Worse Than A Bark

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Humans are bitten by other humans and animals, especially dogs, quite often. Dog bites are estimated to cause tens of millions of injuries around the world every year. Children are at greater risk of dog bites, especially to the head and/or neck. Head and neck bites in children can cause more severe injury and death. Infection is the most important complication of bite wounds, but dog bite wounds and human bite wounds are treated differently.

Human bites are considered more serious and more likely to become infected than animal bites because the human mouth contains over 50 types of bacteria. One third of hand infections are caused by bite wounds. A bite where the skin is broken is called an occlusion bite. Closed fist injuries, where the closed fist is used to punch a person, are more serious because the closed fist may strike bone and/or teeth and the knuckles may be involved. If the knuckle becomes infected, the infection may spread rapidly via nerves and tendons located in the knuckle. Evidence that a hand or leg infection is spreading may include lymphangitis, previously called blood poisoning, where a red line appears and heads towards the groin or armpit, and lymphadenitis, where painful lumps appear in the groin or armpit on the affected side. Human bites should be flushed with a povidone iodine 1% solution (Betadine) followed by copious amounts of saline (salt water) and removal of any fragments like chips of teeth. Hand wounds from human bites are considered to be infected, and, should sutures be needed, they are not placed, and the wound is usually left open. Suturing an infected wound will cause an abscess to form. Antibiotics are almost always prescribed for human bite wounds.

Dog bites should be cleaned with soap and water, then flushed with large amounts of fresh water. A tetanus injection should be given if it is not up to date. The bite should be reported to the authorities and, if possible, the dog owner should be queried about the dog’s vaccination status, especially for rabies. Open animal bites should be evaluated by a medical professional because of the risk of infection. Like human bites, animal bites on the hand are at especially high risk of infection and antibiotics are usually prescribed for animal bites of the hand. Animal bites to other areas of the body may require antibiotics if there are signs of infection like fever, swelling, or redness. To prevent dog bites, avoid unfamiliar dogs. Do not disturb dogs that are sleeping or eating. Make sure small children are supervised if playing with a dog. Lastly, if you are approached by a dog you do not know, leave the area slowly. Avoid making loud noises or running away.

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By Peter Galvin, MD

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