Camel bite injuries in United Arab Emirates: a 6 year prospective study

Patterns of horse and camel- related injuries: A descriptive analysis from a national trauma registry (2007-2021)

BACKGROUND

The large animal-related injuries are emerging major trauma but remain underestimated public health problem worldwide. We aimed to determine the incidence, clinical characteristics, mechanisms and patterns of horse and camel-related injuries (HCRIs) in a Middle Eastern country.

METHODS

A retrospective analysis of all patients who were hospitalized due to HCRIs was conducted. Data included patient's demographics, mechanism of injury, anatomical location and severity of injury, and hospital outcomes.

RESULTS

Between November 2007 and December 2021, there were 273 hospitalized patients with HCRIs representing1.3 % of the total trauma admissions. Of these, 145 (53.1 %) and 128 (46.9 %) were horse (HRI) and camel-related injuries (CRI) respectively. The most common presenting age group of the cohort was 20-29 years and 88 % were males. Patients with HRIs were younger (27.5 ± 11 years) than CRIs (34 ± 13.5 years). Injuries to the extremities were the most common (62 % vs. 40 %), followed by the head injury (25.5 % vs. 31 %) among the HRIs and CRIs, respectively. The most common mechanism of injury was falling off followed by getting kicked by the HCRIs. Major trauma (ISS ≥12) was found in 23 % of HRIs (47.5 %) and CRIs (52.5 %). Only 5 % of patients had shock index >0.90 on admission; two thirds were due to CRIs. There were four fatalities (1.5 %), all attributed to traumatic brain injury, of which three were due to HRIs and one due to CRIs.

CONCLUSION

This study reveals that HCRIs predominantly affect young adult males and may involve serious injuries, exhibit distinct injury patterns, however, it is associated with low mortality. Preventive measures need to be revisited.

Living with lower limb traumas and below-knee amputation in a Jordanian Late Ottoman nomadic community

OBJECTIVE

Paleopathological analysis is combined with ethnohistorical, ethnographic and ethnomedical reports to assess the sociocultural implications for a historical nomadic Bedouin female following her survival of a below-knee amputation and multiple injuries to the stump.

MATERIALS

A middle-aged female recovered from a nomadic-style burial dated to the Late Ottoman Period (1789-1918) in Jordan's Wadi ath-Thamad region.

METHODS

Macroscopic and radiographic assessment.

RESULTS

A supracondylar femur (Hoffa) fracture, knee complex injury and lower leg amputation were observed on the right lower limb. Other pathological lesions that may have affected movement included bilateral os acromiale, intervertebral disc disease, osteoarthritis and right hook of hamate fracture.

CONCLUSIONS

The individual survived a below-knee amputation, two injuries to the stump, and likely experienced lower back pain. Mobility may have been painful, but she likely functioned within the community performing gender-specific daily tasks within the family tent and designated community female workspaces. Ethnohistoric and ethnographic reports suggest that marital demotion by other wives or a return to her father's tent may have occurred.

SIGNIFICANCE

Healed multiple injuries and amputation affecting one limb are rare in paleopathological literature.

LIMITATIONS

It is uncertain whether the amputation or either of the stump injuries occurred during the same event. If they resulted from separate events, slight hip joint osteoarthritis suggests that the amputation preceded the other injuries.

SUGGESTIONS FOR FURTHER RESEARCH

Full pathological assessment of individuals with amputations may provide additional insight into impairment resolution, health problems and injury arising from impairment following amputation.

Camel-related major vascular injuries: A 20-years' experience

BACKGROUND

Majority of human animal-related injuries in the United Arab Emirates are caused by camels. These may involve major vessels and can be life-threatening. We aimed to study the biomechanism, injured regions, management, and outcome of major camel-related human vascular injuries.

METHODS

We retrospectively studied all patients who were admitted to Al-Ain Hospital with camel-related major vascular injury during January 2001 to January 2020. Studied variables included demography, mechanism of injury, injured structures, clinical presentation, vital signs on arrival, associated injuries, surgical management, ICU stay, length of hospital stay, complications, and outcome.

