Human bite

Introduction

A human bite occurs as a result of human teeth penetrating the skin. This can happen on purpose if someone forcibly bites into another person's flesh or it can happen as an accident. Human bites have a high rate of infection.

Causes of human bite

• Violent behavior, often involving alcohol.
• Domestic violence and child abuse
• rough play in daycare
• sports accidents
• Aggressive sexual play or assault
• Thumb sucking or nail biting
• Occupational injuries to workers in the dental field.
• Seizure-related tongue injury
• Self-inflicted wounds in those emotionally or mentally unstable¹

Symptoms and signs of a human bite.

The bite area will probably be painful and tender to the touch. The bite results in a semicircular or oval red. patch and may have bruising associated with it.²

Human bite in children

Children often get bite wounds as a result of rough play. The wounds are usually located on the face, upper arms, and trunk. If the bite mark has an intercanine distance of 3 cm or more, consider adult abuse.²

Human bite in adolescents

Teenagers often have clenched fist injuries where their teeth have scratched their knuckles. These often present as small lacerations, particularly over the third and fourth metacarpophalangeal joints or the proximal interphalangeal joints of the dominant hand.²

Signs of infection

Signs of infection include:¹

• Fever
• Redness
• Swelling
• Sensitivity
• Purulent download From the wound.

Complications of human bites.

Human bites have a higher risk of infection than wounds from animal bites. This is due to the extensive bacterial flora of the mouth and human skin. One study found that in 50 patients who had an infected human bite, on average, four isolates were cultured per wound. Pathogens in human bite wounds included both aerobic and anaerobic bacteria as:³

• Streptococci
• Staphylococcus aureus
• Eikenella
• Fusobacterium
• Peptostreptococcus
• Prevotella
• Porphyromonas spp.

Complications that can arise from a bite wound infection include:¹

• Subcutaneous abscesses
• Osteomyelitis
• Septic arthritis and tendonitis, especially if it is over the knuckle area
• Bacteremia.

A retrospective study found that bite wounds that were larger than 3 mm or perforated had a three-fold increase in infection compared to other wounds.^{4 4}

Management of human bites

Wounds that have not penetrated the skin are not a cause for concern unless abuse is suspected; The resulting bruise will heal on its own.

Initial management

• Wounds that have broken the surface of the skin must be stabilized.
• Stop active bleeding by applying direct pressure.
• Assess neurovascular function and extent of damage. distal to the wound
• Irrigate the wound with sterile saline solution and remove visible remains
• The fabric may require debridement.

Patients with infected bite wounds on initial evaluation should be sent to the hospital for evaluation and appropriate therapy.^{5 5}

Human bite wound care

• Swabs should be taken to assist in antibiotic management, especially if the patient is at high risk for methicillin-resistant Staphylococcus aureus (MRSA), for example, those who have been in the hospital recently, drug users, the military, etc
• Wounds should be elevated to relieve swelling and pain.
• In closed fist injuries, the hand should be immobilized in a position of maximum ligament length.
• Human bite wounds are generally left to heal by secondary intention, the main exception being facial wounds which are managed by plastic surgeons.^{5 5}

Antibiotics

Even if a bite wound does not appear infected, prophylactic Oral antibiotics are recommended for 3 to 5 days, especially if:

• The bite occurred on the hand or near a bone or joint.
• The bite wound was deep.
• The wound was surgically repaired
• Associated with a crush injury
• It happened in a immunocompromised patient.

If signs of infection are found on follow-up, the course of antibiotics can be extended and the swabs repeated.^{5 5} The agent of choice is amoxicillin-clavulanate. Alternative agents include a combination of antibiotics with activity against Eikenella corrodens (e.g., doxycycline) and an antibiotic with anaerobic activity (e.g., metronidazole).^{6 6}

Vaccination

Tetanus immunoglobulin and tetanus toxoid should be offered to patients with less than two primary vaccines Those without a recent booster (last five years) may be offered tetanus toxoid alone.^{5 5}