Animal Bites in the ED (Dog, Bat): Antibiotics & Rabies Prophylaxis
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Mammalian Bites in the Emergency Department: Recommendations for Wound Closure, Antibiotics, and Postexposure Prophylaxis (Trauma CME and Pharmacology CME)

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Table of Contents
 
Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Epidemiology And Pathophysiology
    1. Dog Bites
    2. Cat Bites
    3. Human Bites
    4. Other Mammalian Bites
  6. Prehospital Care
  7. Emergency Department Evaluation
    1. History
    2. Physical Examination
  8. Diagnostic Studies
    1. Imaging
    2. Cultures
  9. Treatment
    1. Wound Care And Repair
      1. General Concepts
      2. Dog-Bite Repair
      3. Cat-Bite Repair
      4. Human-Bite Repair
    2. Antimicrobial Prophylaxis
      1. Dog And Cat Bites
      2. Human Bites
    3. Tetanus Prophylaxis
    4. Rabies
      1. Observation Versus Rabies Postexposure Prophylaxis
      2. Rabies In Rodents And Lagomorphs
      3. Rabies Postexposure Prophylaxis And Bats
      4. Rabies In Ferrets
  10. Special Considerations
    1. Capnocytophaga canimorsus Infection
    2. Cat Scratch Disease
    3. Disease Transmission Via Human Bites
    4. Monkey Bites
    5. Large Cats
  11. Clinical Pathway For Repair And Antibiotic Treatment Of Mammalian-Bite Wounds In The Emergency Department (Trauma CME)
  12. Clinical Pathway For Rabies Prophylaxis For Mammalian-Bite Wounds In The Emergency Department
  13. Disposition
    1. Outpatient Treatment
    2. Inpatient Treatment
  14. Summary
  15. Risk Management Pitfalls For Management Of Mammalian Bites
  16. Time- And Cost-Effective Strategies
  17. Case Conclusions
  18. Tables and Figures
    1. Table 1. Most Common Organisms Isolated From Bite Wounds
    2. Table 2. Types Of Wounds In Which Antibiotic Prophylaxis Should Be Considered
    3. Table 3. Centers For Disease Control And Prevention Rabies Postexposure Prophylaxis Recommendations
    4. Figure 1. Dog Bite
    5. Figure 2. Cat Bite
    6. Figure 3. Bat Bite
  19. References

Abstract

Half of all Americans will experience a mammalian bite at some time in their life, and the cost of caring for these injuries has reached $160 million annually. Emergency clinicians must consider many factors when making decisions regarding care of these injuries: risk of infection, cost of antibiotics, time of wound healing, cosmetic and functional result, and risk of other injuries or diseases. Knowledge of the current literature and practice guidelines facilitates care for these injuries in the most cost-effective and clinically sound manner. This systematic review provides best-practice recommendations based on the best available evidence.

Case Presentations

A 25-year-old woman presents with complaints of redness of her right hand and arm. She reports that 1 day prior to presentation she was playing with a stray cat that she had been feeding and it “lovingly” bit her hand.

A 45-year-old man is brought to the ED after being bitten by a police dog. The arresting officer reports that the man was running away from a crime scene when the dog bit him several times. The patient has multiple gaping lacerations to his leg that range in length from 4 cm to 14 cm.

An 8-year-old boy is brought in by his mother because he was bitten by his guinea pig last week. The child denies any complaints, but the mother is worried that the child has “caught a disease” from the bite.

Which of these patients require antibiotic treatment? Which require rabies prophylaxis? Do any require admission to the hospital?

Introduction

The incidence of mammalian bites is difficult to determine because a large number of these bites are never reported. Analysis of results from a telephone survey estimated that some 4.5 million dog bites occurred annually in the United States, with approximately 20% of those patients seeking medical treatment.1 The cost of healthcare associated with these injuries has risen dramatically over the years, with one report estimating that it exceeds $160 million annually.2 It is estimated that animal bites account for 1% of all emergency department (ED) visits each year.

The majority of bite wounds can be attributed to dogs, cats, and humans, with dog bites constituting about 80% of reported wounds. A small percentage of wounds are inflicted by other mammals, and these wounds are often a larger concern to the general public due to unfamiliarity with their treatment. In this issue of Emergency Medicine Practice, we take an in-depth look at the management of mammalian-bite wounds, including the timing of wound closure, the use of prophylactic antibiotics, and the latest recommendations for rabies postexposure prophylaxis (PEP).

