Human bites in children

We studied 40 children aged four months to 18 years seen in the Emergency Department (ED) to determine the spectrum of human bites and the incidence of infection in treated and untreated wounds. Initial data concerning time elapsed until a physician examined the bite, site and size of the bite, whether the bite was infected when first seen, and whether antibiotics were prescribed, were obtained from the ED chart. Follow-up by phone or mail was available on 33 of the 40 children. The incidence of human bites was one in 600 visits. The commonest lesion was a superficial abrasion of the face, inflicted by another child. Twenty-nine of the 33 bites were uninfected when first seen; 13 of them received no antibiotics; and 16 received oral antibiotics. There was no significant difference in mean age, sex, site, or type of wound between these two groups. None of 13 untreated and one of 16 treated children developed an infection (P = NS). Four patients had infected wounds when first seen; three received oral antibiotics; and one was admitted for intravenous antibiotics. Of the three on oral antibiotics, two were subsequently admitted to the hospital. Conclusions. We came to the following conclusions at the end of the study. (1) The majority of human bites in children are superficial and do not become infected. (2) Antibiotics do not appear to be useful in prophylaxis for minor bite wounds seen shortly after injury. (3) Follow-up is necessary for all bite wounds, since serious infection may develop, or an established, seemingly minor infection may worsen.     

Human bites in children. A six-year experience

Three hundred twenty-two human bites in children, occurring during a six-year period, were reviewed. The majority occurred during warm-weather months between 2 PM and 11 PM. The upper extremities (42%), face and neck (33%), and trunk (22%) were most commonly bitten. At the time of injury, children were most often engaged in fights (61%) or play (26%). Seventy-five percent of wounds were superficial abrasions, 13% were punctures, and 11% were lacerations. None of the 242 abrasions became infected as opposed to 38% of the punctures and 37% of the lacerations. Other factors associated with increased risk of infection were delay in initial physician assessment beyond 18 hours after injury, location of the bite on the upper extremities, and occurrence of injury during sports activities. Prophylactic use of penicillin was probably not effective in reducing infection rates in these children; however, prospective data are needed to properly address this issue.     

Microbiology of human and animal bite wounds in children

Aspirates from bite wounds in 39 children (21 with animal bites and 18 with human bites) were cultured for aerobic and anaerobic bacteria. Aerobic bacteria only were recovered in 7 (18%) wounds, anaerobic bacteria only in 3 (8%) and mixed aerobic and anaerobic bacteria in 29 (74%). A total of 59 isolates was recovered from animal bites (2.8/specimen): 37 aerobes (1.8/specimen); and 22 anaerobes (1.0/specimen). A total of 97 isolates were recovered from human bites (5.4/specimen): 44 aerobes (2.4/specimen); and 53 anaerobes (3.0/specimen). The most frequent isolates in both types of wounds were Staphylococcus aureus, anaerobic cocci and Bacteroides spp. Present only in animal bites were Pasteurella multocida, Pseudomonas fluorescens and M-5. Present only in human bites were Group A streptococci. Eighteen beta-lactamase-producing organisms were isolated in 16 wounds. This study demonstrates the polymicrobial aerobic-anaerobic nature of human and animal bite wounds.     

Prophylactic oral antibiotics for low-risk dog bite wounds.

The use of prophylactic antibiotics in the initial treatment of noninfected dog bite wounds is controversial. All patients with noninfected dog bite wounds who presented to our emergency department (ED) over a two-year period were considered for entry into a randomized prospective study. Patients were excluded from the study if they had any high-risk criteria for infection: puncture wounds, hand or foot wounds, wounds greater than 12 hours old, a history of immunocompromising disorders, or the use of immunosuppressive drugs. Patients in the antibiotic group (n = 89) were treated with local wound care and given either dicloxacillin, cephalexin, or erythromycin orally for seven days. Patients in the control group (n = 96) received local wound care only. All patients had their wounds irrigated with a 1% povidone-iodine solution and debrided and sutured if clinically indicated. All patients were subsequently reevaluated for clinical signs of wound infection. The groups were similar in age, sex, time of delay in seeking treatment, anatomic sites of wounds, depths and types of wounds, and number of wounds requiring suturing. The wound infection rates for the antibiotic and control groups were 1.1 and 5.1%, respectively. This difference was not significant (P = 0.212). There were 36 wounds in the antibiotic group and 37 wounds in the control group that were full thickness. The infection rates for these wounds were 2.8 and 13.5%, respectively. This was not statistically significant (P = 0.132). This study suggests that prophylactic oral antibiotics in low-risk dog bite wounds are not indicated.     

