitten.  Poisonous snakebites are relatively rare.  Dog bites are the most common and generally affect children ages from 5 to 10 years old.  Kids like to cuddle up to the dog and put their face right up close where a dog can inflict terrible wounds on the child’s face.  Most dog bites are from the person’s domestic pet dog.  Cat bites are the second most common animal bites and most generally occur on the hand.  Infections from cat bites are more common.  Human bites are about 5-10% of all of those seen in the emergency room and most aren’t really a bite.  Rather they are a cut on the fist when someone decides to slug another person.

     Other animal bites are relatively rare but can be catastrophic.  I have never seen anyone bitten by a bat, but a bat bite was responsible for 90% of all cases of rabies acquired in the United States from 1981 to 1998.  Skunks, raccoons and foxes are also common animal reservoirs for rabies.  Rabies prophylaxis is absolutely essential whenever a person is bitten by any wild animal or a stray dog or cat that cannot be subsequently isolated and evaluated.  In situations where the bite occurs from a domestic pet, rabies prophylaxis maybe indicated if the animal is exhibiting abnormal behavior such as an unprovoked attack or appears to be clinically ill.  Immediate attention to rabies considerations in these situations is essential to preventing an untreatable fatal problem.

     Humans get something we call “cold sores” that are caused by a virus called herpes simplex.  Monkeys have a similar virus.  But if a monkey virus is transmitted to a human through a monkey bite, it is a fatal condition for which we have no known treatment.  Pet monkeys are not that good of an idea. Poisonous snakebites provide a separate consideration and have been addressed in a previous column.

     The reason for writing this column was the experience of the cowboy above.  The message is to point out how dangerous dog, cat, and human bites can be.  Cat and dog bites are frequently puncture wounds which are the very best way to infect the deep structures of the hand, the face, or the foot.  These infections can be very serious as the case above illustrates.  While only 20% of bite wounds will become seriously infected, taking one chance in five of a serious infection probably is not a wise choice.

     A much better choice is to have the wound seen quickly after the bite occurs and then start antibiotic therapy for a brief period of time to prevent the infection from ever getting started.  Simply rinsing the bite off in soapy water and hoping nothing happens is not a good choice.  Bite wounds require very special attention quite different than a kitchen knife accident or a cut on broken glass or even a hunting knife accident.  Usually the most dangerous aspect of the bite is not the degree of trauma that occurs but the infection that follows.  The healthcare providers at your local clinics are well aware of these considerations and can prevent a whole lot of grief by dealing with the bite wound quickly after it occurs.