Critical Appraisal Of The Literature

A PubMed literature search was conducted using the terms mammalian bites and human bites and excluding the terms reptile, fishes, amphibians, chordata nonvertebrate, invertebrates, insect bites, tick bites, tick toxicoses, and tick paralysis, and limiting the search to articles dating since 2000. This search resulted in 1114 articles for abstract review. From this, 95 articles were identified for complete review. Additionally, the references from these articles were searched, revealing approximately 200 additional articles for review. The Cochrane Database of Systematic Reviews was searched for systematic reviews of mammalian bites and wound infection, and 2 pertinent reviews were identified. Additional resources included guidelines from the Advisory Committee on Immunization Practices (United States Centers for Disease Control and Prevention [CDC]) from 2008 and 2010 regarding rabies prophylaxis; the Public Health Service guidelines from 1991 and 2006 regarding tetanus prophylaxis; and the 2001 guidelines on PEP for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV). These guidelines are consensus statements, not systematic, evidence-based guidelines.

The majority of the literature regarding mammalian bites is weak and consists of reviews and case reports. Most studies regarding mammalian bites are relatively small and lack the power to obtain statistical significance. A few meta-analyses have shown statistical significance, but they are rare in the literature.

Risk Management Pitfalls For Management Of Mammalian Bites

  1. “It’s just a small bite wound from a cat. It’s not going to get infected.”
    All animal-bite wounds have a risk of infection. Cat bites are particularly worrisome because they are puncture wounds that can go deep into tissue, allowing bacteria to be trapped deep under the skin and causing infection.

  2. “He said he just scraped his hand on a wall during a fight.”
    Be very suspicious of any wounds to the hand that occurred during a fight. Patients commonly do not tell the full truth about how they obtained an injury, and a wound to the hand (particularly if overlying the metacarpal-phalangeal joint) may have occurred by striking a person’s mouth/tooth. This type of injury is concerning for bacteria being seeded deep into the joint capsule, causing osteomyelitis or septic arthritis.

  3. “The patient says he has a primary care physician, so as an EMT, is it okay for me to tell the patient to follow up with the doctor in the morning, even though the dog bite looks deep?”
    One of the primary risk factors for infection of bite wounds is time to antibiotics. For this reason, all patients experiencing bite wounds should be advised to seek immediate treatment.

  4. “The patient said he felt something on his arm and then saw a bat fly out of his window. There is no visible wound, so no treatment is necessary.”
    Bat bites can be very small, often requiring magnification to visualize. Bats most often prefer to avoid contact with humans, so any bite or scratch should be taken seriously and the patient should receive rabies prophylaxis.

  5. “It’s just a dog bite, so x-rays aren’t needed.”
    Dogs' jaws exert very high pressure when they bite. The possibility of underlying orthopedic damage is high, and x-rays are generally warranted.

  6. “It’s just a small human bite on the back. The only treatment needed is prophylactic antibiotics.”
    Prophylactic antibiotics are not warranted for most human-bite wounds, unless they are on the hands or feet. However, transmission of other diseases must remain a concern. HIV transmission, while extremely rare, can occur if the biter had blood in his saliva at the time of the bite. Additionally, hepatitis B and C can be transmitted even through nonbloody saliva contact. Discussion must occur regarding PEP for these viral diseases.

  7. “This patient’s dog-bite wound is clean and he is being discharged with antibiotic prophylaxis, so he can follow up with his primary care physician in a week.”
    Even with antibiotic prophylaxis, bite wounds can become infected. It is important to follow up all bite wounds in 24 to 48 hours to evaluate for signs of infection that require admission for more aggressive treatment.

  8. “This patient reports he has been bitten by a stray dog before and received the rabies vaccine at that time. Since he was previously immunized, he does not require any rabies treatment with the bite wound he received today.”
    All patients with bite wounds at high risk for rabies need PEP. If the patient has been previously immunized, then a 2-dose regimen of vaccine at days 0 and 3 can be given rather than the standard 4-dose regimen. Additionally, the patient does not need rabies immune globulin if he has been previously immunized.