Identifying human bite marks in children

Human bite marks in children are relatively common but are either not recognized as such or, when suspected, not subjected to rigorous forensic assessment. When a human bite mark on a child is identified, the explanation generally given is that it was either self-inflicted or the result of being bitten by another child. Adjudication on whether it is a child or adult bite mark must not be attempted, as there is insufficient evidence to determine this by inspection. However, the bite may show sufficient, unique dental characteristics to identify a perpetrator. Thus, it is vital that a forensic odontologist is involved from the outset. This paper describes the characteristics of human bite marks and emphasises the key role of forensic odontology in possible perpetrator identification.     

Posttraumatic stress disorder after dog bites in children

Of 22 children who were victims of dog bite, 12 had symptoms of posttraumatic stress disorder 2 to 9 months after the bite. Violent dog attacks inflicting multiple and/or deep wounds were associated with risk of posttraumatic stress disorder.     

Severe human bite injuries in a 7-day-old newborn infant]

It is reported about a 7-day-old newborn showing considerable bite wounds in his face. Due to the evidence of blood group characteristics on his pajamas and by means of a dental impression, the 2 1/2-year-old brother was "found guilty" of having caused the injuries. During a short antibiotic treatment the bite wounds cleared, showing very good results. Jealousy is assumed to be the reason for the incidence. Based on a comprehensive and also child-psychiatric examination of the family, other reasons could be excluded. Similar cases of sibling violence with newborns, partly fatal, are reported in literature. If infants fear to loose the security of their homes, jealousy may lead to severe aggressive reactions.     

Pasteurella multocida meningitis in infancy. An avoidable infection

Pasteurella multocida is a common commensal in the upper respiratory tracts of cats and dogs. Infection with P multocida in humans usually follows infected bite wounds; however, infection in humans unrelated to animal bites is rare. We describe two infants with P multocida meningitis in whom infection was probably related to nontraumatic facial licking by household pet dogs. Both patients recovered fully. Although the risk is low, parents should be informed that mucous membrane exposure to household pets may expose an infant to the risk of systemic P multocida infection.     

Human bite marks. Differential diagnosis

Human bite marks are common findings in cases of fights among children, child abuse, sexual abuse, among institutionalized persons, and in a number of homicide cases. Human bites can mimic annular or arciform dermatoses. These are reviewed from both a clinical and histologic viewpoint. An example is presented of a 2 year-old girl with several annular lesions that were clinically mistaken for a dermatophyte infection. Antifungal medications were ineffective. After several days, a dermatologist identified the lesions as human bites. Physicians and other health care workers must be able to differentiate the clinical appearance of bite marks from other dermatologic diseases at an early stage so as to initiate proper therapy and counseling and, if indicated, a search for the perpetrator.     

The rise of the rats: A growing paediatric issue

Rat bite fever (RBF), a systemic infection of Streptobacillus moniliformis or Spirillum minus characterized by fever, arthralgias and petechial-purpuric rash on the extremities, carries a mortality rate of 7% to 10% if untreated. In Canada, one adult and two paediatric cases of RBF have been reported since 2000. In recent years, pet rats have become quite popular among children, placing them at an increased risk for RBF. Thus, paediatricians need to be more wary of the potential for RBF in their patients. In the present report, a culture-confirmed case of RBF and two additional cases of suspected infection are described.     

Red-back spider bites to Perth children, 1979-1988

The aim of this study was to describe the pattern of illness caused by red-back spider bites to children in Perth, Western Australia, over a 10 year period, and to compare it with that in adults. The case-notes of 241 (89%) of the 271 children admitted to Princess Margaret Hospital and Fremantle Hospital with suspected red-back spider bite from 1979 to 1988 were available for analysis. A definite bite was defined as a definite bite by a positively identified red-back spider, positive identification of a red-back spider with no definite bite but the later development of typical symptoms or no definite history of red-back spider bite but strong clinical evidence and complete recovery after administration of antivenom. Systemic envenomation was accepted if there were symptoms of vomiting, generalized pain or sweating, or abdominal pain.
Sixty-five per cent of children were definitely bitten. As found in previous adult and mixed studies, there was a peak incidence in the warmer months with a male preponderance (68%); 81% of bites were to the extremities and 83% of bites occurred in the daytime. The syndrome produced in children was usually similar to that seen in adults.
Twenty-one per cent of children received antivenom, a rate comparable to previous studies in older age groups; however, no child received more than one ampoule. Compared with data extracted from a previously published study at Fremantle Hospital, in which 37% of adults treated with antivenom received more than one ampoule, these findings suggest that contrary to current opinion children may not be at an increased risk of morbidity from latrodectism.     

