eMedicine Specialties > Emergency Medicine > Environmental

Bites, Animal: Differential Diagnoses & Workup

Author: Alisha Perkins Garth, MD, Staff Physician, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital
Coauthor(s): N Stuart Harris, MD, FACEP, Assistant Professor in Surgery, Harvard Medical School, Massachusetts General Hospital; Attending Physician, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Jun 25, 2009

Differential Diagnoses

Bites, Human
Neck Trauma
Cellulitis
Osteomyelitis
Fractures, Cervical Spine
Rabies
Hand Infections
Tetanus

Workup

Laboratory Studies

  • Fresh bite wounds without signs of infection do not need to be cultured. Infected bite wounds should be cultured to help guide future antibiotic therapy.
  • Other laboratory tests are indicated as the patient's condition dictates (eg, CBC and blood cultures for patients with sepsis).
  • If C canimorsus sepsis is suspected, examine the peripheral smear for the organism, a bacillus.

Imaging Studies

  • Radiography is indicated if any concerns exist that deep structures are at risk (eg, hand wounds; deep punctures; crushing bites, especially over joints).  
    • Occult fractures or osteomyelitis may be discovered.
    • Radiographs may find foreign bodies in the wound (eg, teeth).
    • Children who have been bitten in the head should be examined for bony penetration with plain films or CT scan. If the child was shaken, consider cervical spine evaluation.

Other Tests

More on Bites, Animal

Overview: Bites, Animal
Differential Diagnoses & Workup: Bites, Animal
Treatment & Medication: Bites, Animal
Follow-up: Bites, Animal
Multimedia: Bites, Animal
References
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References

  1. Centers for Disease Control and Prevention. Nonfatal dog bite-related injuries treated in hospital emergency departments--United States, 2001. MMWR Morb Mortal Wkly Rep. Jul 4 2003;52(26):605-10. [Medline].

  2. Chambers GH, Payne JF. Treatment of dog bite wounds. Minn Med. 1969;52:427-430. [Medline].

  3. Freer L. Bites and injuries inflicted by wild and domestic animals. In: Auerbach PS, ed. Wilderness Medicine. 5th ed. Mosby; 2007:1133-55.

  4. Dire DJ. Cat bite wounds: risk factors for infection. Ann Emerg Med. Sep 1991;20(9):973-9. [Medline].

  5. Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. N Engl J Med. Jan 14 1999;340(2):85-92. [Medline].

  6. Abrahamian FM. Dog Bites: Bacteriology, Management, and Prevention. Curr Infect Dis Rep. Oct 2000;2(5):446-453. [Medline].

  7. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406. [Medline].

  8. Gilchrist J, Sacks JJ, White D, Kresnow MJ. Dog bites: still a problem?. Inj Prev. Oct 2008;14(5):296-301. [Medline].

  9. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. Jan 7 1998;279(1):51-3. [Medline]. [Full Text].

  10. Sacks JJ, Lockwood R, Hornreich J, Sattin RW. Fatal dog attacks, 1989-1994. Pediatrics. Jun 1996;97(6 Pt 1):891-895. [Medline].

  11. Palacio J, Leon-Artozqui M, Pastor-Villalba E, Carrera-Martin F, Garcia-Belenguer S. Incidence of and risk factors for cat bites: a first step in prevention and treatment of feline aggression. J Feline Med Surg. Jun 2007;9(3):188-95. [Medline].

  12. Moscati RM, Mayrose J, Reardon RF, Janicke DM, Jehle DV. A multicenter comparison of tap water versus sterile saline for wound irrigation. Academic Emergency Medicine. May 2007;14 (5):404-9. [Medline].

  13. Oehler RL, Velez AP, Mizrachi M, Lamarche J, Gompf S. Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis. Jul 2009;9(7):439-47.

  14. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med. Mar 1994;23(3):535-40. [Medline].

  15. Gilbert DN, Moellering RC, Eliopoulos FM, Sande MA, eds. Bites. In: The Sanford Guide to Antimicrobial Therapy. 37th ed. 2007:46,47,140.

  16. Guy RJ, Zook EG. Successful treatment of acute head and neck dog bite wounds without antibiotics. Ann Plast Surg. Jul 1986;17(1):45-8. [Medline].

  17. Trott A. Bite wounds. In: Wounds and Lacerations Emergency Care and Closure. 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1997:265-84.

  18. Weber EJ. Mammalian bites. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Mosby; 2006:906-21.

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Further Reading

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Keywords

animal bites, animal bite management, wound management, animal bite treatment, animal bite infection, bite wound, animal bite wound, dog bite, cat bite, pet bite, wild animal bite, bite wound infection, bite-related infection, mammal bites, rodent bites, ferret bites, rabbit bites, pit bull bite, cellulitis, rabies, septic arthritis, Staphylococcus, Streptococcus, Pasteurella, Bacteroides, Capnocytophaga canimorsus, Eikenella, Enterobacter, Proteus, Haemophilus, Klebsiella, Actinomyces, Fusobacterium, Peptostreptococcus, Clostridium, Wolinella, Propionibacterium, osteomyelitis

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Contributor Information and Disclosures

Author

Alisha Perkins Garth, MD, Staff Physician, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital
Alisha Perkins Garth, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Emergency Medicine Residents Association, Phi Beta Kappa, Sigma Xi, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

N Stuart Harris, MD, FACEP, Assistant Professor in Surgery, Harvard Medical School, Massachusetts General Hospital; Attending Physician, Massachusetts General Hospital
N Stuart Harris, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, International Society for Mountain Medicine, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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