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

Human Bite Infections: Follow-up

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

Follow-up

Further Inpatient Care

  • Some patients require hospitalization for surgical intervention, intravenous antibiotic administration, and observation.
  • If surgery is not initially performed, admitting the patient allows prompt surgical intervention if no improvement is noted or the clinical situation deteriorates.
  • Indications for hospitalization
    • Any patient with an injury severe enough to require operative exploration should be observed overnight postoperatively. Some may well require a longer stay, but this is dictated by the specific clinical situation.
    • Any patient with systemic manifestations of infection such as fever, chills, or elevated white blood cell count
    • Patients with significant comorbidities
    • Patients with failure to improve with initial outpatient management
    • Patients with a high likelihood of noncompliance (eg, persons who are emotionally disturbed, mentally handicapped, or homeless; persons with chronic alcoholism)
    • Patients with infected hand wounds

Further Outpatient Care

  • Patients evaluated early, without evidence of infection, and without hand wounds may be treated on an outpatient basis without antibiotics.
    • Patients must return within 48-72 hours for reassessment.
    • The development of any signs or symptoms of infection indicate the need to seek immediate medical attention.
  • Patients with mild-to-moderate infections or hand wounds without infection may also be treated on an outpatient basis with oral antibiotics if they are likely to be compliant with the overall treatment plan.
    • Patients must return within 24-48 hours for reassessment.
    • They must immediately seek medical attention if their clinical condition deteriorates.

Inpatient & Outpatient Medications

  • Antibiotics administered initially or during hospitalization should be continued for the length of time determined by the treating physician.

Complications

  • Cosmetic deformity resulting from wound contraction
  • Permanent hand disability secondary to stiffness and/or chronic pain
  • Tenosynovitis
  • Osteomyelitis
  • Septic arthritis
  • Abscess formation
  • Amputation (rare)
  • Transmission of disease

Prognosis

  • Prognosis is excellent in the compliant patient who promptly seeks medical attention following injury.

Patient Education

  • Patients must clearly understand the signs and symptoms of wound infection for which they must return for immediate reevaluation. These include but are not limited to fever, odor, drainage, purulence, swelling, cellulitis, warmth, pain, and decreased mobility.
  • Patients must clearly understand the importance of early and regular follow-up care for this seemingly minor injury.
  • Patients must clearly understand the rationale for providing antibiotics and the importance of compliance with this recommendation.
  • Patients must clearly understand the potential complications that may develop even with complete compliance with the care plan.
  • Patients should understand that wound revision for cosmetic or functional purposes might be desirable at a later date.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center and Infections Center. Also, see eMedicine's patient education articles Human Bites and Tetanus.

Miscellaneous

Medicolegal Pitfalls

  • These cases are more likely to involve the judicial system, to have an increased likelihood of infection, and to have a significant rate of permanent functional or cosmetic deformity.
  • It is extremely important that the chart reflect the following:
    • An adequate initial evaluation
    • An appropriate care plan
    • That the patient was counseled regarding potential complications and importance of early and regular follow-up care
  • Most jurisdictions require medical professionals to report suspected child abuse.6
 


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
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.