RESULTS

Seven patients were studied; all were males having a median age of 26 years. Five out of six bite injuries (83%) occured during the camel rutting season. The injuries were severe and life-threatening. A camel bite causes four small elliptical wounds of the canine teeth which resembles two stab wounds of 8 cm long, penetrating deeply and injuring major vessels. Four involved the carotid artery, one the femoral artery and vein, one the external iliac vein and one the aorta which was due to a fall from a camel. Although the standard of surgical care was high, the outcome was poor. Six patients were admitted to the ICU for a median of 5 days. One patient died, one became vegetative, and one had arm paralysis.

CONCLUSIONS

Major camel-related vascular injuries have a poor clinical outcome. This is related to the biomechanism of injury which combines penetrating, crushing and blunt trauma. Neck wounds of camel bites can be closed primarily after debridement.

The Flourishing Camel Milk Market and Concerns about Animal Welfare and Legislation

The worldwide dromedary milk production has increased sharply since the beginning of this century due to prolonged shelf life, improved food-safety and perceived health benefits. Scientific confirmation of health claims will expand the market of dromedary milk further. As a result, more and more dromedaries will be bred for one purpose only: the highest possible milk production. However, intensive dromedary farming systems have consequences for animal welfare and may lead to genetic changes. Tighter regulations will be implemented to restrict commercialization of raw milk. Protocols controlling welfare of dromedaries and gene databases of milk-dromedaries will prevent negative consequences of intensive farming. In countries where dromedaries have only recently been introduced as production animal, legislators have limited expertise on this species. This is exemplified by an assessment on behalf of the Dutch government, recommending prohibiting keeping this species from 2024 onwards because the dromedary was deemed to be insufficiently domesticated. Implementation of this recommendation in Dutch law would have devastating effects on existing dromedary farms and could also pave the way for adopting similar measures in other European countries. In this paper it is shown that the Dutch assessment lacks scientific rigor. Awareness of breeders and legislators for the increasing knowledge about dromedaries and their products would strengthen the position of dromedaries as one of the most adapted and sustainable animals.

The nature and consequences of camel-related injuries: A scoping review with special reference to Arab Middle Eastern countries

Animal-related injuries are a substantial but under-reported, emerging public health problem contributing considerably to worldwide morbidity and death. Understanding the behavior of big animals may help in injury prevention. Camels are large long-neck ungulates of the genus Camelus that have been domesticated for millennia as a mode of transportation, race, and food source. Camel-related injuries are not well studied when compared with other animals' injuries. Camels can occasionally be very hostile to humans, inflicting serious injuries. These injuries can be caused by camel bites, falls from their backs, kicks, or collisions with motor vehicles. The relative magnitude of each mechanism has never been extensively studied in the literature. Furthermore, the incidence of camel-related injuries is not well reported worldwide. Camels remain a potential cause of serious injuries and a public health problem for some countries in the Middle East. There are gaps in the incidence, risk factors and mechanism, distribution of camel-related injuries. We aimed to summarize the data and draw conclusions pertaining not just to the most common mechanism of injury but to demographics, incidence, severity, and appropriate methods of prevention of camel-related injuries. This scoping review findings will help for better understanding of the nature and consequences of camel-related injuries, and to improve the existing preventive and management strategies.

Camel Bite Injury to the Face in an Adult Patient: Skin Closure Controversy

Animal bite injuries are prevalent worldwide. Camel bites, as a cause, are relatively rare. Male camels are particularly aggressive, especially during the rutting season. These injuries, when inflicted over the face, have a disfiguration effect with possible psychological repercussions to the patient. The surgical management of facial camel bite is described sporadically and remains a source of deliberation. Our paper reports the mechanism and management of facial soft tissue injury inflicted by camel bite over the face in an adult male with long-time follow-up for the patient post surgical repair without any documented complications. This case report demonstrates the complex nature of camel bite injuries over the face. Inappropriate wound management may result in long-term sequelae, which may affect the patient’s quality of life. Individuals should apply caution when dealing with camels, mainly in the rutting season. Primary skin closure, especially to the face or neck, and proper wound management will decrease the risk of permanent scars and infections.

Poor Outcome in Camel-Related Eye Trauma with Ruptured Globe

Purpose

To report the poor visual outcome of ruptured globe caused by camel bites.

