Human Bite Infections Treatment & Management

Although rare, human bites have been shown to transmit Clostridium tetani. Assess all patients for tetanus immune status and update as appropriate. Erring on the side of caution when deciding to administer tetanus toxoid or tetanus immune globulin is best. These wounds are often several days old and are heavily contaminated or even infected upon first presentation. Bites with no significant skin penetration (abrasions or contusions) require no further care.

• Human bite wounds at risk for transmission of life-threatening disease require individualization of therapy.
• A fully informed patient may make appropriate choices regarding viral prophylaxis when risks and benefits are clearly explained and understood.
• Hepatitis B

  • Offer the patient a single dose of hepatitis B immunoglobulin (HBIG) and an accelerated course of hepatitis B vaccine with doses at 0, 1, and 2 months, unless the patient is known to be immune.
  • If the assailant's hepatitis B status is unknown but is considered high risk and the assailant is unavailable for testing, offer an accelerated course of the hepatitis B vaccine to the patient.
  • If the assailant's status is unknown but is considered low risk and the assailant is unavailable for testing, the accelerated course of the hepatitis B vaccine may be offered to the patient with the understanding that the likelihood of disease transmission is low.
• Human immunodeficiency virus

  • If the assailant is known to carry HIV or is considered high risk but unavailable for testing, the Centers for Disease Control and Prevention (CDC) recommends that patients exposed to potentially infectious fluids be offered zidovudine and, possibly, lamivudine chemoprophylaxis.
  • Draw a baseline specimen from the patient to determine preexposure HIV status.
  • Retest the patient at 3 and 6 months.
  • Failure to convert to HIV-positive status at 6 months makes transmission highly unlikely.

• Surgical intervention is frequently necessary, ranging from simple wound exploration and debridement to repair of complex structures under magnification.
• Certain patients (eg, children, persons who are emotionally unstable, persons who are mentally handicapped) may require surgical exploration under anesthesia to adequately examine the wound.
• Indications for surgical intervention

  • Severe soft tissue infection
  • Abscess
  • Joint penetration
  • Underlying fracture
  • Tendon laceration
  • Osteomyelitis
  • Tenosynovitis
  • Septic arthritis
  • Neurovascular compromise or injury to a complex structure
  • Foreign body

A multidisciplinary approach can lead to maximum patient benefit in certain circumstances.

• Refer to a hand surgeon any hand injury with suspicion of tendon injury, fracture, joint space violation, retained foreign body, injury to nerve or vessel, or significant tissue loss. These have a significant risk for permanent disability and should be referred to a hand therapist.
• Refer to a plastic surgeon any head or neck wound with suspicion of violation of cartilage, retained foreign body, or injury to nerves, vessels, or other complex structure. Also refer to a plastic surgeon any wounds that have caused significant tissue loss creating difficult closure.

After initial immobilization of hand injuries in a position of function and elevation, provide instruction regarding resumption of activity.

• In general, early mobilization (ie, 48-72 h postinjury), once improvement is noted, prevents one of the most common and difficult complications of hand injuries: the stiff joint.
• Continue elevation until edema resolves.