Human Bites

MANUAL MINORS

Human bites are traumatic injuries that can result in skin tears, bruising, and, most importantly, infections due to the bacteria present in the mouth. These bites may occur during fights, accidents, or aggressive behaviours, and are prone to infection due to common oral pathogens such as Streptococcus, Staphylococcus aureus, and Eikenella corrodens. Bites on the hands and fingers are particularly dangerous due to the complex anatomy and risk of deep infections.

Diagnosis

Diagnosis is based on the clinical history of the bite, which usually presents as an arc-shaped wound with skin tears, bruising, or punctures. Physical examination should evaluate the size, depth of the injury, and the condition of surrounding tissues.

It is crucial to identify signs of infection such as redness, swelling, pain, and purulent discharge. In bites involving joints or bones, X-rays should be performed to rule out fractures or foreign bodies, and laboratory tests may be needed if systemic infection is suspected.

Differential Diagnosis

Condition	Key Difference
Animal bite	Similar injuries but different pathogen profile; dog or cat bites usually follow a different pattern.
Incised wound	Cleaner, linear wounds with a lower risk of oral bacterial infection.
Puncture wound	Deeper injury but with a lower risk of polymicrobial infection compared to human bites.
Cellulitis	Skin infection that may occur after a bite if not properly treated.

Emergency Management

In the emergency department, initial management includes thorough wound cleaning with saline and debridement if necessary to remove necrotic or contaminated tissue.

Prophylactic antibiotics should be administered, typically amoxicillin/clavulanate to cover common oral pathogens.

Tetanus vaccination should be updated if it has not been given recently. Bites in high-risk areas, such as the hands, require temporary immobilisation and close follow-up to monitor for infection.

Definitive Treatment

Definitive treatment depends on the risk of infection and the location of the bite. Superficial bites without signs of infection can heal with proper wound care.

In deeper bites or those showing signs of infection, cultures may be performed and antibiotics adjusted accordingly. Infected wounds are often left open or with delayed closure to allow for drainage.

In severe cases, such as deep infections in the hands or joints, surgical intervention may be necessary to drain abscesses or repair damaged structures. Close follow-up is essential to ensure resolution of the infection.