HIV transmission by human bite: a case report and review of the literature-implications for post-exposure prophylaxis

We report a case of a probable HIV-1 transmission by human bite. The analyzed data from ten previously reported  suspected or allegedly confirmed HIV transmissions revealed a deep bleeding bite wound as the primary risk factor. A high HIV plasma viral load and bleeding oral lesions are present most of the time during HIV transmission by bite. HIV post-exposure prophylaxis (PEP) should be recommended in case of a bleeding wound resulting from a bite of an HIV-infected person. PEP was missed in this presented case.

Correction of cheek biting in a dentate patient

Postsurgical injury by teeth to oral mucosa (reconstructed by a flap) can lead to ulceration and subsequent infection at the reconstructed site. A prompt intervention by fabricating a specially designed prosthesis to deflect the reconstruction flap away from the occluding teeth has been described for the treatment of cheek biting in the present clinical report.

Blunt maxillary fracture and cheek bite: two rare causes of traumatic pneumomediastinum

Subcutaneous facial emphysema is a well-known consequence of oral and maxillofacial traumatic injury. In some rare cases, the subcutaneous air collection could spread through the retropharyngeal and paralatero-cervical spaces, reaching the mediastinum. This clinical entity is known as pneumomediastinum and represents a severe and, sometimes, life-threatening condition. Other reported causes of pneumomediastinum are esophageal and tracheal traumatic or iatrogenic rupture. Finally, the so-called spontaneous pneumomediastinum is caused by a sudden increase in alveolar pressure and is usually seen in young men. We present two cases of pneumomediastinum as a consequence of unusual traumatic damage of orofacial tissues, followed by repeated sneezing and Valsalva maneuver.

Managing bite wounds

Animal and human bites are common in the United States. Although evidence-based practice guidelines have not been developed, bite wounds warrant an organized, standardized approach to care to help prevent complications. Such an approach involves first eliciting a history of the circumstances surrounding the bite and the patient's medical history. Next, basic bite wound care should be performed, including cleansing and irrigation of the wound. A good understanding of bite wound bacteriology and the situations in which antibiotics may be indicated is important. Finally, rabies and tetanus prophylaxis should be considered and appropriate follow-up care ensured.

[A woman with swollen lips]

A 23-year-old Caucasian female came to the emergency room with thick and painful lips after using ecstasy the night before. She had been biting her lips all night long. This caused a contusion of her lips, which was accompanied by oedema.

[Love bite on the neck resulted in an embolic stroke]

A 35-year-old woman experienced sudden onset of right-sided weakness due to a left middle cerebral artery stroke 12 hours after she had obtained a love bite on the left side of her neck. Duplex ultrasonography showed a near-occlusion of the left internal carotid artery (ICA) and CT angiography revealed a mural thrombus at the same location. This case report shows that love bites on the neck are a rare cause of embolic stroke. The most likely aetiology is embolization of thrombus material from a local intimal lesion of the ICA.

[Bacteriological study of oral cavity of people of Mexican origin to determine etiology agents of human infections in hand bite]

INTRODUCTION

Hand infections secondary to human bites often leave serious consequences on the functioning of the hand. Such infections are caused by different bacteria. Most bacteriological studies have been made to people of Anglo-Saxon origin or descent, and based on these findings; provide treatment to patients of different origins which may not always be as effective.

METHODS

Descriptive, internal stratified 17 patients were isolated samples of oral cavity and dental plaque bacterial species to identify and define the possible treatment according to the species identified.

RESULTS

Microorganisms were isolated Gram (+) and Gram (-) belonging to the normal flora of the oral cavity and dental plaque in all the cases studied, presenting a variable number of microorganisms according to age but not by sex. The group of Gram-positive bacteria isolated showed sensitivity to: erythromycin, chloramphenicol and ciprofloxacin. In the group of Gram negative: kanamycin, amoxicillin + clavulanic acid, ciprofloxacin and norfloxacin, E. Corrodens sensitive to the group of quinolones as ciprofloxacin, norfloxacin as well as ceftriaxone and cefoperazone sulbactam.

CONCLUSIONS

The bacterial species that are commonly found in normal flora of the oral cavity and dental plaque may be potential pathogens in a hand injury where to find the appropriate conditions for their development.

Above-elbow amputation and death following human bite mismanaged by quacks: a case report and review of literature

BACKGROUND

Human bite is a common injury sustained during a fight, love passion, self mutilation, cannibalism or vampirism. Although widely reported as being more dangerous than animal bites, such complications as limb amputation from gangrene and eventually death is either uncommon or scarcely reported in our environment.