Amniotic Fluid Infection Syndrome and Neonatal Mortality Caused by Eikenella corrodens

Different microorganisms not commonly found in the female genital tract have been implicated as causative agents for amniotic fluid infections. Eikenella corrodens is part of the normal flora in the human oral cavity and upper respiratory tract. It is most commonly found in the clinical setting of polymicrobial infections involving human bite wounds, head and neck infections, and periodontitis. On rare occasions, E. corrodens has been reported as a cause of gynecologic infections. There are only 3 reports of documented E. corrodens chorioamnionitis of the placenta resulting in preterm labor, one of which is associated with early neonatal demise. We report a case of preterm delivery of twin infants at 23 weeks of gestation with documented E. corrodens infection in 1 twin who was not resuscitated.     

封闭负压引流在儿童四肢皮肤软组织缺损中的应用

目的 探讨封闭负压引流(Vacuum Sealing drainage,VSD)技术在儿童四肢皮肤软组织缺损中的应用效果.方法 对30例四肢创伤性皮肤软组织缺损患儿先行清创及VSD治疗,再择期闭合创面.结果 30例患儿创面肉芽生长新鲜,均于肉芽组织大致覆盖创面后行游离植皮、直接缝合或组织瓣移植,获得成功.结论 儿童四肢...     

Dog bites in a U.S. county: age,body part and breed in paediatric dog bites

Aim

To compare characteristics of gender, age, body part and breed in dog bites.

Methods

We reviewed 14 956 dog bites (4195 paediatric) reported to the Allegheny County Health Department, USA, between 2007 and 2015. Using predefined age groups, we performed linear regression to assess for subject age and bite frequency and used binary logistic regression to evaluate for differences in gender and body part. We used chi‐squared test with Bonferroni correction to evaluate for differences in reported breeds with age.

Results

There was a negative correlation (?0.80, r² = 0.64) between age and bite frequency. Children 0–3 years had a higher odds ratio (OR) of bites to the face [21.12, 95% confidence interval (CI): 17.61–25.33] and a lower OR of bites to the upper (OR: 0.14, 95% CI: 0.12–0.18) and lower (OR: 0.19, 95% CI: 0.14–0.27) extremities. ‘Pit bulls’ accounted for 27.2% of dog bites and were more common in children 13–18 years (p < 0.01). Shih‐Tzu bites were more common in children three years of age and younger (p < 0.01).

Conclusion

Dog bites occur with higher frequency at younger ages, and head and neck injuries are more common in younger children. Pit bull bites are more common in adolescents and Shih‐Tzu bites more common in younger children.     

Causes of febrile illnesses after a tick bite in Slovenian children

BACKGROUND: To establish the etiology in Slovenian children with febrile illnesses occurring after a tick bite. METHODS: Eighty-six febrile patients younger than 15 years referred to our institution in 2001 with a history of a tick bite within 6 weeks before onset of the illness were included in this prospective study. Acute and convalescent serum samples were tested for the presence of antibodies to tick-borne encephalitis virus, Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Ehrlichia chaffeensis, Rickettsia conorii, Babesia microti, Bartonella henselae, Bartonella quintana and Francisella tularensis. Cerebrospinal fluid was investigated in patients in whom meningeal involvement was clinically suspected. Blood and/or cerebrospinal fluid from the patients were cultured in modified Kelly-Pettenkofer medium. PCR was performed to detect ribosomal DNA of A. phagocytophilum and E. chaffeensis. RESULTS: Of 86 patients 33 (38%) were excluded because a well-defined febrile illness not associated with tick bite was established. Tick-borne illness was diagnosed in 28 (53%) of the 53 remaining patients. The most common diagnosis was tick-borne encephalitis (64%), followed by Lyme borreliosis (46%), human monocytic ehrlichiosis and human granulocytic ehrlichiosis (serologic evidence of infection in 9 and 4%, respectively). In 6 (21%) patients there was evidence for infection with more than 1 tick-borne agent. CONCLUSIONS: Tick-borne illness was established in 53% of the patients younger than 15 years presenting with febrile illness occurring within 6 weeks after a tick bite. The most common identified illnesses were tick-borne encephalitis and Lyme borreliosis.     

Morsures de vipères chez l’enfant

Adder bites and their progression to severe envenomations are more frequent in children than in adults.

Aim

To describe the clinical, biological, and therapeutic characteristics of children bitten by adders and to identify risk factors associated with severe envenomations corresponding to grades II and III of the Audebert et al. classification (Toxicon 1992).

Material and methods

A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary children's hospital. The data collected were: age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity based on the Audebert et al. classification; presence of fang marks; prehospital care; use of specific immunotherapy (Viperfav^®), associated treatments; length of stay; orientation, progression, and any complications.

