Edit concept Question Editor Create issue ticket

Dog Bite


Presentation

If children are the victims, generally the dog bites them on the face. In case of adults, the site of attack is usually their hands, feet or legs. The dog bite wound is generally deep in nature injuring the soft tissues and immature bones of the children.

Rigor
  • Future interventions should include multiple follow-ups on dog-bite rates from an international perspective using rigorous randomized controlled trials. The Author 2016.[ncbi.nlm.nih.gov]
  • Future interventionists should adopt RCT designs so intervention efficacy can be evaluated more rigorously.[doi.org]
Collapse
  • Acute cartilage grafts were not used due to concern of wound contamination; however, some resultant collapse of the nasal vestibule was noted and selectively addressed with subsequent cartilage grafting.[ncbi.nlm.nih.gov]
Lower Abdominal Pain
  • A 63-year-old Caucasian taxi driver presented with a 3-week history of malaise, night sweats, 7 kg weight loss, generalized arthralgia, and persistent mid-lower abdominal pain.[ncbi.nlm.nih.gov]
Upper Abdominal Pain
  • She suffered from general fatigue and right upper abdominal pain. She had leukocytosis and abnormal liver function tests. She showed abnormal findings of the gallbladder by abdominal computed tomography and ultrasonography.[ncbi.nlm.nih.gov]
Regurgitation
  • This report describes a case of a previously fit and well 66-year-old female dog handler who, after an apparently minor dog bite to the hand, developed fulminant acute Staphylococcus aureus endocarditis and life-threatening aortic regurgitation.[ncbi.nlm.nih.gov]
Night Sweats
  • A 63-year-old Caucasian taxi driver presented with a 3-week history of malaise, night sweats, 7 kg weight loss, generalized arthralgia, and persistent mid-lower abdominal pain.[ncbi.nlm.nih.gov]
Facial Scar
  • All result in permanent facial scars. This report describes the treatment and outcomes of dog bites of the face, scalp, and neck based on a case series of 107 children over a 10-year period.The average children's age was 5.9 years.[ncbi.nlm.nih.gov]
Rabies
  • Our aim was to evaluate respondent knowledge of canine rabies and response to dog bite incidents towards improved rabies control.[ncbi.nlm.nih.gov]
  • The high (n 705, 90.97%) defaulted PEP and average 155 AHD from rabies implied urgent need for policy formulation on national programme for rabies prevention in Liberia. Copyright 2017 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • BACKGROUND: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority.[ncbi.nlm.nih.gov]
  • Only 71% of the victims were treated with Imogam Rabies brand of Rabies Immunoglobulin G. Sixty-three dog owners claimed that their dogs were vaccinated. Of the total victims, 137[95.80%] completed their routine 5 days anti-rabies regimen.[ncbi.nlm.nih.gov]
  • […] of a possible rabies exposure.[aafp.org]
Meningism
  • The meningitis caused by P. multocida could be considered a cause of human meningitis in dog lovers without an animal bite.[ncbi.nlm.nih.gov]
  • The organism can cause septicemia, meningitis, and endocarditis in humans after contact with dogs or cats.[ncbi.nlm.nih.gov]
  • The symptoms that led to the diagnosis were fever in 3 patients, meningitis in two, brain abscess in one child and four of them developed neurological signs. All of the children had surgical intervention after diagnosis.[ncbi.nlm.nih.gov]
  • These include: Meningitis Sepsis Wound gangrene Endocarditis Facial bone fractures Post bite trauma or fear The most popular known phenomenon of dog bite is that these animals are provoked and hence they bite.[symptoma.com]
  • […] the bite are often caused by Pasteurella. 10 – 12 Capnocytophaga canimorsus is an emerging human pathogen that has been isolated from the mouths of 24% of dogs and 17% of cats. 10, 12, 21 This fastidious gram-negative bacterium can cause septicemia, meningitis[aafp.org]
Screaming
  • Do not run from a dog and scream. Remain motionless (e.g., "be still like a tree") when approached by an unfamiliar dog. If knocked over by a dog, roll into a ball and lie still (e.g., "be still like a log").[web.archive.org]
  • Don't scream or run around your dog—loud noises and quick movements can scare him or her or trigger chasing. Don't bother a dog that is eating, ill, or caring for puppies. Wake a dog by calling it rather than touching it.[berkeleywellness.com]
  • Do not run from a dog or scream. Remain motionless (e.g., "be still like a tree") when approached by an unfamiliar dog. If knocked over by a dog, roll into a ball and lie still (e.g., "be still like a log").[web.archive.org]
  • . - Never run from a dog and scream. - Remain motionless when approached by an unfamiliar dog (e.g., "be still like a tree"). - If knocked over by a dog, roll into a ball and lie still (e.g., "be still like a log"). - Never play with a dog unless supervised[cdc.gov]
Agitation
  • People who encounter a dog that is loose on the street need to consider that, even though it is probably a pet, it may be scared, agitated or potentially injured, and that any unknown dog may have been abused or neglected, and as a result more inclined[expertlaw.com]
  • Sedation is often necessary because patients might become extremely agitated, especially in the presence of stimuli such as loud noises, air currents, and the sight or sound of running water, particularly during the acute neurologic phase of the disease[cdc.gov]

