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Bites and stings
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Common pathogens associated with bite wounds include streptococci, staphylococci, Pasteurella spp., Capnocytophaga canimorsus, and anaerobes. Breast implant infection and lung abscesses due to Pasteurella multocida have both been linked to cats, and staphylococcal endocarditis has been reported after a cat bite. Brain abscess formation has been observed following a dog bite. In immunocompromised patients, there is a significant risk of Pasteurella or Capnocytophaga sepsis. Capnocytophaga canimorsus sepsis has a high mortality rate and has been associated with purpura fulminans. Human bites have a higher likelihood of infections with Staphylococcus aureus and Eikenella corrodens.
Infections and infestations affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
This is an uncommon infection mainly due to scratch injuries and bites by domestic animals, mainly pet cats;101 it is more frequently seen in veterinary personnel.102 Hence, fingers, hands, and arms are most frequently involved.103,104Bartonella (Rochalimea) henselae is the common pathogen, but B quintana and claridgeiae were also described.105, 106 The latency period is between one week to one month. The disease usually starts with fever and lymphadenopathy before a papule at the inoculation site appears. Reactive arthritis was observed after a cat bite.107
Skin and Soft Tissue Infections
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
The incidence of infection after a cat bite is >50% (26). The most frequent organism isolated is P. multocida. Otherwise the spectrum of pathogens is similar to those of dog bites. Infection by Bartonella henselae, the cause of cat-scratch disease, may occur after a cat bite. The management step is similar to dog bite wounds including the need of tetanus toxoid and risk assessment for rabies postexposure prophylaxis.
Acute epiglottitis due to Pasteurella multocida after contact with a feral cat
Published in Baylor University Medical Center Proceedings, 2019
Lauren Sisco, Lizbeth Cahuayme-Zuniga
A 57-year-old white man with no known medical history was awakened from sleep with a sore throat that progressed within hours to neck pain, dyspnea, trouble swallowing, and difficulty handling his oral secretions. He reported a cat bite and scratches to his hands 2 days prior while feeding a feral cat. He lived alone with his dog in a rural area in Texas and worked a desk job. He smoked about one-half packs of cigarettes daily for the past 12 years and drank alcohol most days of the week.
Unexpected return visits to emergency department: A healthcare quality management challenge
Published in International Journal of Healthcare Management, 2020
Raheel Sharfeen Qureshi, Isma Qureshi, Mohamed Abbasy, Waseem Ahmad Malik, Benny Ponnapan, Amjad Gauhar, Sohaib Chaudhry, Sameer Pathan, Dominic Jenkins, Stephen H. Thomas
Depending on the diagnosis, there are myriad URV chief complaints – some that may appear unrelated to the initial-visit chief complaint – that depict good care, rather than poor diagnostic acumen. A patient with mild head injury may have a worsening headache, a patient with febrile illness could develop a stiff neck, or a patient with a cat bite could see redness in their wound. In none of these cases is a URV necessarily indicative of suboptimal care; the URV may be a manifestation of good physician–patient communication regarding return precautions [13–15]. Unfortunately, in any retrospective study, there are many cases in which it is difficult to know with certainty, the extent to which a particular URV is related to good care (including good discharge instructions). For cases in which there was no obviously directive documentation (e.g. initial-visit discharge instructions directed patients to return the next day for repeat lab testing), URVs assessed in this study are often inherently subject to different judgments as to categorization. Due to this unavoidable subjectivity, the large number of URVs, and this study’s focus on physician agreement about URV categorization (i.e. not the actual ‘truth’ behind a given URV presentation), this study de-emphasized the search for medical details underlying each URV. Rather than closely detail the clinical parameters surrounding all 1753 URVs for an endpoint that was only indirectly related to the study’s aim, the study plan called for URV reasons to be assessed in detail by only one reviewer, for only the one-third of overall cases for which this reviewer was primarily responsible (392 or 33.3% of 1178 non-LWBS cases). In fact, the assessment of URV reasons in nearly 400 cases does place this study subset at or above the n found in some other investigations of URVs [3,16,17]. However, the limited data on URV reasons is still a study limitation and the clinical information regarding the URVs should be taken as it is intended, as a rough guide rather than a precise set of estimates about clinical reasons for URVs at the study center. A third consideration regarding URV definition is the time frame defining the return visit. This study utilized a 48-h cutpoint to define URV (one of the limitations of the study). The same 48-h cutpoint is reported in other settings [3,17], although definitions vary and some define ‘bounceback’ cases as those presenting within 72 h [18,19] or even up to a week[6] after ED discharge. The current investigation was not designed to determine the best cutoff to define URV, but rather to assess the applicability of the actual URV numbers (i.e. defined at the 48-h cutoff) as reported to the study center’s governmental regulatory body. However, the study’s external validity is limited to any center in which URV cutpoints are different from the 2-day period used at HGH.ED overcrowding and increase patient waiting time was a big challenge as in any hospital [27] resulting in LWBS and eventually return back to ED.
