Human Bite Infections Clinical Presentation

A thorough, detailed history is necessary to facilitate communication between various health care professionals involved in the treatment of the patient and to document why the plan of care was appropriate.

When questioned as to the nature of the injury, patients often mislead the examiner out of embarrassment or fear of legal repercussion. These cases are often assault cases and are more likely to involve the judicial system. With that in mind, documentation should be clear, concise, and complete.

• Natural history of the wound

  • Circumstances surrounding the injury
  • Precipitating event or activity
  • Exact mechanism of injury
  • Time of occurrence
  • Location of occurrence
  • Whether the other party involved is known to the patient and available should testing be indicated
  • Treatment initiated prior to presentation
• Presence of signs or symptoms related to the wound

  • Pain
  • Fever
  • Swelling
  • Discharge or odor
  • Tobacco, alcohol, or recreational drug use
• Medications or allergies to medications
• Tetanus immune status
• Ability to comprehend the magnitude of injury and to cooperate with the treatment plan
• Comorbid conditions that may place the patient at a higher risk for infection or its sequelae

  • Diabetes mellitus
  • Chronic edema of the region (eg, prior ipsilateral axillary node dissection for an upper extremity wound)
  • Prior splenectomy
  • Liver disease
  • Immunosuppression
  • Presence of a prosthetic valve or joint
  • Regional arterial or venous disease

• A thorough physical examination is necessary to evaluate the overall state of health, comorbidities, nutritional status, and mental status of the patient.
• Following the general physical examination, turn attention toward the wound. Assessment of the wound can be quite difficult and is often inaccurately or inadequately performed.
• Adequate examination of the wound may require administration of intravenous or oral pain medication to ensure patient comfort.
• Small wounds, particularly in the hands, may require extension for adequate evaluation.
• Important aspects of wound assessment

  • Location
  • Shape
  • Size
  • Type (puncture, laceration, avulsion or crush)
  • Depth of penetration
  • Drainage (quantity, character, odor)
  • Presence of a foreign body (tooth fragments, particulate matter)
  • Loss of tissue
  • Tenderness
  • Asymmetry
  • Surrounding erythema, edema, cellulitis, or crepitance
  • Neurovascular status
  • Violation of tendon, cartilage, joint spaces, or bone: This may be difficult to detect on initial examination and may require operative exploration to adequately diagnose.
  • Regional lymphadenopathy
  • Examine hand injuries through the full range of hand motions, particularly in clenched-fist injuries
  • Although not standard in all centers, the following guidelines for wound documentation in cases of assault have been established by the American Board of Forensic Odontology:^[3]
    • Photographic documentation
    • Wound diagram, including notation of arch pattern and intercanine width
    • Bite mark impressions
    • Swabbing of the wound for tissue typing

• Aggressive behavior, often in combination with alcohol (the cause of most clenched-fist injuries)
• Rough sexual play or sexual assault
• Domestic violence
• Child abuse
• Occupational injury to dental personnel
• Seizure-related tongue lacerations
• Nose-biting (punishment for adultery in several cultures^[4] )
• Accidents during sporting events
• Aggressive play of children in daycare centers
• Self-inflicted wounds in persons who are emotionally disturbed or mentally handicapped