Observations

A 48-year-old camel caregiver presented to the emergency department after being bitten by a camel in the left side of his face. Ophthalmic examination revealed a superior scleral wound from 9 to 2 o’clock, about 6 mm from the limbus extending to the equator with prolapse of uveal and vitreous tissues, an opaque cornea, total hyphema, diffuse subconjunctival hemorrhage, and a lower lid laceration involving the lid margin and the nasolacrimal duct. The patient has undergone surgical repairs of ruptured globe and lid laceration, followed by retinal detachment surgery. Following these surgical interventions, the patient preserved a light perception vision with flat retina.

Conclusion

Camel-related injuries might primarily involve the ophthalmic structures, especially in camel bites. Camel-related eye trauma might lead to poor visual and anatomical outcomes which might not improve following surgical interventions.

Camel-Related Deaths-A Forensic Overview

ABSTRACT

Camels are ungulates of the genus Camelus and have been used for centuries in parts of Asia and Africa for transport and sustenance. Handling of camels is not without its dangers, and 4 cases from South Australia are reported with a review of lethal camel-related issues. Case 1 is a 56-year-old man who died of multiple blunt force injuries after he had attempted to move a 7-year-old female dromedary (Camelus dromedarius). Case 2 is a 65-year-old woman who was crushed by 1 or more camels that she had been training. Case 3 is a 1-year-old girl who died of blunt craniocerebral trauma after the car in which she was traveling rolled when the driver swerved to avoid a herd of camels that had strayed onto the road. Case 4 is a 66-year-old woman who died of ischemic and hypertensive cardiac disease exacerbated by physical activity while rounding up camels. Deaths associated with camels involve kicking, stomping, kneeling or sitting on a victim, or biting and shaking and throwing. Lethal mechanisms include hemorrhage from vascular injuries and internal organ disruption, crush asphyxia, and blunt craniospinal injuries. Death may also follow falls from camels or vehicle collisions. Camels also carry a wide range of zoonotic diseases, the most significant of which is Middle Eastern respiratory syndrome. Handling of camels may also exacerbate underlying organic illnesses such as cardiac disease. Those working with camels should be aware that the size, strength, and temperament of these animals may make them dangerous and that they also carry potentially lethal zoonotic diseases.

Neglected challenges in the control of animal rabies in China

Complex rabies transmission dynamics, including in dogs, wildlife livestock, and human-acquired rabies, can be observed in China. A temporary decrease in human rabies deaths with a simultaneous increase in animal rabies transmission is a typical example of "sectoral management separation" but not of the recommended "one-health" concept. In contrast to reliance on mass dog vaccination, reliance on postexposure prophylaxis to reduce human rabies burden is costly and ineffective in the prevention of rabies transmission from dogs to humans and other susceptible animal species. To answer the WHO call for the "elimination of dog-mediated human rabies by 2030," China faces the challenge of a lack of a strong political commitment and a workable plan and must act now before the rabies transmission dynamics become increasingly complicated by spreading to other species, such as ferret badgers in the Southeast and raccoon dogs and foxes in the North.

Housing Management of Male Dromedaries during the Rut Season: Effects of Social Contact between Males and Movement Control on Sexual Behavior, Blood Metabolites and Hormonal Balance

Simple Summary

The effect of different housing management systems on the behavior, metabolites and hormonal balance in male dromedaries during the rutting season was evaluated. Male dromedaries that were housed in groups and allowed to walk around had significantly higher frequencies of ruminating, standing, walking and sexual-related behaviors than those housed individually or tied. Movement control had significant effects on blood serum metabolites and hormone concentrations. Fenced and exercised male dromedaries had higher (p < 0.05) concentrations of blood serum transaminases, free radicals, glucose, cholesterol and testosterone and lower (p < 0.05) concentrations of cortisol and triiodothyronine (T3) than tied male dromedaries. Animal social interaction is of particular importance for maintaining physical; psychological and sexual behaviors. Allowing walking-around exercise for captive animals improves their metabolic status and decreases captive stress effects. Housing systems that guarantee social interaction and physical activity are being the most suitable housing management systems for male dromedaries during the rutting season.

