Extensive clinical data and treatment recommendations pertaining to bite wounds made by exotic animals and resulting infection are based on anecdotal case reports. In general, it is best to adhere to the dictum that the bacteriology of the bite wound will reflect the normal oral flora of the inflicting animal as opposed to the normal skin flora of the patient. General principles of local wound care—including irrigation and surgical debridement, wound cultures as appropriate, and tetanus and rabies prophylaxis—should be followed.
Nonhuman primate (monkey) bites are likely to be seen in animal handlers and researchers. The organisms most often encountered in the mouths of rhesus monkeys (Macaca mulatta) are Neisseria sp., a-hemolytic streptococci, and Haemophilus parainfluenza. Also, E. corrodens is a pathogen from primate bite infections. The combination of penicillin and cefoperazone has been recommended as an initial antibiotic regimen for monkey bite injuries. In addition, the potential for transmission of Herpesvirus simiae (B virus) must be considered, from bites, scratches, or needle sticks. The potential consequences of inoculation with B virus are grave and include local neurologic symptoms, encephalitis (91 percent), and death (68 percent). The affected area must be scrubbed with povidine-iodine for 15 min, and then copiously rinsed with water. Ocular or mucous membrane exposure requires a 15-min irrigation with saline or water. Treatment with acyclovir 800 mg PO five times a day beginning immediately after injury should be considered when a wound from a rhesus monkey is sustained. The monkey should be quarantined and carefully examined for oral mucosal lesions. Questions can be directed to the NIH B virus Research Laboratory (404-651-0808).
The large feline carnivores, such as lions and tigers, like domestic cats, also carry Pasteurella among their normal oral flora. Wound care should be the same as for other species, with awareness for the potential for major skeletal and internal injuries.
Alligator bites (Alligator mississippiensis) may be frequently encountered in the southeastern United States. Bite wounds can be polymicrobial, but the aerobic organism Aeromonas hydrophila has been a consistent isolate. Trimethoprim-sulfamethoxazole is considered a front-line agent for treatment, with an aminoglycoside, imipenem, meropenem, or tetracycline as an alternative. Bacteroides and Clostridium species have also been isolated from alligator bites.
Bites from the common or green iguana (Iguana iguana), readily available in the United States as a pet, are generally innocuous. These animals do not harbor the rabies virus. Local topical antiseptic wound care and verification of tetanus status is all that is needed for the emergency treatment of an iguana bite.
Rat bites may be complicated by leptospirosis, a zoonosis transmitted primarily through the direct or indirect exposure of mucous membranes or abraded skin to the urine of an infected animal. The domestic rat may serve as the primary reservoir of leptospirosis in urban areas. Subclinical infections are common and most clinical infections are self-limiting. Oral doxycycline for 7 days is effective when initiated within 4 days of symptom onset. Parenteral penicillin G for 7 days is indicated for the more severe icteric disease. In addition, rat-bite fever may be transmitted by several small rodents, including the rat, mouse, and gerbil. The causative organisms are Streptobacillus moniliformis and Spirillum minor. Prophylactic therapy with penicillin, amoxicillin/clavulanate, or doxcycline for 5 days is recommended.
Camels can inflict serious bites as well as other associated injuries due to their enlarged canine teeth and long necks, which allow them to reach around and bite the rider violently, lift the rider into the air, and throw him or her to the ground. The bacteriology of camel bite wounds has not been well studied; however, an anecdotal report of successful treatment with high-dose penicillin G, gentamicin, and clindamycin has been published.
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