Human Bite – Wise
English name: Human Bite
It is estimated that 250,000 human bites occur each year in the United States, most of them in children; Up to 25% of these infections are contaminated. The possibility of infection of the bite is determined by the depth and location of the wound and other factors related to the infected person such as the strength of his or her immune system. There is no truth in what is circulated among people that a human bite is more dangerous than an animal bite.
Types of bites
Determining the type of bite is important to determine how to treat and deal with it. Therefore, bites can be divided into three main types:
First: minor bites
They happen unintentionally, such as what happens when you are nervous about biting your fingertips or clipping your nails with your teeth. The contamination rate is 2%.
Second: occlusal bite
Occlusal bites are blunt bites from human teeth, appearing as a semicircular or oval area with redness or bruising, most often occurring on the fingers, hands, or arms of young children and adult women. If the bite does not penetrate the skin, this generally means that no infection has occurred. The incidence of contamination is 10%.
In children, snap bites on the face, upper limbs or torso occur as a result of aggressive play; These wounds are often minor. However, a large bite mark on the child (the distance between the canines is more than 2.5 cm) may indicate that the bite was from an adult and it must be ensured that there is no domestic violence or intentional abuse of the child.
Third: Clenched-fist injuries
Clenched fist injuries are painful lacerations that occur when one person’s fist strikes another’s teeth. It most commonly occurs in teens and men. Finger bones and knuckles can lead to introduction of both skin and oral microbes into the superficial layers of the hand, with possible spread to nearby soft tissues and joints. The scratches are small (usually less than 15 mm) and usually occur on the knuckles of my middle and ring fingers.
Human bite wounds should be carefully evaluated for signs of infection, and the condition of the blood vessels and nerves surrounding the bite. Hand wounds should be examined with fingers extended and in a clenched fist position. The infection rate is 25%.
Signs of infection
The infection may be superficial, such as dermatitis, or it may be deep and reach joints and bones. Signs of infection are usually few upon arrival at the hospital, but this does not negate contamination of the wound or the presence of infection because it may be in its infancy and may increase upon returning home if the wound is not treated properly.
It is characterized by the presence of heat, pain, redness, and swelling, and this may be accompanied by purulent secretions. A superficial abscess may also form.
In addition to the signs of superficial infection, the pain develops within a few days, and the intensity of the pain is greater than the intensity expected from the shape of the bite (a simple injury with severe pain). The whole body temperature may rise, with the pain continuing even after the external disinfection of the bite and the use of antibiotics. Deep infection occurs more often in patients with immunodeficiency or nerve damage.
Microbes associated with a human bite
* Microbes live naturally on human skin or inside the mouth.
Other microbes include:
- Hepatitis B
- Hepatitis C
- Herpes simplex virus HSV
– If the bite is simple, superficial and uncontaminated, there is no need for any laboratory tests.
– If the bite is contaminated and there are signs of muscle or bone inflammation, laboratory tests are necessary. Cultures should also be obtained from contaminated wounds to accurately identify the microbes causing the infection and direct antibiotic treatment accordingly. In some severe cases, blood poisoning may occur, which requires a blood culture as well.
Patients with clenched fist injuries require radiographs to look for a fracture, joint disorder, or the presence of a foreign body. Ultrasound may help differentiate cellulitis from a purulent abscess.
1. An uninfected bite
In the absence of signs of wound infection (upon physical examination or imaging), treatment includes wound care and removal of foreign bodies (if present). In addition, the need for antibiotics and prophylaxis for tetanus, hepatitis B, and HIV should be evaluated.
Clean the wound
The most important factors for preventing infection in patients with bite wounds include:
- Control of bleeding
- Clean the wound with soap and water, povidone-iodine, or another antiseptic solution
- Local anesthesia and then better cleaning by sterile saline solution and removal of damaged tissue
- Carefully re-examine the clean wound
- Determine whether wound closure is appropriate
Should human bite wounds be closed?
in general no Wounds resulting from a human bite must be closed because closing the wound with the possibility of microbes inside it increases the risk of infection, and the edges of large wounds can be rounded, but not completely closed.
There are some exceptions, such as facial wounds, which can leave an unsightly mark if left open, but if they are closed, the wound must be carefully monitored to ensure that no infection occurs.
Prevention using antibiotics
Minor, superficial human bites that did not penetrate the skin do not require antibiotic prophylaxis.
However, there are some factors that may prompt the doctor to prescribe antibiotics, such as:
- Tendon ruptures and wounds that require surgical repair
- Wounds on the hand, face, or genital area
- Wounds near a bone or joint (including artificial joints)
- Weakened immunity in the affected person (including diabetes)
- Cracking and deformation of the area around the wound
* The duration of prophylactic oral antibiotics is three to five days.
2. An infected bite
If signs of infection are present, treatment includes assessment of the need for surgical consultation, removal of damaged tissue and foreign bodies (if present), transplantation (wound culture as well as blood culture), and antibiotic treatment. In addition, the need for prophylaxis against tetanus, hepatitis B, and HIV should be assessed.
Clean the wound
The wound is cleaned in the same way as before, taking care to remove damaged tissue. If the wound was closed with sutures (stitches); It must be loosened and left open, with the possibility of rounding the borders of the wound slightly, but not closing it completely.
In cases where the doctor suspects the presence of microbes in the wound, he will prescribe an antibiotic, and he may take samples from the wound and blood and send them for transplantation.
In some cases, the doctor may need to give antibiotics by injection, such as:
- Signs of toxicity (eg: fever over 38°C, low blood pressure, or persistently increased heart rate)
- Deep infection (arthritis, osteoarthritis, tenosynovitis, or bacteremia)
- Rapid spread of inflammation surrounding the wound
- The condition worsened 48 hours after treatment with oral antibiotics
- Inability to tolerate oral therapy
In the absence of an abscess or blood poisoning, the duration of treatment generally continues from 5 to 14 days through oral medication, provided that the treatment continues for one or two days after the disappearance of symptoms. In the event of an abscess, it must be opened and cleaned, and he may receive injection therapy for a short period, then return to oral treatment for the same previous period. As for when there is blood poisoning, treatment is at the discretion of the doctor and usually requires a longer period.
- In cases where the skin has been penetrated, a tetanus shot should be given if the patient has not received it recently.
- The possibility of transmission of the human immunodeficiency virus, or hepatitis B and C through the human bite is very low, except in the case of the appearance of the blood of the victim mixed with the saliva of the perpetrator, then a doctor should be referred immediately to take the necessary action.
- In some countries, especially in which infectious diseases such as AIDS and hepatitis are spread, the interest in human bites is greater, and doctors there take additional steps to prevent these injuries, especially if the attacker is unknown.