Workup

A thorough examination of the bite is necessary to evaluate signs of infection on the site of the wound. If signs of infection are evident then it is necessary that culture is done in order to decide the future course of antibiotic regime. Blood work that would determine the total blood count may also be necessary.

In cases, when Capnocytophaga canimorsussepsis infection is suspected which is potentially life threatening, then a peripheral smear may have to be carried out [6].

Imaging studies like CT scan examination and radiography may be required to determine the presence of any foreign bodies in the wound. If the child has been bitten in the head, then a CT scan would help determine the presence of foreign particle which may have penetrated.

Streptococcus Pneumoniae
  • Sudden and unexpected nontraumatic death in individuals with asplenia or hyposplenia is usually due to fulminant bacterial sepsis, most often involving Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae.[ncbi.nlm.nih.gov]
Candida
  • She improved within 2 weeks but, despite all efforts to prevent nosocomial infection, her hospital course was complicated by Enterococcus species and Candida albicans pleuropneumonia that prolonged her stay in the intensive care unit, and necessitated[ncbi.nlm.nih.gov]

Treatment

Prompt treatment is the basis of appropriate care of dog bite. Before individuals can seek medical help it is necessary that they thoroughly wash the wound with tap water and cover it with a sterile dressing.

The doctor would then clean the wound by means of irrigation to prevent infection. Following this, he would also remove dead tissues, blood clots and any other foreign particles.
If the wound is deep enough then sutures may be necessary; though its use is still controversial. In some centers, primary wound closure is done for dog bites affecting a large surface area. Although infection rate is 6.7% its cosmetic satisfaction is way above the delayed closure method [7].

The use of sutures will largely depend on the site and nature of the wound. The doctor would then put the victim on antibiotic regime for 7 – 14 days to prevent development of infection [8]. Facial injuries due to dog bites may require immediate reconstruction to prevent complication and achieve better patient satisfaction [9].

Prognosis

If the dog bite has not caused any deep wound and there are just abrasions with the skin intact then one can wait for the signs and symptoms of infection to appear. Here it gets worth mentioning that, if individuals are not keen to seek immediate medical assistance then if it is possible the immunization status of the dog must be analyzed immediately.

In cases, when the dog bite has caused deep injuries then the victim should be taken to the doctor at once without any delay. Whatever be the case, it is always wise to consult doctor immediately after any kind of dog bite.

Complications

Infection is one of the major complications that can set in after a dog bite. If the victim is not appropriately treated with full course of antibiotics then infections can develop. In addition, there are other secondary complications that can result due to inappropriate treatment regime. These include:

Etiology

The most popular known phenomenon of dog bite is that these animals are provoked and hence they bite. But, fact of the matter is something else. It has been proven that most attacks by dogs are unprovoked. There are several reasons for dog bites which include:

  • When dogs are disturbed while they are having their meals or during sleeping time.
  • They demand attention and can get furious when not given the same.
  • Dogs can also turn wild when they are threatened.
  • If attacked with stone or any other objects, dogs get provoked to attack.

All these reasons can cause dogs to attack an individual and bite them.

Epidemiology

Dog bites are common and children are often the victims [1]. Worldwide statistics indicate that half of all children population is bitten by dogs at some point in their life.

The reports also state that every year about 740 individuals per 100,000 populations are victims of dog bites. Dog bites if not attended to in time can be a significant cause of mortality.

It has been estimated that, in the US, about 57% of deaths in children are caused due to dog bites. Yet another report states that more than 4 million Americans every year are victims of dog bites. Children belonging to the lower socioeconomic strata are more prone to dog bites [2].