Abstract

The current study aimed to evaluate the effect of different housing management systems on behavior, blood metabolites and hormonal balance in male dromedaries during the rutting season. Forty-eight adult male dromedaries were stratified in a two by three factorial experiment design, testing effects of social contact (single and group) and movement control (tied, fenced and exercise). During a ten-week experimental period, male dromedaries were filmed weekly for 20 min three times per day to evaluate their behaviors. Blood samples were collected and analyzed for serum metabolites and hormones. Both animal social contact and movement control significantly affected maintenance, posture and sexual behaviors. Male dromedaries housed in groups expressed higher frequencies of sexual desire-related behaviors (teeth grinding, open legs, tail flapping, dulla “soft palate exteriorization”, blathering and urination) than those individually housed. Animal movement control significantly affected sexual behavior; fenced and exercised male dromedaries expressed higher frequencies of sexual desire-related behaviors than tied ones. Male dromedaries housed in groups and allowed to walk around had significantly higher frequencies of ruminating, standing, walking and sexual-related behaviors than those housed individually or tied. Movement control had significant effects on blood serum metabolites and hormone concentrations. Fenced and exercised male dromedaries had higher (p < 0.05) concentrations of blood serum transaminases, free radicals, glucose, cholesterol and testosterone (2.91 and 2.09 ng/mL, respectively) and lower (p < 0.05) concentrations of cortisol (44.12 and 53.52 nmol/L, respectively) and triiodothyronine (1.68 and 1.91 ng/mL, respectively) than tied male dromedaries. In conclusion, animal social interaction is of particular importance for maintaining physical, psychological and sexual behaviors. Allowing walking-around exercise for captive animals improves their metabolic status and decreases captive stress effects. Housing systems that guarantee social interaction and physical activity are the most suitable housing management systems for captive male dromedaries during the rutting season.

Detection of blood pathogens in camels and their associated ectoparasitic camel biting keds, Hippobosca camelina: the potential application of keds in xenodiagnosis of camel haemopathogens

Background: Major constraints to camel production include pests and diseases. In northern Kenya, little information is available about blood-borne pathogens circulating in one-humped camels ( Camelus dromedarius) or their possible transmission by the camel haematophagous ectoparasite, Hippobosca camelina, commonly known as camel ked or camel fly. This study aimed to: (i) identify the presence of potentially insect-vectored pathogens in camels and camel keds, and (ii) assess the potential utility of keds for xenodiagnosis of camel pathogens that they may not vector. Methods: In Laisamis, northern Kenya, camel blood samples (n = 249) and camel keds (n = 117) were randomly collected from camels. All samples were screened for trypanosomal and camelpox DNA by PCR, and for Anaplasma, Ehrlichia, Brucella, Coxiella, Theileria, and Babesia by PCR coupled with high-resolution melting (PCR-HRM) analysis. Results: In camels, we detected Trypanosoma vivax (41%), Trypanosoma evansi (1.2%), and " Candidatus Anaplasma camelii" (68.67%). In camel keds, we also detected T. vivax (45.3%), T. evansi (2.56%), Trypanosoma melophagium (1/117) (0.4%), and " Candidatus Anaplasma camelii" (16.24 %). Piroplasms ( Theileria spp. and Babesia spp.), Coxiella burnetii, Brucella spp., Ehrlichia spp., and camel pox were not detected in any samples. Conclusions: This study reveals the presence of epizootic pathogens in camels from northern Kenya. Furthermore, the presence of the same pathogens in camels and in keds collected from sampled camels suggests the potential use of these flies in xenodiagnosis of haemopathogens circulating in camels.

Detection of blood pathogens in camels and their associated ectoparasitic camel biting keds, Hippobosca camelina: the potential application of keds in xenodiagnosis of camel haemopathogens

Background: Major constraints to camel production include pests and diseases. In northern Kenya, little information is available about blood-borne pathogens circulating in one-humped camels ( Camelus dromedarius) or their possible transmission by the camel haematophagous ectoparasite, Hippobosca camelina, commonly known as camel ked or camel fly. This study aimed to: (i) identify the presence of potentially insect-vectored pathogens in camels and camel keds, and (ii) assess the potential utility of keds for xenodiagnosis of camel pathogens that they may not vector.

Methods: In Laisamis, northern Kenya, camel blood samples (n = 249) and camel keds (n = 117) were randomly collected from camels. All samples were screened for trypanosomal and camelpox DNA by PCR, and for Anaplasma, Ehrlichia, Brucella, Coxiella, Theileria, and Babesia by PCR coupled with high-resolution melting (PCR-HRM) analysis.

