Who killed my dog? Use of forensic genetics to investigate an enigmatic case.

Genetic testing of animal biological material has become a valuable tool in forensic investigations, and it is successfully used to identify unknown crime perpetrators, to unmask food frauds, or to clarify cases of animal attacks on humans or other animals. When DNA profiling is not possible due to inadequate amounts of nuclear DNA, mitochondrial DNA (mtDNA) testing is the only viable alternative, as in the case of shed hair samples. In this case, a dog was allegedly killed by wild animals while being hosted in a boarding house. Extraneous hair fragments recovered from the dog's mouth and paws were subjected to genetic analysis: the cytochrome b gene located on mtDNA was amplified and sequenced in order to determine the species responsible for the killing. The mtDNA analysis provided evidence that the dog was killed by other dogs, thus unmasking a false wild animal attack and putting the case in an entirely different perspective.

Variable Mechanisms of Dog-Related Deaths.

As the literature has tended to focus on injuries and deaths due to active dog attacks, the following review was undertaken to examine the range of circumstances and mechanisms that may be associated with all types of fatal encounters with dogs. A search was undertaken of the literature and the Forensic Science SA, Australia, autopsy database for cases where deaths had been caused by dog-related activity. Only 2 cases were found in the autopsy database over a 15-year period from 2005 to 2019. The first was a 55-year-old man who bled to death from a large degloving dog bite to his forehead exacerbating underlying cardiovascular disease. The second was a 40-year-old previously splenectomized man who died of Capnocytophaga canimorsus sepsis shortly after being bitten by his dog. Dogs may be involved in vehicle crashes if drivers swerve to avoid them or if pedestrians attempt to rescue dogs that have strayed onto roads. In the literature, trauma has also occurred from "non-bite dog-related injuries" where individuals have been pulled over by, or tripped on, dogs. Dogs may also be responsible for specific types of infections such as echinococcosis and C. canimorsus, which may have potentially lethal consequences. Thus, the types of cases of injuries, illnesses, and deaths associated with dogs encountered by pathologists in a forensic context may be extremely diverse and not always straightforward.

Thoracic dog bite wounds in dogs: A retrospective study of 123 cases (2003-2016).

OBJECTIVE: To report the clinical, radiographic, and surgical findings and determine prognostic factors for outcome in dogs with thoracic dog bite wounds. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n = 123). METHODS: Medical records of dogs with thoracic dog bite wounds between October 2003 to July 2016 were reviewed for presenting findings, management, and outcomes. Standard wound management included debridement and sterile probing, extending the level of exploration to the depth of the wound. Univariable and multivariable binary logistic regression were used to assess risk factors for exploratory thoracotomy, lung lobectomy, and mortality. RESULTS: Twenty-five dogs underwent exploratory thoracotomy, including lung lobectomy in 12 of these dogs. Presence of pneumothorax (odds ratio [OR] 25.4, confidence interval (CI) 5.2-123.2, P < .001), pseudo-flail chest (OR 15.8, CI 3.2-77.3, P = .001), or rib fracture (OR 11.2, CI 2.5-51.2, P = .002) was associated with increased odds of undergoing exploratory thoracotomy. Presence of pleural effusion (OR 12.1, CI 1.2-120.2, P = .033) and obtaining a positive bacterial culture (OR 23.4, CI 1.6-337.9, P = .021) were associated with increased odds of mortality. The level of wound management correlated with the length of hospitalization (Spearman rank order correlation = 0.52, P < .001) but was not associated with mortality. CONCLUSION: Dogs that sustained pseudo-flail chest, rib fracture, or pneumothorax were more likely to undergo exploratory thoracotomy. Nonsurvival was more likely in dogs with pleural effusion or positive bacterial culture. CLINICAL SIGNIFICANCE: Presence of pseudo-flail, rib fracture, or pneumothorax should raise suspicion of intrathoracic injury. Strong consideration should be given to radiography, surgical exploration, and debridement of all thoracic dog bite wounds.

Penetrating Thoracic Injury and Fatal Aortic Transection From the Barb of a Stingray.