OBJECTIVE

To highlight the dangers of human bite as a potential cause of severe morbidity and mortality especially when poorly managed.

METHODOLOGY

A 30 year old Fulani herdsman with gangrene of the right hand, and distal forearm presenting in coma 10 days after sustaining human bite is presented and relevant related literature reviewed.

CASE REPORT

M.U. is a 30 year old Fulani herdsman who presented to us at the accident and emergency unit with 10 days history of human bite to the first web space of the right hand, 5 days history of gangrenous hand and distal foreman, and 2 days history of loss of consciousness. The injury was inflicted by a fellow herdsman during a fight. He then commenced treatment with a patent medicine dealer. A few days later the hand became swollen with associated severe pains, serous discharge and subsequent darkish discoloration, frank pus exudates and loss of hand function. Two days prior to presentation, he lapsed into unconsciousness after complaining of severe weakness and fever. Following his presentation, clinical examination and investigation, he was offered a below elbow guillotine amputation. However by the next day, he deteriorated with GCS of 5/15 and subsequently died after 24 hours of presentation.

CONCLUSION

Human bite can be a cause of severe morbidity and mortality. Treatment by quacks should be discouraged while early presentation, surgical debridement and delayed wound closure should be emphasized along with other surgical principles.

Bites to the hand: are they more than we can chew?

Animal bites to the hand caused by dogs, cats and humans are common conditions that general practitioners, emergency physicians and hand surgeons encounter in their practice. These bites are prone to infection and represent great cost to the patient in terms of time, money and disability, if not treated optimally from the outset. Other than lacerations to the skin, injuries to the tendons, nerves, bone and joints are commonplace given their proximity to the skin surface in the hand. Optimal treatment of acute animal bites to the hand should include clearance of contamination by surgical debridement, prophylactic antibiotics and tetanus toxoid, as well as staged reconstruction of all damaged tissue, including the skin, once the wound is deemed clean.

Risk factors for anterior disc displacement with reduction and intermittent locking in adolescents

AIMS

To test the hypothesis that oral parafunctions and symptomatic temporomandibulair joint (TMJ) hypermobility are risk factors in adolescents for both anterior disc displacement with reduction (ADDR) and intermittent locking.

METHODS

Participants were two hundred sixty 12- to 16-year-old adolescents (52.3% female) visiting a university clinic for regular dental care. ADDR and symptomatic TMJ hypermobility were diagnosed using a structured clinical examination. During the anamnesis, reports of intermittent locking and of several parafunctions were noted, eg, nocturnal tooth grinding, diurnal jaw clenching, gum chewing, nail biting, lip and/or cheek biting, and biting on objects. The adolescents' dentitions were examined for opposing matching tooth-wear facets as signs of tooth grinding. Risk factors for ADDR and intermittent locking were first assessed using univariate logistic regression and then entered into a stepwise backward multiple model.

RESULTS

While in the multiple model, ADDR was weakly associated only with increasing age (P = .02, explained variance 8.1%), intermittent locking was weakly correlated to diurnal jaw clenching (P = .05, explained variance 27.3%).

CONCLUSION

In adolescence, diurnal clenching may be a risk factor for intermittent locking while age may be a risk factor for ADDR. Symptomatic TMJ hypermobility seems to be unrelated to either ADDR or to intermittent locking.

Wound infections on board ship--prevention, pathogens, and treatment

Wounds are common in seafarers and they can easily become infected in the marine environment. Pre-sea tetanus immunization is essential. Without diagnostic facilities and only a limited range of antibiotics onboard, injury prevention and early treatment to reduce the likelihood of infection are important measures. Suturing clean cuts reduces healing time and risk of infection. Fresh, clean cuts, especially on the face or head, can be closed by adhesive tape or sutures, but if infection arises, then one or more sutures should be removed to enable drainage. Most wounds must be considered contaminated and should not be closed, just covered with sterile dressing after cleaning. Antibiotic treatment should be started immediately in seafarers with hand and puncture wounds. The primary treatment for a simple abscess is incision and drainage. Antibiotic treatment is recommended for abscesses if the infection spreads to the surrounding tissue (associated cellulitis), if there is lack of response to incision and drainage alone, or if the abscess is in an area difficult or dangerous to drain (e.g. face, palm, genitalia). Recommended therapy for cellulitis is 5-10 days of dicloxacillin, cephalexin, clindamycin, or erythromycin, but if there is no improvement after 2-3 days, methicillin-resistant Staphylococcus aureus (MRSA) should be suspected. Bites and burn wounds require special attention. Since wound infections can deteriorate rapidly, a telemedicine advice service (TMAS) should be consulted during the early stages, and serial digital photographs of the affected area, transmitted by e-mail to TMAS, are often useful during treatment at sea.

