Animal bites can become quite severe very quickly, or lay dormant for a period of time. Human, fox, bat, squirrel, cat, and dog bites are the most frequent and the worst bites in decreasing order causing cellulites, abscess, and infections of the skin. With the exception of human bites this is the decreasing order for rabies infection. Rabies is an infection that usually is caused by an animal being bitten by an infected animal. They are distempered, rabid, and usually frothing at the mouth. The same thing can happen to a human from this infection process. If you are bit by a wild animal, pet, or neighbors pet, you need to make sure that you have or can get the animal's immunization records to ensure that they have had their rabies vaccine and it is up to date. If you were bitten by a wild animal, it needs to be trapped for testing for rabies. If not you may have to get a rabies vaccine series of injections.
The P's of pet bites described by Lewis Pasture are still generally true today. Pet's often get a bacterial infection from pasturelli, a bacteria discovered by Lewis Pasture. Peptostreptococcus, staphylococcus aureus, and staphylococcus epidermis often found in the gingival, the pockets of the pets mouth where the tooth meets the gums, and in the plaque on the animals teeth. When one of these animals bites or nips you most of the time it is a superficial scraping that usually drains to the surface. However, when they bite you and penetrate the skin deeply and leave these bacteria in the skin they can cause very serious infections.
Saw Bits
For some reason cats seem to have a low incidence with bites of an initial showing infection. However, when they do get infected these organisms can be devastating. The farther you go away from the heart or down the extremity towards the finger tips or toes, the greater the increased chance for infection because of less blood supply directed from these sites. In other words an upper arm or thigh is generally less likely to get infected then the finger tips and toes. Lower extremity bites usually seem to be worse than upper extremities.
Hand bites from cats maybe worse because their type of tooth structure is more porus and has more bacteria. The cats tooth penetrates deeper leaving more bacteria therefore getting infected. The wound may be warm, red, and swollen within a few hours. In 12, 24, or 48 hours the wound can really swell with even ¼ to a ½ cup of pus under the skin. The lymphatic's can often be involved causing streaks up from the site moving up towards the heart. This is called blood poisoning. The heart pumps blood to the tips of the extremities and the veins usually bring about 99% of the blood back. However, the lymphatics bring the infection and this additional 1% back towards the heart. Lymphatics are very soft vessels something like a latex surgical glove. Their diameter is small like a single strand of hair increasing to the diameter of a pencil as it nears the heart. They have one way valves, and nodes with high concentrations of cellular antibodies to kill the bacteria. These nodes and valves are usually located on the flexor sides of a joint i.e. behind the knees or on the flexor surface.
When you bend these joints you pump this lymphatic fluid back towards the heart and it is purified and hopefully the bacteria are killed before it gets back to the superior vena cava just before the heart. The red streaking you see especially often in cat bites indicates lymphatic infection which is not under control and this can cause blood poisoning, amputation of the extremity, sepsis, and even death without proper immediate treatment. Immediate use of tablet antibiotics of a synthetic PCN mixed with clavulinic acid which helps stop antibiotic resistance to the bacteria is at least necessary. Additionally probably an injection of something like a 3rd generation cephalosporin plus an aminoglycocide like gentamicin with redness and red streaking are probably essential to quickly stop the infection. The bacteria double exponentially about every 20 minutes creating a huge pus pocket, often requiring major substantial surgical drainage. This is often performed in the office but sometimes it is necessary to be done in the O.R. with drains for those who are resistant to immediately starting antibiotic therapy or waiting several days. The current correct therapy for an abscess is drainage.
We are required by law and do report animal bites. After infection there can be pain for some time and the worry is that the bite may have gone down and nicked a bone causing a periostal cellulitis of the bone. This may require IV for weeks of therapy. It may require a nuclear bone scan to prove if the bite infected the bone. The bone could become infected without proper care and cause significant and progressive degeneration of the bone crumbling and weakening the bone and having you quite sick. Fever, chills, and rigors, shaking are all signs of skin cellulites, abscess, subcutaneous skin, under the skin infections, and even sepsis an infection of the bacteria in the blood.
If it is a wild animal that bit you, it usually must be trapped for diagnosis of rabies. Verification of pet immunizations for rabies is essential and do not hesitate or wait to have this treated by your physician and probably be placed on antibiotics. Many and most infections will just heal from many domestic animals. You will usually know pretty quickly the infected ones will start getting hot and swollen and will not get any better. When in doubt see your physician. This is an absolute that the earlier the better treatment that needs to be evaluated by an experienced physician. Be sure to get your tetanus immunization and keep it up to date. If you are taking steroids, immune suppression, blood disorders, cancer, major organ disease like kidney failure, heart problems seeing your doctor as quickly as possible is even more important.
John Drew Laurusonis, MD
Doctors Medical Center
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