Sex distribution
Age distribution

Pathophysiology

As compared to any other mammal bites, dog bites are considered to be the most dangerous. This is so because the jaws of the dogs are powerful in nature and exert pressure of 200 – 450 psi during the biting process.

The injury caused due to dog bites are deep in nature and can crush tissues and tender bones due to the powerful impact of their jaws. The dogs generally make use of their front teeth to get hold of their victim and use their other teeth to bite and tear the neighboring tissues.

Prevention

Prevention is the best means to avoid dog attack. Following are some tips that would help children and adults to avoid dog bites.

  • It is better to maintain a safe distance from stray dogs.
  • Dogs should never be disturbed when they are nurturing their puppies, sleeping, eating or while playing.
  • Kids should never be left alone even with pet dogs.
  • When a dog is coming to attack, it is best to move away slowly and avoid eye contact with it.
  • Children must be given a formal dog bite prevention education [10].

Summary

Dog bites can be dangerous and can cause life threatening injuries. Most of the time children become victims of dog bites and the injuries are generally deep in nature requiring immediate attention. It is not necessary that only stray dogs bite, pet dogs can also turn wild and attack kids and even adults for that matter.

Statistical reports have documented the fact that children aged between 5 to 9 years are more prone to dog bites. In addition, it has also been postulated that amongst the adult population, men are frequent victims of dog bites as compared to women who commonly fall prey to cat bites.

Patient Information

Definition  

Bite imposed by a dog is termed as dog bite. Dog bites are common with about 880,000 cases each year in the United States.
Dog bites are dangerous in nature and need immediate medical attention. The resulting wound can be deep in nature due to the powerful impact of the jaws of the dog that exerts tremendous pressure on the site of attack.

Cause

A dog is tempted to attack an individual when provoked. However, there have been cases, when these animals have attacked without any provocation. 

Symptoms

Dogs apparently attack the children on their face and neck; whereas adults suffer injuries on their hand, legs and feet.

Diagnosis

The doctor would also examine for signs of infection and order blood culture and other blood work. A strong antibiotic regime is administered for 7 – 14 days. The individuals are asked to see their doctor after 3 days to study the improvement in the wound.

Treatment

Appropriately treating dog bites is necessary to avoid infections. Washing the wound with disinfectant solution is necessary to get rid of any foreign particles in the wound. 

References

Article

  1. Davis AL, Schwebel DC, Morrongiello BA, Stewart J, Bell M. Dog bite risk: an assessment of child temperament and child-dog interactions. Int J Environ Res Public Health. 2012; 9(8):3002-13 (ISSN: 1660-4601)
  2. Hemagiri K, Someshwar GM, Karinagannanavar A. An epidemiological study on dog bite and its management in Bellary, Karnataka. J Commun Dis. 2012; 44(1):15-23 (ISSN: 0019-5138)
  3. Oya J, Hanai K, Miura J, Maruyama S, Ishii A, Syono K, Shinjo T, Iwamoto Y. Diabetic gangrene in multiple fingers and toes after a dog bite in an elderly patient with type 2 diabetes. Intern Med. 2011; 50(12):1303-7 
  4. Wei LA, Chen HH, Hink EM, Durairaj VD. Pediatric facial fractures from dog bites. Ophthal Plast Reconstr Surg. 2013; 29(3):179-82 (ISSN: 1537-2677)
  5. Boat BW, Dixon CA, Pearl E, Thieken L, Bucher SE. Pediatric dog bite victims: a need for a continuum of care. Clin Pediatr (Phila). 2012; 51(5):473-7 
  6. O'Rourke GA, Rothwell R. Capnocytophaga canimorsis a cause of septicaemia following a dog bite: a case review. Aust Crit Care. 2011; 24(2):93-9
  7. Xiaowei Z, Wei L, Xiaowei H, Yunbei X, Zhenhua L, Yeqing Y, Jiaqi Y, Chuanlin W. Comparison of primary and delayed wound closure of dog-bite wounds. Vet Comp Orthop Traumatol. 2013; 26(3):204-7
  8. Wu PS, Beres A, Tashjian DB, Moriarty KP. Primary repair of facial dog bite injuries in children. Pediatr Emerg Care. Sep 2011; 27(9):801-3.
  9. Gurunluoglu R, Glasgow M, Arton J, et al. Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area. J Trauma Acute Care Surg. May 2014; 76(5):1294-300.
  10. Dixon CA, Mahabee-Gittens EM, Hart KW, Lindsell CJ. Dog bite prevention: an assessment of child knowledge. J Pediatr. 2012; 160(2):337-341.e2

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:49