  9. “Even though the edges are red, I need to close this 3-day-old dog-bite wound to the face to prevent scarring.”
    Erythematous edges could be a sign of infection. Any dog bite with evidence of infection should not be closed primarily. A better cosmetic result will occur with secondary closure after the infection is treated.

  10. “This patient with a dog bite reports his last tetanus shot was 7 years ago, so he doesn’t need one today.”
    Bite wounds are considered high-risk for tetanus, and prophylaxis should be given if the patient has not received prophylaxis within the past 5 years.

Tables and Figures

Table 1. Most Common Organisms Isolated From Bite Wounds

References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study are included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

  1. Gilchrist J, Sacks JJ, White D, et al. Dog bites: still a problem? Inj Prev. 2008;14(5):296-301. (Telephone survey; 9864 households)
  2. Quinlan KP, Sacks JJ. Hospitalizations for dog bite injuries. JAMA. 1999;281(3):232-233. (Commentary)
  3. Nonfatal dog bite-related injuries treated in hospital emergency departments--United States, 2001. MMWR Morb Mortal Wkly Rep. 2003;52(26):605-610. (Epidemiology report)
  4. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. 1998;279(1):51-53. (Epidemiology report)
  5. Brogan TV, Bratton SL, Dowd MD, et al. Severe dog bites in children. Pediatrics. 1995;96(5 Pt 1):947-950. (Retrospective; 40 patients)
  6. Wiseman NE, Chochinov H, Fraser V. Major dog attack injuries in children. J Pediatr Surg. 1983;18(5):533-536. (Retro¬spective; 57 patients)
  7. Chambers GH, Payne JF. Treatment of dog-bite wounds. Minn Med. 1969;52(3):427-430. (Retrospective; 74 patients)
  8. Forrester JA, Holstege CP, Forrester JD. Fatalities from venomous and nonvenomous animals in the United States (1999-2007). Wilderness Environ Med. 2012;23(2):146-152. (Retrospective; 1802 patients)
  9. Sacks JJ, Sinclair L, Gilchrist J, et al. Breeds of dogs involved in fatal human attacks in the United States between 1979 and 1998. J Am Vet Med Assoc. 2000;217(6):836-840. (Retrospective; 238 patients)
  10. * Abrahamian FM, Goldstein EJ. Microbiology of animal bite wound infections. Clin Microbiol Rev. 2011;24(2):231-246. (Review)
  11. Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340(2):85-92. (Prospective; 107 patients)
  12. Talan DA, Abrahamian FM, Moran GJ, et al. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis. 2003;37(11):1481-1489. (Prospective; 50 patients)
  13. Benson LS, Edwards SL, Schiff AP, et al. Dog and cat bites to the hand: treatment and cost assessment. J Hand Surg Am. 2006;31(3):468-473. (Retrospective; 111 patients)
  14. Griego RD, Rosen T, Orengo IF, et al. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33(6):1019-1029. (Review)
  15. Palacio J, Leon-Artozqui M, Pastor-Villalba E, et al. Incidence of and risk factors for cat bites: a first step in prevention and treatment of feline aggression. J Feline Med Surg. 2007;9(3):188-195. (Retrospective; 936 patients)
  16. Jaindl M, Grunauer J, Platzer P, et al. The management of bite wounds in children--a retrospective analysis at a level I trauma centre. Injury. 2012;43(12):2117-2121. (Retrospective; 1592 patients)
  17. Westling K, Farra A, Cars B, et al. Cat bite wound infections: a prospective clinical and microbiological study at three emergency wards in Stockholm, Sweden. J Infect. 2006;53(6):403-407. (Prospective; 78 patients)
  18. Harrison M. A 4-year review of human bite injuries presenting to emergency medicine and proposed evidence-based guidelines. Injury. 2009;40(8):826-830. (Retrospective; 191 patients)