Results: In camels, we detected Trypanosoma vivax (41%), Trypanosoma evansi (1.2%), and “ Candidatus Anaplasma camelii” (68.67%). In camel keds, we also detected T. vivax (45.3%), T. evansi (2.56%), Trypanosoma melophagium (1/117) (0.4%), and “ Candidatus Anaplasma camelii” (16.24 %). Piroplasms ( Theileria spp. and Babesia spp.), Coxiella burnetii, Brucella spp., Ehrlichia spp., and camel pox were not detected in any samples.

Conclusions: This study reveals the presence of epizootic pathogens in camels from northern Kenya. Furthermore, the presence of the same pathogens in camels and in keds collected from sampled camels suggests the potential use of these flies in xenodiagnosis of haemopathogens circulating in camels.

Globe rupture caused by a camel bite

Camel bites are uncommon. They are more common during the rutting season where male camels become more aggressive. Herein, we report a unique case of a 25-year-old man who was repeatedly bitten to his face and neck by an aggressive camel that resulted in left eye evisceration, parotid duct, and facial nerve injury. To our knowledge, Globe rupture caused by a camel bite has not been previously reported.

Head, face and neck camel-related injuries: Biomechanics and severity

INTRODUCTION

Large animal-related human injuries are associated with high morbidity and mortality. There are no studies on biomechanics of the camel-related head, face, and neck (HFN) injuries. We aimed to study the mechanism, anatomical distribution and severity of camel-related HFN injuries.

METHODS

We analyzed our prospectively collected data of patients who were admitted to Al Ain Hospital with camel-related HFN injury during the period of October 2001 to January 2010.

RESULTS

Seventy-three patients were studied; all were males having a median (range) age of 28 (5-89) years. Camel kick was the most common mechanism of injury (45%) followed by falling from a camel (22%). Facial fractures were significantly more common in patients who were kicked by a camel. Severe head injuries were significantly more in patients who fell from a camel or who had a car collision with a camel. Car collision with a camel was significantly associated with lower cervical spine fractures (p = 0.017) and severe cervical spine injuries (p = 0.004). Two patients died (overall mortality 3%) CONCLUSIONS: Our study provides an insight into the complex biomechanics and severity of camel-related HFN injuries. It is essential to adopt protective measures in our community so as to reduce camel-related HFN injuries.

Camel bite injury to the maxillofacial region: unusual cause and uncommon location

Animal bite injuries are prevalent worldwide, but the causative animal and the spectrum of injuries are dependent on the kind of animals cohabitating with the human population. Camel bites as a cause are relatively rare. Camels are particularly aggressive, especially during the mating season, when conflicts between the males occasionally lead to dangerous fights resulting in the death of one or both of the combatants. We present a case of camel bite injury to the maxillofacial region inducing an uncommon fracture and the management of both soft and hard tissue injuries, especially addressing the literature for this uncommon bite injury. Because of the unique mode of injury, the ramus was horizontally fractured and displaced. The fracture was also compound because of the deep intraoral bite wounds. The ramal fracture itself is a rare entity. The issue of primary or delayed closure in such cases is addressed.

Effect of different management systems on rutting behavior and behavioral repertoire of housed Maghrebi male camels (Camelus dromedarius)

Camel management has been changing in recent years from an extensive to a semi-intensive or intensive system, particularly for breeding bulls and dairy dromedary camels. Captivity may affect animal welfare, and low libido is the major complaint for housed breeding bulls. Since welfare status could also affect reproductive performance, the aim of this study was to evaluate different management practices on behavior, particularly on sexual behavior, and to identify some behavioral needs of male dromedary camels reared for semen collection. The effects of the following management systems on their behavior were compared: (i) traditional: housing in a single stall for 24 h (H24), (ii) housing in a single stall for 23 h with 1 h free in the paddock (H23), and (iii) housing in a single stall for 22 h and 30 min with 1 h paddock time and 30 min exposure to a female camel herd (ExF). During the trial, blood cortisol concentrations were assessed and camels were filmed daily for 30 min in the mornings and during a female passage in the evenings. Videos were analyzed in order to fill out a focal sampling ethogram and to score sexual behavior. As a result, there were no differences between the H24 and H23 systems, whereas ExF had a significant positive impact on their sexual behavior score and behavioral repertoire, further reducing cortisol levels. Overall, it seems that male dromedary camel welfare status improves when their behavioral needs for social interaction and movement are satisfied.

