Mammalian Bites Author: Jeffrey D. Kravetz, MD; Daniel G. Federman, MD
Editorial changes - 2008-01-23
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Diagnosis
  • Obtain characteristics of the mammal inflicting the bite wound in order to determine initial therapy.
  • Examine the patient to determine the depth of the wound and likelihood of infection.
  • Understand patient characteristics that play a role in management of bite wounds.
  • Use laboratory testing in patients with evidence of infection to guide therapy.
  • Obtain appropriate radiographic imaging in patients with mammalian bites.
History and Physical Examination Elements for Mammalian Bites (table)
Laboratory and Other Studies for Mammalian Bites (table)
Differential diagnosis table not applicable to this module

Obtain characteristics of the mammal inflicting the bite wound in order to determine initial therapy. B

  • Determine if the bite was caused by a dog, cat, or human.
  • Determine if the bite was caused by a provoked or unprovoked animal.
  • Obtain the animal's vaccination history, especially if the bite was unprovoked.
  • Determine the time interval between bite and presentation for evaluation.
  • Use the history to determine the size of the dog inflicting bite wounds.
  • See table History and Physical Examination Elements for Mammalian Bites
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Examine the patient to determine the depth of the wound and likelihood of infection. B

  • Document all sites of bite wounds on the patient and characterize the bites as lacerations or punctures.
  • Determine the depth of the bite wound to identify injuries to underlying structures.
  • Differentiate if a human bite was occlusional (typical bite to any site other than the hand) or caused by a clenched fist (punch to another individual's mouth).
  • Examine the wound for evidence of infection (fluctuance, purulent drainage, bullae, vesicles, necrosis, ulceration, edema) or infectious complications (septic arthritis, osteomyelitis, tendonitis, tenosynovitis).
  • See table History and Physical Examination Elements for Mammalian Bites.
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Understand patient characteristics that play a role in management of bite wounds. C

  • Recognize that immunosuppressed patients are more prone to infection and can present with attenuated signs of soft tissue infection on examination.
  • Determine the tetanus and rabies immune status of all patients with bite wounds.
  • Obtain a complete allergy history from all patients presenting with mammalian bites.
  • See table History and Physical Examination Elements for Mammalian Bites.
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Use laboratory testing in patients with evidence of infection to guide therapy. C

  • Obtain both aerobic and anaerobic cultures from infected wounds before debridement and after removal of overlying tissue.
  • Do not culture bite wounds that do not appear infected clinically.
  • See table Laboratory and Other Studies for Mammalian Bites.
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Obtain appropriate radiographic imaging in patients with mammalian bites. C

  • Obtain x-rays in patients with crush injuries, suspected fractures, and to evaluate for foreign bodies or osteomyelitis.
  • Obtain an ultrasound of the finger if there is evidence of purulent or pyogenic tenosynovitis on examination.
  • Consider computed tomography scans of the head to evaluate for facial fractures in children with dog bite wounds to the head and midface.
  • Consider carotid angiography in dog bite wounds to the neck or base of skull.
  • See table Laboratory and Other Studies for Mammalian Bites.
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FAQs
Daniel G. Federman, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Jeffrey D. Kravetz, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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