  19. Merchant RC, Zabbo CP, Mayer KH, et al. Factors associated with delay to emergency department presentation, antibiotic usage and admission for human bite injuries. CJEM. 2007;9(6):441-448. (Retrospective; 388 patients)
  20. Patzakis MJ, Wilkins J, Bassett RL. Surgical findings in clenched-fist injuries. Clin Orthop Relat Res. 1987(220):237- 240. (Retrospective; 191 patients)
  21. Smith KM, Smith KF, D’Auria JP. Exotic pets: health and safety issues for children and parents. J Pediatr Health Care. 2012;26(2):e2-e6. (Review)
  22. Hirschhorn RB, Hodge RR. Identification of risk factors in rat bite incidents involving humans. Pediatrics. 1999;104(3):e35. (Epidemiology report)
  23. Langley RL. Animal-related injuries resulting in emergency department visits and hospitalizations in the United states, 2006-2008. Human-Wildlife Interactions. 2012 Spring;6(1):123-136. (Epidemiology report)
  24. Ordog GJ, Balasubramanium S, Wasserberger J. Rat bites: fifty cases. Ann Emerg Med. 1985;14(2):126-130. (Prospective; 50 patients)
  25. Kizer KW, Constantine DG. Pet ferrets--a hazard to public health and wildlife. Western Journal of Medicine. 1989;150(4):466.
  26. Moscati RM, Mayrose J, Reardon RF, et al. A multicenter comparison of tap water versus sterile saline for wound irrigation. Acad Emerg Med. 2007;14(5):404-409. (Prospective;
  27. Dire DJ. Cat bite wounds: risk factors for infection. Ann Emerg Med. 1991;20(9):973-979. (Prospective; 186 patients)
  28. Basadre JO, Parry SW. Indications for surgical debridement in 125 human bites to the hand. Arch Surg. 1991;126(1):65-67. (Retrospective; 124 patients)
  29. Paschos NK, Makris EA, Gantsos A, et al. Primary closure versus non-closure of dog bite wounds. a randomised controlled trial. Injury. 2014;45(1):237-240. (Prospective; 168 patients)
  30. American College of Emergency Physicians: clinical policy for the initial approach to patients presenting with penetrating extremity trauma. Ann Emerg Med. 1999;33(5):612-636. (Practice guideline)
  31. Nassoura ZE, Ivatury RR, Simon RJ, et al. A reassessment of Doppler pressure indices in the detection of arterial lesions in proximity penetrating injuries of extremities: a prospective study. Am J Emerg Med. 1996;14(2):151-156. (Prospective; 258 patients)
  32. Boenning DA, Fleisher GR, Campos JM. Dog bites in children: epidemiology, microbiology, and penicillin prophylactic therapy. Am J Emerg Med. 1983;1(1):17-21. (Prospective; 55 patients)
  33. Callaham M. Controversies in antibiotic choices for bite wounds. Ann Emerg Med. 1988;17(12):1321-1330. (Review)
  34. Stevenson TR, Thacker JG, Rodeheaver GT, et al. Cleansing the traumatic wound by high pressure syringe irrigation. JACEP. 1976;5(1):17-21. (Animal study)
  35. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2012;2:CD003861. (Meta-analysis)
  36. Lineaweaver W, Howard R, Soucy D, et al. Topical anti¬microbial toxicity. Arch Surg. 1985;120(3):267-270. (Animal study)
  37. Balin AK, Pratt L. Dilute povidone-iodine solutions inhibit human skin fibroblast growth. Dermatol Surg. 2002;28(3):210- 214. (Human tissue model study)
  38. * Cheng HT, Hsu YC, Wu CI. Does primary closure for dog bite wounds increase the incidence of wound infection? A meta-analysis of randomized controlled trials. J Plast Reconstr Aesthet Surg. 2014;67(10):1448-1450. (Meta-analysis)
  39. Xiaowei Z, Wei L, Xiaowei H, et al. Comparison of primary and delayed wound closure of dog-bite wounds. Vet Comp Orthop Traumatol. 2013;26(3):204-207. (Prospective; 120 patients)
  40. * Rui-feng C, Li-song H, Ji-bo Z, et al. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: a prospective randomized trial study. BMC Emerg Med. 2013;13 Suppl 1:S2. (Prospective; 600 patients)
