CT scan and surgery in subdural empyema: a case report

A high index of suspicion is required to pick up cases of subdural empyema in clinical practice. CT scan may be normal in the initial stages. Early neurosurgical intervention is desirable to reduce mortality and morbidity in this condition.

Toxic shock syndrome due to an infected human bite

We report a case of nonmenstrual toxic shock syndrome. A 21-year-old man presented with severe pain in the right hand after an altercation in which he sustained a bite from a person. Physical examination revealed a small abscess on the right proximal interphalangeal joint with edema in the fourth and fifth digits and tenderness of the flexor sheath. The patient was hypotensive with diffuse macular erythematous skin. He responded to surgical drainage and antibiotics.

Vulvar hematoma secondary to a human bite. A case report

A case of vulvar hematoma resulting from cunnilingus occurred in an alcoholic woman. Incision and drainage with debridement of devitalized tissues, systemic antibiotics covering both anaerobes and aerobes, and counseling are usually required for the optimal result in such cases.

Human and animal bite wounds

Bite wounds account for 1 percent of emergency department visits. Most bites occur on the hands. Human bites cause serious injury more often than animal bites do. Pasteurella multocida is found in about 25 percent of dog bites and a higher percentage of cat bites. Alpha-hemolytic streptococci are the most frequent isolates from human bite wounds. Anaerobic bacteria are commonly found in all types of infected bites.

Human bites. Guidelines for prompt evaluation and treatment

Human bites are a relatively common injury. They often involve the hand and may have serious sequelae because of the structures involved, the bacteriologic spectrum, or poor patient compliance with the treatment regimen. A careful history and physical examination are important, and treatment involves good local wound care, appropriate antibiotic coverage (including both a penicillin and a penicillinase-resistant penicillin), immobilization and elevation of the injured area, and close follow-up, as well as early rehabilitation.

Etiology of nonvesicular genital ulcers in Winnipeg

Twenty-eight patients with recent onset of nonvesicular ulcerative genital lesions were studied prospectively to define the microbial etiology. Causative agents identified included herpes simplex virus (HSV), Chlamydia trachomatis, Haemophilus ducreyi, and Treponema pallidum. Three women and 25 men (seven of whom were homosexual) were studied. Ten patients did not have an etiology identified. Nine patients had syphilis, six had genital herpes, one had chancroid, one had granuloma inguinale, and one had a human bite injury. Six of seven homosexual men had syphilis, as compared with one of eight heterosexual men (P less than .002). Among heterosexual men, five had atypical HSV infections, three with extensive balanoposthitis and two with chancroidal ulcers. Of the clinical characteristics examined, induration of the ulcer base and tenderness on palpation were predictive of etiology, whereas numbers of ulcers and regional lymphadenopathy were not. H. ducreyi was not a common cause of genital ulcers in Winnipeg, and it was not found as a commensal or superinfecting organism in ulcers caused by other agents.

Natural course of the human bite wound: incidence of infection and complications in 434 bites and 803 lacerations in the same group of patients

Human bites and common lacerations are frequent in certain residential groups in institutions for the care of developmentally disabled individuals. We screened the records of such an institution and studied the course and outcome of 434 human bite wounds and 803 lacerations in the same group of clients. Infection developed in 13.4% of the lacerations, and 17.7% of the bite wounds (chi 2 = 3.474; p greater than 0.06). Prophylactic antibiotics were administered after 14.0% of the bite wounds, and 3.2% of the lacerations. Infection supervened after prophylactic antibiotics in 29.5% of the bites and 34.6% of the lacerations. No patient with a bite wound required debridement, initial or subsequent surgical intervention other than wound closure, admission to hospital, or intravenous antibiotics. There is no recorded instance of a bite wound complication other than immediate loss of tissue. These data substantiate a higher incidence of infection in human bite wounds, but they are scant support for admonition that such wounds are indication for routine antimicrobial prophylaxis or aggressive surgical intervention.

Human bites to the hand

Because of the virulence of human oral flora, complications from relatively common human bites can be far more serious than those caused by animal bites. Types of infection of various kinds of human bites, the common pathways of extension of these infections and the appropriate treatment for these injuries as well as the prevention of what may be devastating and crippling sequelae are reviewed.

Infections with Eikenella corrodens in a general hospital: a report of 33 cases

Of 33 cases of Eikenella corrodens infection occurring in a general hospital during an 18-month period, 18 were related to human bites or fist-fight injuries, and nine of these 18 cases were complicated by septic arthritis and/or osteomyelitis. Because E. corrodens grows slowly, requires an atmosphere containing 5%-10% CO2, and may be overgrown by other organisms, it may be missed on routine culture. The high rate of recovery of the organism in this study was attributable to the use of a selective medium. Because infections due to E. corrodens commonly mimic or occur in association with anaerobic infections, they are sometimes treated inappropriately. E. corrodens should be considered a possible pathogen in infections associated with oral contamination. Empiric antibiotic treatment of these infections with clindamycin or metronidazole alone is inappropriate since E. corrodens is generally resistant to these agents.

Human bites of the hand: a study of one hundred six patients

One hundred six patients with human bites of the hand (HBH) were studied in detail. This study was characterized by a higher than expected incidence among women, by a large number of patients who presented for treatment more than 1 week after injury, and by a high complication rate and a low incidence of hospitalization. The overall morbidity rate of these patients was considerable. Early and delayed cases of HBH were typified by an absence of complications. Except for partial or complete traumatic amputations, their recovery time was short, and the final functional result was usually favorable. Late cases were characterized by a high rate of infection-related complications, a prolonged morbidity period, and a less favorable final functional result. One hundred of our patients were successfully treated as outpatients. This led us to believe that most HBH can be treated on an outpatient basis. Hospitalization should be mainly reserved for patients with infection-related complications and for extremely unreliable patients. The time interval between injury and the commencement of treatment appears to be the single most important factor governing the final result in HBH.

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.

Infections of the hand

The unique anatomic arrangements in the hand make possible rapid extension of infections through synovial-lined spaces if abscesses are not drained and pressure is allowed to build up. Adequate knowledge of these anatomic features and of routes for surgical drainage is mandatory if one is to give adequate management of hand infections. Localized processes, such as paronychia, felon, and human bite infections also require special insight for adequate treatment.

Human bites of the lip

Human bites of the lips are very common. If less than 10 mm in size, they are treated conservatively and if greater, are treated surgically. Many lip bites are treated immediately, when infection is present, surgery is performed a few days later.

Eikenella corrodens in human bite infections of the hand

Over a 51/2-year period 30 patients were found with Eikenella corrodens infections of the hand following closed fist injury. Twenty-four had mixed infections; six grew pure cultures of Eikenella. Twenty-one of the 30 patients had positive cultures from an injured metacarpophalangeal joint. A delay in presentation or an inaccurate initial diagnosis appeared to be the most significant factors leading to the complications of osteomyelitis (in five patients) and significant loss of joint function (in eight other patients). Clinicians must have a high index of suspicion when evaluating any hand injury and clenched fist injuries of the hand should be treated by early adequate surgical debridement followed by IV penicillin given until operative cultures confirm or deny contamination with Eikenella corrodens.