Stingrays are found in open waters and are also kept in exhibits in many aquariums throughout the world. They are generally nonaggressive creatures by nature, but they can inflict injuries with their spines if provoked. We present a case of a 62-y-old diver who was pierced in the chest by the barb of a stingray while transferring the animal to another tank as part of his work in a public aquarium. He was rescued immediately from the tank but was found to be in cardiac arrest. Bystander cardiopulmonary resuscitation was promptly initiated by his colleagues. He was rapidly evacuated to the nearest emergency department, where he was noted to be in pulseless electrical activity. A single puncture wound was noted over the right second intercostal space, with the spine of the stingray still impaled in the chest. Trauma surgeons were activated promptly, and resuscitation was continued based on advanced cardiac and trauma life support guidelines, which included ongoing cardiopulmonary resuscitation, securing the airway, and emergency blood transfusion. An emergency department thoracotomy was performed, but despite aggressive resuscitation the thoracic injury was fatal. An autopsy revealed transection of the aorta by an impaled barb. We present a review of stingray injuries and suggest a general approach to management.

Fatal mauling by tigers.

Lethal injuries due to large animal attack are uncommon in routine forensic practice in Europe. Specifically, few incidents are reported concerning tiger/lion attacks that usually involve captive circus or zoo animals. We present the case of a 61-year old animal tamer who was mauled to death by four tigers while he was training them for a circus performance. Careful investigation of the circumstances surrounding the fatality revealed that the tamer had most likely been struck with a tiger paw and then mauled by additional tigers resulting in serious and fatal injuries. Although a full medico-legal autopsy was not authorized, total body CT scan coupled with post-mortem external examination allowed a reconstruction of events.

A Case Report of a Bite From the Nile Crocodile (Crocodylus niloticus) Managed with Regional Anesthesia.

Crocodile attack injuries plague communities near bodies of water and continue to be an infrequent but significant form of trauma encountered in our medical facility. Regional anesthesia techniques are a novel adjunct to treatment and may facilitate simplified definitive management and better utilization of constrained operating room resources. We report a case of an adult male who presented with a large lower extremity wound after a crocodile bite. The patient was managed with initial debridement and irrigation and serial wound care entirely under regional anesthesia at the bedside. The patient did not develop wound infection, eventually receiving a skin graft with good functional outcomes. Regional anesthesia techniques are increasingly being used in the trauma setting, and their versatility allows for their use in multiple settings, by practitioners with limited experience and in resource-limited environments. No specific guidelines exist for performance of neuraxial techniques in the setting of animal bite injuries, but concerns about infectious complications have been raised. Regional anesthesia techniques may be useful in the management of extremity trauma due to crocodile attacks without infectious complications. They may reduce utilization of theatre resources and reduce opioid requirements.

Cougar (Puma concolor) Injury in the United States.

INTRODUCTION: Human encounters with the cougar (Puma concolor) are rare in the United States but may be fatal. METHODS: We performed a retrospective analysis of cougar attacks in the United States. We asked Fish and Wildlife Department officials from the 16 states in which cougars are known to live to identify all verified cougar attacks recorded in state history. Variables describing the human victim, cougar, and conditions surrounding the attack were recorded. The Fisher exact test was used for comparison. RESULTS: Ten states reported 74 cougar attacks from 1924 to 2018. Persons less than 18 y of age were heavily represented among victims; 48% were <18 y old, and 35% were less than 10 y old. Attacks were more common in the summer and fall months. Most attacks occurred during daylight hours. The head, neck, and chest were the most common anatomic sites of injury. Sixteen (46%) victims were hospitalized after being attacked, among the 35 victims with these data available. Eleven (15%) attacks were fatal among 71 reports with this information. None of the hospitalized victims died (P=0.02). No victim variables were predictive of death. CONCLUSIONS: Cougar attacks are uncommon but can be fatal. Attacks commonly affect children and young adults, although all age groups are at risk of attack and death. Most attacks occur during the daytime in the summer and fall. As development and recreational activities put humans in closer contact with cougars, establishing validated public health messaging is critical to minimize injurious encounters.