  41. Maimaris C, Quinton DN. Dog-bite lacerations: a controlled trial of primary wound closure. Arch Emerg Med. 1988;5(3):156-161. (Prospective; 98 patients)
  42. Philipsen TE, Molderez C, Gys T. Cat and dog bites. What to do? Guidelines for the treatment of cat and dog bites in humans. Acta Chir Belg. 2006;106(6):692-695. (Retrospective; 34 patients)
  43. Pfortmueller CA, Efeoglou A, Furrer H, et al. Dog bite injuries: primary and secondary emergency department presentations--a retrospective cohort study. Scientific World Journal. 2013:393176. (Retrospective; 431 patients)
  44. Mehta PH, Dunn KA, Bradfield JF, et al. Contaminated wounds: infection rates with subcutaneous sutures. Ann Emerg Med. 1996;27(1):43-48. (Animal study)
  45. Chen E, Hornig S, Shepherd SM, et al. Primary closure of mammalian bites. Acad Emerg Med. 2000;7(2):157-161. (Prospective; 145 patients)
  46. Mennen U, Howells CJ. Human fight-bite injuries of the hand. A study of 100 cases within 18 months. J Hand Surg Br. 1991;16(4):431-435. (Retrospective; 100 patients)
  47. Chadaev AP, Jukhtin VI, Butkevich AT, et al. Treatment of infected clench-fist human bite wounds in the area of metacarpophalangeal joints. J Hand Surg Am. 1996;21(2):299-303. (Retrospective; 221 patients)
  48. Rosen RA. The use of antibiotics in the initial management of recent dog-bite wounds. Am J Emerg Med. 1985;3(1):19-23. (Prospective; 150 patients)
  49. Dire DJ, Hogan DE, Walker JS. Prophylactic oral antibiotics for low-risk dog bite wounds. Pediatr Emerg Care. 1992;8(4):194-199. (Prospective; 185 patients)
  50. Jones DA, Stanbridge TN. A clinical trial using co-trimoxazole in an attempt to reduce wound infection rates in dog bite wounds. Postgrad Med J. 1985;61(717):593-594. (Prospective; 113 patients)
  51. * Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med. 1994;23(3):535-540. (Meta-analysis; 8 trials)
  52. * Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001(2):CD001738. (Meta-analysis; 8 trials)
  53. Aghababian RV, Conte JE Jr. Mammalian bite wounds. Ann Emerg Med. 1980;9(2):79-83. (Prospective; 160 patients)
  54. Lindsey D, Christopher M, Hollenbach J, et al. Natural course of the human bite wound: incidence of infection and complications in 434 bites and 803 lacerations in the same group of patients. J Trauma. 1987;27(1):45-48. (Retrospective; 1237 wounds)
  55. Tabaka ME, Quinn JV, Kohn MA, et al. Predictors of infection from dog bite wounds: which patients may benefit from prophylactic antibiotics? Emerg Med J. 2015;32(11)860-863. (Prospective; 495 patients)
  56. Elenbaas RM, McNabney WK, Robinson WA. Evaluation of prophylactic oxacillin in cat bite wounds. Ann Emerg Med. 1984;13(3):155-157. (Prospective; 11 patients)
  57. Broder J, Jerrard D, Olshaker J, et al. Low risk of infection in selected human bites treated without antibiotics. Am J Emerg Med. 2004;22(1):10-13. (Prospective; 127 patients)
  58. Zubowicz VN, Gravier M. Management of early human bites of the hand: a prospective randomized study. Plast Reconstr Surg. 1991;88(1):111-114. (Prospective; 48 patients)
  59. Singer AJ, Quinn JV, Thode HC Jr, et al. Determinants of poor outcome after laceration and surgical incision repair. Plast Reconstr Surg. 2002;110(2):429-437. (Prospective; 814 patients)
  60. Baker MD, Lanuti M. The management and outcome of lacerations in urban children. Ann Emerg Med. 1990;19(9):1001- 1005. (Prospective; 2834 patients)
  61. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. 1991;40(RR-10):1-28. (Practice guideline)
  62. Kretsinger K, Broder KR, Cortese MM, et al. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR Recomm Rep. 2006;55(RR- 17):1-37. (Practice guideline)
  63. Broder KR, Cortese MM, Iskander JK, et al. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-3):1-34. (Practice guideline)
