eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Human Bite Infections: Differential Diagnoses & Workup

Author: Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine
Contributor Information and Disclosures

Updated: Aug 5, 2009

Differential Diagnoses

Cellulitis
Tetanus

Workup

Laboratory Studies

  • No laboratory studies are required unless bacteremia or sepsis is suspected.
  • If indicated, draw appropriate baseline viral titers from the patient and the assailant.

Imaging Studies

  • Radiography may be useful, particularly in hand injuries or over bone, to reveal fractures, foreign bodies (tooth fragment), or air within a joint.
  • Radiography of chronic wounds may reveal underlying osteomyelitis.

Other Tests

  • Routine culture of all human bite wounds is unnecessary because they are costly, demonstrate no growth in more than 80% of cases, and rarely alter first-line therapy.
  • Wounds subsequently manifesting signs of infection often have bacteriologic profiles differing from the initial cultures.
  • Wound cultures are indicated in wounds manifesting signs of infection (eg, cellulitis, swelling, purulence) and in wounds not showing clinical improvement despite seemingly appropriate antimicrobial therapy.
  • Obtain and grow aerobic and anaerobic cultures for 7-10 days to identify slow-growing pathogens. This allows quantification and identification of bacterial species and their antibiotic susceptibilities. If possible, obtain cultures prior to the initiation of antimicrobial therapy.

Procedures

  • Meticulous wound care is the cornerstone of human bite wound management.
  • Copious irrigation decreases the incidence of wound infection.  
    • Use isotonic sodium chloride solution, dilute povidone-iodine (Betadine), or dilute hydrogen peroxide to thoroughly cleanse the wound.
    • Cleansing is best performed with a 10-mL syringe with an 18-gauge angiocatheter attached.
    • Take care to avoid injection of the tissues and to prevent additional trauma.
  • Careful debridement of devitalized tissue, particulate matter, and clot is also necessary to reduce the infection risk and to improve the cosmetic result.
  • Faster wound healing and better scarring result from clean, surgically created wound margins.
  • Wound closure is a source of controversy in the management of patients with human bite wounds.  
    • In general, do not close hand wounds, puncture wounds, infected wounds, and wounds more than 12 hours old. Allow such wounds to heal by secondary intention. They may be closed secondarily or revised at a later date.
    • Head and neck wounds, being in a cosmetically sensitive area, may be closed if they are less than 12 hours old and not obviously infected. These wounds have been closed with a low incidence of infection, probably because of excellent blood supply and infrequency of edema.
    • The following points deserve specific mention:  
      • Antibiotic prophylaxis is mandatory in these patients.5
      • Perform closure in a simple, interrupted fashion, avoiding layered closure with buried sutures.
      • The objective is to provide wound edge approximation that is not watertight and still allow for drainage.

More on Human Bite Infections

Overview: Human Bite Infections
Differential Diagnoses & Workup: Human Bite Infections
Treatment & Medication: Human Bite Infections
Follow-up: Human Bite Infections
References
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References

  1. Khajotia RR, Lee E. Transmission of human immunodeficiency virus through saliva after a lip bite. Arch Intern Med. Sep 8 1997;157(16):1901. [Medline].

  2. Vidmar L, Poljak M, Tomazic J, Seme K, Klavs I. Transmission of HIV-1 by human bite. Lancet. Jun 22 1996;347(9017):1762. [Medline].

  3. Freeman AJ, Senn DR, Arendt DM. Seven hundred seventy eight bite marks: analysis by anatomic location, victim and biter demographics, type of crime, and legal disposition. J Forensic Sci. Nov 2005;50(6):1436-43. [Medline].

  4. Okimura JT, Norton SA. Jealousy and mutilation: nose-biting as retribution for adultery. Lancet. Dec 19-26 1998;352(9145):2010-1. [Medline].

  5. Presutti RJ. Bite wounds. Early treatment and prophylaxis against infectious complications. Postgrad Med. Apr 1997;101(4):243-4, 246-52, 254. [Medline].

  6. Welbury RR, Murphy JM. The dental practitioner's role in protecting children from abuse. 3. Reporting and subsequent management of abuse. Br Dent J. Feb 14 1998;184(3):115-9. [Medline].

  7. Bunzli WF, Wright DH, Hoang AT, Dahms RD, Hass WF, Rotschafer JC. Current management of human bites. Pharmacotherapy. Mar-Apr 1998;18(2):227-34. [Medline].

  8. Chidzonga MM. Human bites of the face. A review of 22 cases. S Afr Med J. Feb 1998;88(2):150-2. [Medline].

  9. Corabianu O, Laredo JD, Woimant F, Haguenau M. Hazards of tongue-biting: Streptococcus oralis bacteraemia and vertebral osteomyelitis following a grand mal seizure. J Neurol. Jan 1998;245(1):47-9. [Medline].

  10. Donkor P, Bankas DO. A study of primary closure of human bite injuries to the face. J Oral Maxillofac Surg. May 1997;55(5):479-81; discussion 481-2. [Medline].

  11. Epstein JB, Scully C. Mammalian bites: risk and management. Am J Dent. Jun 1992;5(3):167-71. [Medline].

  12. Goldstein EJ, Citron DM, Hudspeth M, Hunt Gerardo S, Merriam CV. In vitro activity of Bay 12-8039, a new 8-methoxyquinolone, compared to the activities of 11 other oral antimicrobial agents against 390 aerobic and anaerobic bacteria isolated from human and animal bite wound skin and soft tissue infections in humans. Antimicrob Agents Chemother. Jul 1997;41(7):1552-7. [Medline].

  13. Goldstein EJ, Citron DM, Hudspeth M, Hunt Gerardo S, Merriam CV. Trovafloxacin compared with levofloxacin, ofloxacin, ciprofloxacin, azithromycin and clarithromycin against unusual aerobic and anaerobic human and animal bite-wound pathogens. J Antimicrob Chemother. Mar 1998;41(3):391-6. [Medline].

  14. Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. Dec 1995;33(6):1019-29. [Medline].

  15. Kelly IP, Cunney RJ, Smyth EG, Colville J. The management of human bite injuries of the hand. Injury. Sep 1996;27(7):481-4. [Medline].

  16. Ruskin JD, Laney TJ, Wendt SV, Markin RS. Treatment of mammalian bite wounds of the maxillofacial region. J Oral Maxillofac Surg. Feb 1993;51(2):174-6. [Medline].

  17. Ulione MS, Dooling M. Preschool injuries in child care centers: nursing strategies for prevention. J Pediatr Health Care. May-Jun 1997;11(3):111-6. [Medline].

  18. [Guideline] University of Texas, School of Nursing, Family Nurse Practitioner Program. Management of human bite wounds. Austin (TX): University of Texas, School of Nursing; 2007 May. 22 p. [41 references].

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Further Reading

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Keywords

human bite infections, human bites, infection, oral flora, saliva, hand wounds, clenched-fist injury, occlusive bites, hepatitis B, hepatitis C, herpes simplex virus, HSV, syphilis, tuberculosis, actinomycosis, tetanus, HIV, AIDS, Eikenella corrodens, E corrodens, Staphylococcus aureus, S aureus, Clostridium tetani, C tetani, Streptococcus, Corynebacterium, Bacteroides, Peptostreptococcus, bacteremia, sepsis

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Contributor Information and Disclosures

Author

Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine
Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Thomas J Marrie, MD, Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine
Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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