Cat bite: an injury not to underestimate
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Amin Kheiran, Vishal Palial, Rebecca Rollett, Clare J. Wildin, Urjit Chatterji, Harvinder P. Singh
Cat bites in hand and wrist tend to be small puncture wounds that seal off almost immediately or within 48 h of initial bite [3,11]. As such, the risk of deep infections can be easily underestimated, despite its benign outward appearance [6]. The majority of these wounds can be treated uneventfully without hospitalization or even surgery [6,11]. However, some of these wounds can become severely infected and the use of antibiotics alone, when abscess or collection exist, is ineffective and mandates further surgery [4–6,11]. The key to management in such cases is wound exploration and debridement of unhealthy zones, and opening up the puncture site, so that the wound can be allowed to drain [3]. Eighteen out of 20 cases in this study underwent surgical treatment. Of these, 55% (n = 11) presented within 48 h of their injury and almost 36% of these (4 out of 11) underwent surgery within 24 h of the initial bite. Our results also show that seven cases (35%) underwent multiple debridement due to residual soft-tissue infection or extensive soft-tissue necrosis. Of these, four (57%) had amputation. All of these cases presented late, at median of 11 days (range, 1.4–23) following initial injury. Delay in presentation is a critical factor that prolongs recovery and necessitates more invasive treatment [3,11]. Dire reviewed 216 cat bite and scratch wounds with 45% affecting the hand. Dire demonstrated that longer intervals from injury to ED visit, older age and deeper wounds carried significantly higher risk of severe infection [11]. Mitnovetski and Kimble found that 15 of 41 (37%) patients with cat bites required hospital admission and five (12%) of these underwent surgery. Three had a single operation; one had two operations due to septic arthritis, and one required three procedures due to extensive soft tissue necrosis, but none of their cases underwent a non- salvageable surgery (amputation). The interval between the initial injury and surgery was not clearly described [5]. Benson et al., retrospectively reviewed 40 patients sustaining cat bite to the upper limb. They reported that 13 out of 40 cat bites required surgery secondary to deep infection, of these seven cases underwent multiple surgery and long-term intravenous antibiotic due to osteomyelitis [3]. The average time from bite to presentation was reported as 7.8 days including dog bites. They concluded that delay in presentation has particular implications with respect to the cost of care [3]. More recently Babovic et al. [6], retrospectively reviewed a large case series (n = 193) of cat bites to the hand and evaluated the predictors of hospitalization and severe infection. Mean time from bite to presentation (interval) was reported 27 h in overall, and the interval was not significantly different between those hospitalised and those were not. They demonstrated that almost 20% (n = 38 out of 193) of cases required surgical intervention. Of these, 21% (n = 8) had multiple surgery. Nonetheless, their study lacks clear explanation regarding the interval (time from bite to presentation) in those had surgical intervention, and reasons for complicated surgery [6].