  64. Hampson K, Coudeville L, Lembo T, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 2015;9(4):e0003709. (Epidemiology report)
  65. WHO Expert Consultation on Rabies. Second report. World Health Organ Tech Rep Ser. 2013(982):1-139. (Epidemiology report)
  66. Dyer JL, Yager P, Orciari L, et al. Rabies surveillance in the United States during 2013. J Am Vet Med Assoc. 2014;245(10):1111-1123. (Epidemiology report)
  67. Blanton JD, Palmer D, Rupprecht CE. Rabies surveillance in the United States during 2009. J Am Vet Med Assoc. 2010;237(6):646-657. (Epidemiology report)
  68. Udow SJ, Marrie RA, Jackson AC. Clinical features of dog- and bat-acquired rabies in humans. Clin Infect Dis. 2013;57(5):689-696. (Retrospective; 122 patients)
  69. Fitzpatrick JL, Dyer JL, Blanton JD, et al. Rabies in rodents and lagomorphs in the United States, 1995-2010. J Am Vet Med Assoc. 2014;245(3):333-337. (Epidemiology report)
  70. Childs JE, Colby L, Krebs JW, et al. Surveillance and spatiotemporal associations of rabies in rodents and lagomorphs in the United States, 1985-1994. J Wildl Dis. 1997;33(1):20-27. (Epidemiology report)
  71. De Serres G, Dallaire F, Cote M, et al. Bat rabies in the United States and Canada from 1950 through 2007: human cases with and without bat contact. Clin Infect Dis. 2008;46(9):1329- 1337. (Retrospective; 61 patients)
  72. Johnson N. Airborne transmission of lyssaviruses. J Med Microbiol. 2006 Jun;55(Pt 6):785-790. (Animal study)
  73. Winkler WG. Airborne rabies virus isolation. Wildl Dis. 1968;4(2):37-40. (Animal study)
  74. Manning SE, Rupprecht CE, Fishbein D, et al. Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR-3):1-28. (Practice guideline)
  75. De Serres G, Skowronski DM, Mimault P, et al. Bats in the bedroom, bats in the belfry: reanalysis of the rationale for rabies postexposure prophylaxis. Clin Infect Dis. 2009;48(11):1493-1499. (Epidemiology report)
  76. * Rupprecht CE, Briggs D, Brown CM, et al. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010;59(RR-2):1-9. (Practice guideline)
  77. Butler T. Capnocytophaga canimorsus: an emerging cause of sepsis, meningitis, and post-splenectomy infection after dog bites. Eur J Clin Microbiol Infect Dis. 2015;34(7):1271-1280. (Retrospective; 484 patients)
  78. Lion C, Escande F, Burdin JC. Capnocytophaga canimorsus infections in humans: review of the literature and cases report. Eur J Epidemiol. 1996;12(5):521-533. (Review; meta-analysis)
  79. Jackson LA, Perkins BA, Wenger JD. Cat scratch disease in the United States: an analysis of three national databases. Am J Public Health. 1993;83(12):1707-1711. (Epidemiology report)
  80. Mitnovetski S, Kimble F. Cat bites of the hand. ANZ J Surg. 2004;74(10):859-862. (Retrospective; 41 patients)
  81. Carithers HA. Cat-scratch disease. An overview based on a study of 1,200 patients. Am J Dis Child. 1985;139(11):1124- 1133. (Retrospective; 1200 patients)
  82. Andreo SM, Barra LA, Costa LJ, et al. HIV type 1 transmission by human bite. AIDS Res Hum Retroviruses. 2004;20(4):349-350. (Case report)
  83. Vidmar L, Poljak M, Tomazic J, et al. Transmission of HIV-1 by human bite. Lancet. 1996;347(9017):1762. (Case report)
  84. Levy JA, Greenspan D. HIV in saliva. Lancet. 1988;2(8622):1248. (Prospective; 55 patients)
  85. Barr CE, Miller LK, Lopez MR, et al. Recovery of infectious HIV-1 from whole saliva. J Am Dent Assoc. 1992;123(2):36-48. (Prospective; 75 patients)
  86. Fox PC, Wolff A, Yeh CK, et al. Salivary inhibition of HIV-1 infectivity: functional properties and distribution in men, women, and children. J Am Dent Assoc. 1989;118(6):709-711. (Prospective; 34 patients)
  87. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. 2001;50(RR-11):1-52. (Practice guideline)