Results

Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years (range, 1.8–15 years). Bites occurred more often between 12:00 pm and 6:00 pm (62%), and were most often located in the lower extremities (77%). The classification of envenomation was: 83% low grade (grade 0, absence of envenomation, fang marks present; grade I, minor envenomation) and 17% high grade (grades II and III, moderate and severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav^® F(ab’)₂ fragments against Vipera aspis, Vipera berus, and Vipera ammodytes). The mean time from bite to Viperfav^® injection was 23 ± 11 h (range, 8–36 h). Being bitten on the upper extremities (p < 0.001), during the afternoon (p = 0.025), feeling an immediate violent pain (p = 0.037), and high initial glycemia (p = 0.016) were associated with a significant risk of progressing to high-grade envenomation. There was no significant correlation between age, gender, and upper extremity bite. In the final model of the multivariate statistical analysis, three factors remained associated with this risk: bite location in the upper extremities (relative risk [RR] = 60.5 [3.5–1040[; p = 0.005), immediate violent pain (RR = 21.5 [1.3–364.5[; p = 0.03), and female gender (RR = 17.5 [0.9–320.3[; p = 0.053).

Conclusion

A certain number of criteria seem related with a more significant risk of progression to high-grade envenomation following an adder bite. These results need to be studied on a larger cohort of patients. Bites to the upper extremities should be handled with caution because of the association with more severe envenomation.     

Snake Bite in Children: A Five Year Population Study from South-East Queensland

A consecutive series of 71 childhood snake bite incidents is reported. The children were admitted for suspected or confirmed snake bite to four hosptials in south-east Queensland in the 5-year period 1971–1975. Toddlers (1–3 years) constituted the most common age group involved. Information on predisposing factors leading to the bite was available in 33 cases; in 75% of these the children were not provoking the snake, which contrasts with the findings from adult series. The snake was seen in 58% of cases, and felt but not seen in a further 16%. Lay identification was made in 18% only. Definite puncture marks were present in 73% of cases. In 73% of victims there were no observed constitutional signs or symptoms whatsoever suggesting, in practice, that bites are generally by snakes of low potential danger. Seventeen per cent showed signs of envenomation. Antivenene was used in two cases. One fatality occurred, but the rest recovered without sequelae. In two of the 71 cases an effective tourniquet was applied.     

Penetrating brain injuries from a dog bite in an infant

Brain lesions due to dog bites are not frequent and mainly concern infants in the first years of their life because they are short in height, the size of the infant's head is relatively large compared to the body and the skull bones are thin. We report the case of an infant with bilateral skin, skull and brain injuries secondary to a dog bite, and review the relative reports in the literature. We stress the need to consider the possibility of penetration into the intracranial compartment occurring in cases of dog bites of the scalp, because these wounds on the scalp and the skull may appear relatively limited, small in size and slight, in spite of associated potentially dangerous deeper lesions involving the intracranial structures that may be missed on the first observation. Infection is the main possible complication, and may be the cause of permanent and serious neurological deficits. Prompt diagnosis and therapy are mandatory to avoid complications and to achieve good clinical results.     

Multilocular erythema migrans in borreliosis

BACKGROUND: Borreliosis is the most common vector transmitted disease in childhood. Although the disease manifests with an erythema migrans in 80 % of the patients, multilocular skin manifestations are only observed in 2-18 % of these. Differential diagnoses of erythema migrans include erysipelas, persistent insect bite reaction, and fixed drug eruption, in particular when the clinical history does not reveal a tick bite. PATIENT: We report on a 5-year-old boy showing nine erythemas with central pallor on his face, trunk, arms and legs. He recalled a tick bite 3 weeks before. RESULTS: Serological studies revealed an acute infection with Borrelia burgdorferi. After antibiotic treatment with orally administered amoxicillin skin manifestations resolved within three days. During a follow-up period of six months the patient revealed no signs of persistent borreliosis. CONCLUSION: Multilocular erythema migrans is a possible manifestation of borreliosis and is classified as disseminated early infection which is frequently associated with systemic reactions, including malaise, arthritis, carditis, headache and even meningeal signs. Treatment is based on antibiotics, which should preferably be given intravenously in case of systemic signs.     

Infection after farm machine-related injuries in children and adolescents

Infection played an important role in prolonging hospitalization and increasing morbidity in 68 children injured in farm settings. Predominantly gram-negative enteric organisms, group D streptococci, and anaerobic organisms were isolated in cultures of specimens obtained from wounds. Infection was more often associated with severe injuries of the large bones of the extremities than in amputation injuries of the digits and crush or roll-over injuries when the skin barrier was intact. The occurrence of infection in farm injuries was associated with prolonged hospitalization for parenteral antibiotic therapy, multiple surgical débridements with a need for general anesthesia, and permanent disability (decreased range of motion and loss of limbs and digits). Early aggressive surgical débridement and antimicrobial therapy guided by isolation and sensitivity testing of the major organisms are required because of polymicrobial invasion of vascularly compromised tissue.