Posttraumatic head injury resulting in spasticity disorders and oral injury: application of prosthodontic skills for tissue protection--a case report

Patients who have experienced significant brain injury (such as hemorrhagic stroke or trauma) can suffer brain damage that leads to altered neurologic functioning. One such ill effect is the development of aberrant mandibular reflexes that may inflict serious trauma to oral and labial tissues. As primary oral health care providers, dental clinicians may be called upon to function as part of the medical team managing the patient. This case report reviews one such scenario in which the unique skills of trained specialists were used to provide a protective oral device to allow for tissue protection and healing.

[Human hand bite causing soft tissue infection and finger amputation: a case report]

A 50-year-old female patient presented to our institution with a human bite wound on her left hand. Her complaints started 15 days ago after her husband bit her hand. Oral antibiotics and local wound treatment had been given by another medical center to which she first presented. The treatment was changed to intramuscular antibiotics after her complaints worsened. The patient was neither hospitalized nor immobilized. She then presented to our clinic with deep wound infection. After hospitalization, intravenous (IV) antibiotics were given and open debridement was performed. F b hemolytic streptococci were isolated in cultures and IV antibiotic therapy was revised. The wound care and circulation of the second digit worsened despite the new therapy. As a result, ray-amputation through the second proximal metacarpal was performed. After amputation, the wound responded well to antibiotics and infection was resolved at the wound site. After one-year follow-up, she had minimal functional disability and all hand joints had full range of motion. In conclusion, hospitalization, IV antibiotic therapy and effective debridement should be performed in elderly patients who are at risk to achieve a favorable outcome.

HIV postexposure prophylaxis for Special Forces soldiers

Exposure to human immunodeficiency virus (HIV) is a recognized occupational hazard to healthcare personnel. The virus also presents an operational hazard to deployed Special Operations Forces (SOF) personnel. Management guidelines for work related exposure to HIV mainly deal with healthcare workers in a first world hospital environment. Formal guidelines for postexposure prophylaxis (PEP) regarding potential HIV exposure in third world environments have not been established. SOF personnel deploy to regions such as sub-Saharan Africa with a reported HIV prevalence of 35% or higher. This article examines the case of a SOF servicemember exposed to HIV in a confrontation with host nation personnel, the problems with trying to utilize current CDC guidelines and host-nation healthcare capabilities, and a proposed solution devised to ensure appropriate PEP in future cases.

Life-threatening bite injury of the lower lip after use of metamizole

INTRODUCTION

Bite wounds of the oral mucosa heal after eliminating the causative irritant, but there are serious exceptions from the rule. We present the case of a 37-year-old woman with an ulcer of the mucosa of the lower lip, which had been present for 10 days, and leucopenia.

DISCUSSION

Agranulocytosis after the use of metamizole is part from leukaemia and lues, a rare reason for non-healing ulcers of the mucosa of the oral cavity without fulminant signs for inflammation.

CONCLUSION

As this is a life-threatening disease, medical therapy must begin immediately.

Involuntary human bite to the eyebrow

Human bites to the face are very rare and only one case of human bite to the eyebrow has so far been reported. The final functional and cosmetic result of reconstruction mainly depends on the size of the injury, the viability of the tissue and the promptness of surgical intervention. We here present one case of human bite to the eyebrow that resulted in complete avulsion and loss of tissue due to delayed presentation to the hospital. The lesion was reconstructed in two stages with good functional and decent cosmetic outcome. Unfortunately long term follow up was not possible for this patient.

A case of human bite by an 11-year old HIV positive girl in a paediatrics ward

Biting is a possible mode of transmission of HIV infection, though the risk of such transmission is believed to be low. Children infected with HIV are at risk of psychological complications as a result of direct or indirect effects associated with the disease. We report the case of an 11 year old HIV positive girl with clinical stage IV disease, who was involved in multiple disputes while on admission on the ward. During one of the disputes she inflicted a deep bite injury on a 10-year old boy, HIV post-exposure prophylaxis (PEP) was commenced 6 hours after the bite and he has remained HIV negative 12 months later. What is peculiar about this case is that the incident occurred in a hospital setting and biting is not usually expected among children of this age. In the era of HIV/AIDS, it is recommended that persons involved in childcare be aware of this potential risk during interactions among children. It is also essential for health care personnel to have sufficient knowledge about PEP in order to reduce the risk of HIV transmission in similar settings. In addition, a multidisciplinary approach to the management of children living with HIV is important in order to identify and address psychosocial factors that may influence symptoms and medical treatment outcome. The risk of transmission of HIV through human bites and the psychosocial impact of the disease on children are also discussed.

