HUMAN BITE

EPIDEMIOLOGY
Human bites are ranked as third leading cause of all bites seen in hospital emergency department
(after dog and cat bite).
Accounting for 3.6% – 23% of bite wounds
Approximately 60% occurs in an upper extremity most frequently the dominant one . While
15% occurs in the head and neck region most commonly the ear nose or lips the remainder
occurs on the breast, genital, thighs and other areas
Clenched fist infection are predominantly found in men presumably owing to their more
aggressive behaviour.
Occlusive bite wound occurs with equal frequency in males and females.
INTRODUCTION
 Human bites commonly cause multimicrobial infection, including both aerobic and anaerobic
bacteria.
 Human bites can be as dangerous as or even more dangerous than animal bites because of the
type of bacteria and viruses contained in the mouth.
 A bite may be mild, moderate, or severe.
 You may have breaks in the skin with or without blood, Bruising may also occur.
 Depending on the location of the bite, you might have injury to a joint or tendon.
 ETIOLOGY
 Aggressive behaviour, often in combination

with alcohol ( the cause of most clenched fist injuries)

 Rough sexual play or sexual assault.
 Domestic violence.
 Child abuse.
 Occupational injury to dental personnel.
 Seizure- related tongue laceration.
 Nose biting ( punishment for adultery in severe cultures)
 Accidents during sporting events.
 Self inflicted wounds in person who are emotionally

disturbed or mentally handicapped – LESH NYHAN SYNDROME

is uncommon disorder that includes mutilation through bitting
CLENCHED FIST INJURY

 They occur as the closed first strikes the

teeth of another individual with sufficient force

to create a small wound, usually 3-8 mm in length

 The injury usually occurs over the dorsal

surface of the 3rd and 4th metacarpophalangeal (MCP)

or proximal interphalangeal joints of the dominant hand .

 Potential injuries include joint penetrations

metacarpal fracture and extensor tendon laceration.

 OCCLUSIVE BITES

 Ooclusieve bites occurs when there is sufficient force to break the skin .
 Such injuries to the hand have a higher infection rate than similar bites to other parts of the
body because of the thinness of the skin in this area.
 SIGNS OF INFECTION
 Intense pain and swelling.
 Pus around the wound.
 If wound feels warm to touch ( if it’s hot, the wound is likely infected).
 Reddening of the skin ( erythema ) in the wound area.
 A fever, chills, or generally feeling unwell.
COMMON ORGANISMS INCLUDE:

 Streptococci
 Staphylococcus aureus
 Eikenella corrodens
EIKENELLA CORRODENS
 Eikenella corrodens is a commensal of the human mouth and upper respiratory tract.
 Infection most commonly occur in patients with cancers of the head and neck, but can occurs
in human bite infection especially “ reverse bite”, fight bite or clinched first
injuries.
 It can also cause infection in insulin dependent diabetes and intravenous drug users who licks
their needles.
 NEESLE LICKERS OSTEOMYELITIS
 It’s one of the HACEK group of infection which are a cause of cultural negative endocarditis.
 About one third of all hand infection are caused by human bite wound.
 Human bites have been shown to transmit hepatitis B , hepatitis C , herpes
simplex virus (HSV), syhpilis, tuberculosis, actinomycosis l, and tetanus.
 Evidence suggests transmission of human immunodeficiency virus (HIV)
through human bites is possible but very unlikely.
COMPLICATIONS
 Cosmetic deformity resulting from wound contraction
 Permanent hand disability secondary to stiffness and chronic pain
 Infectious tenosynovitis
 Septic arthritist
 Abscess formation
 Amputation
 Transmission of disease
 Osteomyelitis
 Necrotizing facilities
 Joint infections
INVESTIGATIONS
 CBC
 Blood cultures
 Renal and liver function tests if bacteria or sepsis Is suspected
 If indicated draw appropriate baseline viral titres from the patient and the assailant
 Radiography may be useful particularly in hand injury or over bones to reveal fractures,
foreign bodies or air within a joint.
 MANAGEMENT
 Wound cleaning and closure ( selected wound)
 The first step in management is cleansing of the wound

and irrigation with saline.

 Co-amoxiclav is recommended, as for animal bites.

( It works by combining Amoxicillin with Clavulanic acid

to kill the bacteria that causes an infection ).
 Any bites that puncture the skin deeper than one centimetre also require an immediate tetanus shot.
 You will need to follow up with your doctor in 24 to 72 hours, and even quicker if you begin notching
any sign of infection.
 The risk of viral infection such as HIV and HEPATITIS also be done .
 Possible reconstructive surgery.
THANK YOU