Shark Related Injuries: A Case Series of Emergency Department Patients.

INTRODUCTION: Shark-related-injuries (SRIs) are not thoroughly evaluated in the medical literature given their rare occurrence. Previous studies involve the utilization of large-independent databases and have demonstrated that shark attacks appear to be increasing, even though mortality of SRIs has decreased from 51% in 1958 to 8.3% in 2001. METHODS: We performed a retrospective chart review on patients presenting to 10 emergency departments (ED) in southeastern Virginia from February 22, 2008 through December 31, 2016. We used a free-text search feature to identify patients documented to have the word "shark" in the record. We reported descriptive statistics for patient demographics, disposition, mortality, time of injury, body injury location, activity during injury, injury severity score (ISS), antibiotic use, and if the patient was in the International Shark Attack File(ISAF) or the Global Shark Attack File(GSAF). RESULTS: We identified 11 patients. Most patients were male (81.8%) and Caucasian (90.9%) with a mean age of 35 years old (SD = 13.4, range17-55). Most patients (72.7%) arrived to the ED by private vehicle. Seventy-eight percent of patients were safely discharged from the ED. There were no deaths. There was a bimodal distribution of the time of injury around noon and early evening. Only 1 of our patients was present in the GSAF and 4 were present in the ISAF. CONCLUSION: Most SRIs can be safely evaluated, treated, and discharged from the ED. Utilization of large databases for shark related research may underestimate its prevalence in the US. Further research is needed into the care of SRIs in the ED.

Characteristics of Dog Bites in Arkansas.

OBJECTIVE: Dog bite injuries are encountered frequently in emergency departments and can cause significant morbidity. The objective of this study was to explore the associations between the multiple variables at play during these occurrences (eg, the patient's age, the bite location, the bite severity, the dog's relationship with the patient, the breed of dog). METHODS: This two-institution study collected and analyzed dog bite data from Arkansas' only Level I trauma centers. The charts of 740 patients were included in our retrospective chart review. The chart review extracted data, including each individual patient's age, sex, dog bite location, and dog bite severity, as well as the patient's relationship to the dog and the dog's breed. To determine the relation between and among variables, contingency tables were created and analyzed to determine odds ratios (ORs) and confidence intervals (CIs). In addition, standard t tests were used in statistical comparisons of means and proportions. RESULTS: Of the 740 patient charts reviewed, 574 were for patients who presented to Arkansas Children's Hospital and 166 were for patients who presented to the University of Arkansas for Medical Sciences. Of the patients across both institutions, 267 (37.1%) required some form of repair, with 225 (30.4%) receiving closure within the emergency department and 42 (6.7%) requiring an operative intervention. Among children, those younger than age 5 years were >8 times as likely to require an operative repair (OR 8.1, 95% CI 2.77-23.58, P < 0.0001), >4 times as likely to be bitten on the head and neck (OR 4.30, 95% CI 3.00-6.16, P < 0.0001), and ≤3 times as likely to be bitten by a family dog (OR 2.97, 95% CI 2.10-4.20, P < 0.0001). Conversely, children older than age 12 years were >3 times as likely to be bitten on an extremity (OR 3.43, 95% CI 2.08-5.65, P < 0.0001). CONCLUSIONS: The results of this retrospective review are aligned mostly with the general trends found in previous national and global studies, supporting the notion that family dogs represent a more significant threat than often is realized and that, among the breeds identified, pit bulls are proportionally linked with more severe bite injuries. Our data further validate previous studies that note an increased risk of bites and bite severity in children younger than 5 years. In addition, our data show that bites to the head and neck occurred more frequently among children younger than 5 years than among older children, and that boys younger than 5 years were bitten more frequently than girls.

Ophthalmic Manifestations of Facial Dog Bites in Children.