Evaluation of sexual behavior of housed male camels (Camelus dromedarius) through female parades: correlation with climatic parameters

Camels are seasonal breeders, and their sexual behavior is influenced by environmental conditions, but the relationship between climatic factors and sexual behavior has been poorly described in the available literature. Nowadays, the male camel living habit is shifting towards captivity; thus, this study was carried out to evaluate the sexual behavior of housed male dromedary camel through female's parades and to correlate it with climatic parameters. Four housed sires, reared for semen collection, and one dam were used and the trial lasted 8 weeks, considering the first week as control. Six days per week and during evenings, the female was brought near each males' boxes, while two observers filled a behavioral sampling ethogram and scored the male sexual behavior. After this parade, blood samples were taken from the female to evaluate the estradiol concentration. In addition, the following meteorological parameters were recorded, everyday, at 9:00 a.m. and 19:00 p.m.: pressure, wind, temperature, humidity, and H-index. The correlation between sexual behavioral score and female estradiol concentration and climate parameters was analyzed. All the behavioral parameters showed a significant upward trend; female estradiol concentration varied during the period and picked at week 5. Male sexual behavior was negatively correlated with morning H-index, wind, and temperature, and positively correlated with pressure and evening humidity, whereas it was not correlated with estrogen. In conclusion, female parade was a successful method to evaluate and stimulate the occurrence of housed male dromedary camel sexual activity that resulted to be negatively affected by hot temperature, warm wind, and lack of rain.

Camel-related pancreatico-duodenal injuries: a report of three cases and review of literature

BACKGROUND

Human pancreatico-duodenal injuries caused by camels are extremely rare.

OBJECTIVE

We report three patients who sustained camel-related pancreatico-duodenal injuries and review the literature on this topic.

RESULTS

A 32-year camel caregiver was kicked by a camel which then stepped on his abdomen trying to kill him. The patient's abdomen was soft and lax. CT scan of the abdomen showed free retroperitoneal air. Laparotomy revealed a complete tear of the anterior wall of the second part of duodenum which was primarily repaired. A 40-year camel caregiver was directly kicked into his abdomen by a camel. He developed traumatic pancreatitis which was treated conservatively. A 31-year-old male fell down on his abdomen while riding a camel. Abdominal examination revealed tenderness and guarding. Abdominal CT Scan showed complete transection of the neck of the pancreas which was confirmed by laparotomy. The patient had distal pancreatectomy with preservation of the spleen. All patients were discharged home in good condition.

CONCLUSION

These cases demonstrate the misleading presentation of the camel-related pancreatico-duodenal injuries and their unique mechanism of injury.

Camel-related injuries: prospective study of 212 patients

BACKGROUND

Camel-related injuries have been less well studied than other animal-related injuries. We aimed to study prospectively the incidence, mechanism, distribution of injury, and outcome of patients admitted to hospital with camel-related injuries in Al-Ain, United Arab Emirates.

METHODS

All patients who were admitted to Al-Ain Hospital with a camel-related injury were prospectively studied during the period of October 2001 to January 2010. Patient's demography, time of injury, mechanism of injury, and distribution and severity of injury were studied.

RESULTS

A total of 212 patients, all male, with a median age of 28 years (5-89 years) were studied. The estimated incidence of hospitalized camel-related injured patients in Al-Ain City was 6.88 per 100,000 population per year. Camel kicks were most common (36.8 %) followed by a fall from a camel (26.4 %) and camel bites (25.0 %). Camel kicks and falling from a camel were more common during the hot month of August, and camel bites were more common during the rutting season (November to February). Patients with a kick-related injury had a significantly higher rate of maxillofacial fractures compared with other mechanisms. Spinal injuries occurred significantly more often in vehicle occupants who collided with camels compared with other mechanisms (3/7 compared with 7/205, p = 0.0022, Fisher's exact test). Twelve patients (5.7 %) were admitted to the intensive care unit. The mean hospital stay was 8.6 days (1-103 days). Two patients died (overall mortality 1 %).

CONCLUSIONS

Understanding the biomechanisms and patterns of injury and correlating them with the behavior of the camel is important for identification and prevention of camel-related injuries.