Human bites in the classroom: incidence, treatment, and complications

It has been estimated that at least one half of the population will experience some type of bite in their lifetime. Human bites are the third leading cause of all bites seen in hospital emergency departments after dog and cat bites. Human bites can be the source of exposure to body fluids, transmission of communicable diseases, infections ranging from cellulitis to osteomyelitis, and joint deformity from septic arthritis. Approximately 10-15% of human bites will become infected. In the school setting, a teacher or other staff member can sustain a human bite while trying to protect a student from injury. Often the first responder to this type of incident is the school nurse. The role of the school nurse is to promote early reporting, accurate history taking of the time and mechanism of injury, administering immediate wound care, initiating early referrals to appropriate medical providers, and supporting proactive care in the form of adult hepatitis B immunization.

The replantation of an amputated tongue by supermicrosurgery

The tongue has important roles in deglutition, speech, airway protection, taste, and sexual function, and its amputation is very serious. Using supermicrosurgical techniques, we replanted successfully a patient's tongue, the distal part of which had been amputated by the bite of another person, through the anastomosis of a blood vessel that was only 0.7-0.8mm. The result was that the state of the replanted tongue was relatively good both functionally and aesthetically, and the patient was very satisfied.

Traumatic globe luxation and enucleation caused by a human bite injury

A 55-year-old woman presented to the emergency room with complete loss of vision in the left eye after being bit in the face by her autistic grandson. She had a small upper eyelid laceration and an anophthalmic socket on the left side. A thorough history revealed that the bite had caused traumatic luxation of her globe, which had allowed the child to transect the optic nerve with his teeth. Careful attention was directed toward the prevention of retrograde infection in this unusual case of traumatic enucleation.

Facial emphysema caused by cheek bite

Biting of the buccal mucosa is very frequent injury, whereas facial emphysema caused by cheek bite is rare. We report a case of facial emphysema causing puffing of the cheek through a self-inflicted bite of the buccal mucosa.

Technical refinements in the Washio tempororetroauricular flap in reconstruction of the nasal wing

Retroauricular tissue for reconstruction of external nasal defects was described by Washio. We describe our recent experiences in elderly patients, in whom the risk of reconstruction after excision of a malignant growth is high. We present seven reconstructions, six after excision of malignant disease, together with our ideas about how to maximise its possibilities.

Best evidence topic report. Are antibiotics indicated following human bites?

A short cut review was carried out to establish whether antibiotics are indicated for human bites. Eighty nine papers were found using the reported search, of which two represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. Prophylactic antibiotics should be given to all patients with human bites to the hands, feet, and skin overlying joints or cartilaginous structures, and to all patients with bites that penetrate deeper than the epidermal layer.

Management of human and animal bite wounds: an overview

Serious infections can result from wounds that are caused by bites from animals and humans. Organisms recovered from bite wounds generally originate from the oral cavity of the biting animal, as well as from the patient's skin flora. Anaerobes have been isolated from animal and human bite wound infections, especially those associated with abscess formation. In addition to local wound infections, common complications, such as lymphangitis, septic arthritis, tenosynovitis, and osteomyelitis, and uncommon complications, such as endocarditis, meningitis, brain abscess, and sepsis, may occur. Wound management includes proper local care and, when needed, antimicrobial therapy.

Penile ulcer from traumatic orogenital contact

Human bite injuries, although less frequent than animal bites, usually stem from aggressive behavior, sports participation, or sexual activity. Human genital bites and similar traumatic events also occur, but are infrequently reported because of embarrassment. A genital ulceration following mild trauma during oral-genital contact is reported and appropriate diagnostic and therapeutic interventions reviewed. The ulcer was infected, as verified by culture, with an aggressive oral flora organism, Eikenella corrodens. The genital ulceration healed following appropriate antibiotic therapy. Treatment of human bites focuses on obtaining an accurate history and salient physical examination, as well as performing early irrigation and debridement. Prophylactic antibiotic treatment and primary closure of bite wounds remain areas of controversy. Because there is an inherent high risk of infection, genital human bite wounds (and similar traumatic events related to orogenital contact) should be managed with prophylactic antibiotic administration.