  88. Heiberg IL, Hoegh M, Ladelund S, et al. Hepatitis B virus DNA in saliva from children with chronic hepatitis B infec¬tion: implications for saliva as a potential mode of horizontal transmission. Pediatr Infect Dis J. 2010;29(5):465-467. (Prospective; 46 patients)
  89. van der Eijk AA, Niesters HG, Hansen BE, et al. Paired, quantitative measurements of hepatitis B virus DNA in saliva, urine and serum of chronic hepatitis B patients. Eur J Gastroenterol Hepatol. 2005;17(11):1173-1179. (Prospective; 150 patients)
  90. Fabris P, Infantolino D, Biasin MR, et al. High prevalence of HCV-RNA in the saliva cell fraction of patients with chronic hepatitis C but no evidence of HCV transmission among sexual partners. Infection. 1999;27(2):86-91. (Prospective; 48 patients)
  91. Couzigou P, Richard L, Dumas F, et al. Detection of HCV-RNA in saliva of patients with chronic hepatitis C. Gut. 1993;34(2 Suppl):S59-S60. (Prospective; 37 patients)
  92. Hui AY, Hung LC, Tse PC, et al. Transmission of hepatitis B by human bite--confirmation by detection of virus in saliva and full genome sequencing. J Clin Virol. 2005;33(3):254-256. (Case report)
  93. Cunningham SJ, Cunningham R, Izmeth MG, et al. Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped. Epidemiol Infect. 1994;112(1):195-200. (Retrospective/prospective; 209 patients)
  94. Cancio-Bello TP, de Medina M, Shorey J, et al. An institutional outbreak of hepatitis B related to a human biting carrier. J Infect Dis. 1982;146(5):652-656. (Case report)
  95. Dusheiko GM, Smith M, Scheuer PJ. Hepatitis C virus transmitted by human bite. Lancet. 1990;336(8713):503-504. (Case report)
  96. Gautret P, Schwartz E, Shaw M, et al. Animal-associated injuries and related diseases among returned travellers: a review of the GeoSentinel Surveillance Network. Vaccine. 2007;25(14):2656-2663. (Epidemiology report)
  97. Akhras N, Blackwood RA. Monkey bites: case report and literature review. Clin Pediatr (Phila). 2013;52(6):574-576. (Case report)
  98. Cohen JI, Davenport DS, Stewart JA, et al. Recommendations for prevention of and therapy for exposure to B virus (cercopithecine herpesvirus 1). Clin Infect Dis. 2002;35(10):1191- 1203. (Practice guidelines)
  99. Ritz N, Curtis N, Buttery J, et al. Monkey bites in travelers: should we think of herpes B virus? Pediatr Emerg Care. 2009;25(8):529-531. (Case report)
  100. Filippone C, Betsem E, Tortevoye P, et al. A severe bite from a nonhuman primate is a major risk factor for HTLV- 1 infection in hunters from Central Africa. Clin Infect Dis. 2015;60(11):1667-1676. (Prospective; 269 patients)
  101. Cohle SD, Harlan CW, Harlan G. Fatal big cat attacks. Am J Forensic Med Pathol. 1990;11(3):208-212. (Case series; 2 patients)
  102. Schiller HJ, Cullinane DC, Sawyer MD, et al. Captive tiger attack: case report and review of the literature. Am Surg. 2007;73(5):516-519. (Case report)
  103. Loefler IJ. Big cats attack at the nape of the neck. J Trauma. 1997;43(3):560. (Commentary)
  104. Wolf BC, Harding BE. Fatalities due to indigenous and exotic species in Florida. J Forensic Sci. 2014;59(1):155-160. (Case series; 7 patients)
  105. Rollins CE, Spencer DE. A fatality and the American mountain lion: bite mark analysis and profile of the offending lion. J Forensic Sci. 1995;40(3):486-489. (Case report)
  106. Wiens MB, Harrison PB. Big cat attack: a case study. J Trauma. 1996;40(5):829-831. (Case report)
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Publication Information
Authors

Mary Ann Edens, MD; Jose A. Michel, MD; Nathaniel Jones, MD

Publication Date

April 1, 2016

CME Expiration Date

May 2, 2019

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