Initial assessment, investigation and wound care

• initial clinical assessment includes:
  • documenting the timing and nature of the bite and the animal (including if result of human) involved, any immunosuppression, and any known antibacterial allergies
  • if the bite is particularly severe
    • before a detailed clinical assessment, a patient may require urgent first aid treatment (e.g. to control bleeding)
  • examine wound and adjacent structures for infection; foreign bodies (e.g. broken teeth, especially in deep or crush wounds); damage to blood vessels, nerves, tendons, joints or bones; and lymphadenopathy
    • diagrams and masurements and diagrams may be helpful, particularly to document the extent of cellulitis in established infections
• identification of infective organisms:
  • swabs should be obtained from potentially contaminated or clinically infected bite wounds
  • blood cultures should also be taken for microbial culture under aerobic and anaerobic conditions if the patient is systemically unwell
    • prolonged culture for up to 7 days may be required to allow for the growth of certain anaerobic Porphyromonas spp (formerly classified within the Bacteroides spp) - therefore it is important to inform the laboratory of the nature of the injury and what sort of mammal bit the patient
    • additional culture for mycobacteria and fungi may be required when wounds are contaminated by soil, vegetative debris or water from ponds, lakes or aquaria; or if the patient is immunosuppressed, including by HIV infection; or if the patient has a wound that does not respond to antibacterial therapy
    • after a human bite, sequential serum samples may be required from the patient to check for hepatitis or HIV seroconversion
• initial wound care:
  • should include immediate irrigation with normal saline (or running drinking water if saline is not available)
  • hydrogen peroxide solution or povidone iodine are also sometimes used - however these are not recommended for large or deep wounds
  • if a person has an infected, inflamed or oedematous wound on the limbs, a human bite to the hand, or a cat-bite puncture wound over or near a joint (especially on the hands), the respective limb(s) should be elevated

Note1: if the bite is from a macaque monkey, and so could have transmitted simian herpes virus, then advice should be sought from a clinical virologist or from the Health Protection Agency.

Reference:

1. Drug and Therapeutics Bulletin (2004);42:65-72.