[Extended nasal skin reconstruction with a retroauricular free flap harvested on the superficial temporal pedicle]

The microsurgical coverage of large nasal skin avulsion was performed in a 40 years old patient after a human bite. Widely exposing the columelle, the alar cartilages and the distal part of the septum, the defect was covered with a retroauricular free flap harvested on the superficial temporal pedicle and transferred on the upper labial vessels in the nasogenian area. Thanks to its excellent colour and texture match with the nose integuments, this flap enjoyed of an optimal integration in the centrofacial area. Its potential indications, advantages, drawbacks and technical variants are discussed in the present paper.

[Bite wound infections]

BACKGROUND

The lifetime risk of experiencing a bite wound, human or animal, is approximately 50%, and bite wounds account for approximately 1% of all visits to emergency departments. The majority of bite wounds are inflicted by dogs and cats.

MATERIAL AND METHODS

A review of the literature on the diagnosis and treatment of bite wound infections is presented.

RESULTS

The most common pathogens associated with bite wounds are Streptococcus species, Staphylococcus species, Pasteurella multocida, Capnocytophaga canimorsus and anaerobic bacteria. Sporadically other pathogens are isolated from bite wounds. Human bites differ from animal bites by higher prevalence of Staphylococcus aureus and Eikenella corrodens.

INTERPRETATION

It is important to be aware of the possibility of complicating infections following bite wounds, particularly after cat bites. Phenoxymethyl penicillin should be the drug of choice in treatment of infections associated with cat and dog bites. However, in case of slow recovery or no improvement, simultaneous lymphadenopathy or pneumonia, S. aureus or Francisella tularensis should be suspected; ciprofloxacin is recommended. For human bite infections the recommend treatment is phenoxymethyl penicillin in combination with penicillinase-stable penicillin.

A human bite to the scrotum: a case report and review of the literature

Human bites to the scrotum are rare and can be associated with a high morbidity rate if poorly managed. We report a case of a human bite to the scrotum that was successfully treated with a 5-day course of antibiotics, surgical debridement and healing by secondary intention.

Forensic odontology: a global activity

Forensic odontology is an important and expanding field of dentistry. The application of these forensic techniques in identification, criminal justice and dental liability are being practiced worldwide. In some mass disaster events, notably large commercial aircraft crashes, the traumatic forces are such that fragmentation and conflagration result in only the most durable of human tissues-dentition survive and become a potential source of identification.

Primary repair of a flexor tendon after a human bite

Successful uncomplicated primary closure of a human bite injury of the hand with simultaneous zone II flexor tendon injury has not been previously reported to our knowledge. We report the case of a man who was bitten on his left ring and right middle and index fingers. He was treated with antiseptic lavage, intravenous antibiotics, and operation. He had complete transsection of the flexor digitorum profundus at the middle phalanx. This was repaired primarily and he made a good recovery.

Common acute hand infections

Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Tetanus prophylaxis is indicated in patients who have at-risk infections. Paronychia, an infection of the epidermis bordering the nail, commonly is precipitated by localized trauma. Treatment consists of incision and drainage, warm-water soaks and, sometimes, oral antibiotics. A felon is an abscess of the distal pulp of the fingertip. An early felon may be amenable to elevation, oral antibiotics, and warm water or saline soaks. A more advanced felon requires incision and drainage. Herpetic whitlow is a painful infection caused by the herpes simplex virus. Early treatment with oral antiviral agents may hasten healing. Pyogenic flexor tenosynovitis and clenched-fist injuries are more serious infections that often require surgical intervention. Pyogenic flexor tenosynovitis is an acute synovial space infection involving a flexor tendon sheath. Treatment consists of parenteral antibiotics and sheath irrigation. A clenched-fist injury usually is the result of an altercation and often involves injury to the extensor tendon, joint capsule, and bone. Wound exploration, copious irrigation, and appropriate antibiotics can prevent undesired outcomes.

Unusual inflicted hot oil burns in a 7-year-old

Pediatric burn injuries occur not infrequently as the result of abuse. While the majority of these burns are inflicted scald burns, those due to contact or contact/scald mechanisms may present diagnostic challenges. A child with unusual combined contact and scald burns caused by a metal spatula heated in hot cooking oil is described. The odd pattern of healed injury limited the initial diagnosis to inflicted healing burns. Despite the initial lack of disclosure, an inflicted etiology was supported by clearly delineated margins, macular lesions with hyper-pigmented rims and variegated central regions. Additional findings of numerous adult bites and bruises provided adjunctive support for an inflicted etiology. Aspects of this case are atypical for the usual demographics of a burn victim. This case extends the known presentations of inflicted contact/scald burns.