PURPOSE: To characterize ophthalmic manifestations and periocular injuries of pediatric facial dog bites. METHODS: A retrospective review of all children younger than 18 years who sought medical attention after a dog bite to the face between January 1, 2003 and May 22, 2014 was performed at a large tertiary pediatric hospital. Data on type and location of injury, surgical intervention, and complications were collected. RESULTS: A total of 1,989 children aged 0.19 to 17 years were identified with dog bites. Dog bites to the face occurred in most patients (n = 1, 414 [71%]). Of those children with facial dog bite injuries, 230 (16%) suffered ophthalmic manifestations. The average age was 4.3 years. Eyelid injuries occurred in 227 (99%) of children, 47 (20%) sustained canalicular system injuries, 3 (1.3%) suffered corneal abrasions, and 2 patients sustained facial nerve injury resulting in lagophthalmos. No patients suffered vision loss. Complications occurred in 32 patients (14%), with the most common being epiphora in 9 patients (28%), upper eyelid ptosis in 8 (25%), and prominent scar formation in 4 patients (13%). Thirteen children (5.7%) needed one or more secondary procedure to correct complications. CONCLUSIONS: The authors report the clinical features and management on the largest series of ophthalmic and periocular injuries associated with pediatric facial dog bites. These injuries occur in about 1 in 6 dog bites to the face and primarily involve the ocular adnexa. Despite early and appropriate surgical management, complications and the need for revision surgery are relatively common.

Autopsy Features of Fatal Donkey Attack.

Lethal donkey attacks have very rarely been described. The case of a 65-year-old man who was found deceased on a country road with 2 domestic donkeys nearby is, therefore, reported. Examination of the body revealed contusions and lacerations of the face and scalp, a comminuted fracture of the left maxilla, comminuted fracturing of the right radius and ulna and of the left anterior superior iliac spine, a flail chest, and pulmonary contusions. In addition, there were bite marks on the left thigh, right buttock, right axilla/upper arm, and left cheek which corresponded to the dental arcades of the donkeys. Death had resulted from blunt chest trauma due to an attack by 1 or 2 donkeys. Deaths and serious injuries are much more commonly caused by horses; however, this case shows that even domesticated donkeys may also rarely be capable of inflicting significant trauma and so should be approached with circumspection.

Injuries and envenomation by exotic pets in Hong Kong.

INTRODUCTION: Exotic pets are increasingly popular in Hong Kong and include fish, amphibians, reptiles, and arthropods. Some of these exotic animals are venomous and may cause injuries to and envenomation of their owners. The clinical experience of emergency physicians in the management of injuries and envenomation by these exotic animals is limited. We reviewed the clinical features and outcomes of injuries and envenomation by exotic pets recorded by the Hong Kong Poison Information Centre. METHODS: We retrospectively retrieved and reviewed cases of injuries and envenomation by exotic pets recorded by the Hong Kong Poison Information Centre from 1 July 2008 to 31 March 2017. RESULTS: There were 15 reported cases of injuries and envenomation by exotic pets during the study period, including snakebite (n=6), fish sting (n=4), scorpion sting (n=2), lizard bite (n=2), and turtle bite (n=1). There were two cases of major effects from the envenomation, seven cases with moderate effects, and six cases with mild effects. All major effects were related to venomous snakebites. There were no mortalities. CONCLUSION: All human injuries from exotic pets arose from reptiles, scorpions, and fish. All cases of major envenomation were inflicted by snakes.

An Update on Fatalities Due to Venomous and Nonvenomous Animals in the United States (2008-2015).

INTRODUCTION: To review recent (2008-2015) United States mortality data from deaths caused by nonvenomous and venomous animals and compare with historical data. METHODS: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was queried to return all animal-related fatalities between 2008 and 2015. Mortality frequencies for animal-related fatalities were calculated using the estimated 2011 United States population. Inclusion criteria included all mortalities that were a consequence of bite, contact, attack, or envenomation (International Classification of Diseases 10th revision codes W53-W59 and X20-X29). RESULTS: There were 1610 animal-related fatalities, with the majority from nonvenomous animals (4.8 deaths per 10 million persons annually). The largest proportion of animal-related fatalities was due to "other mammals," largely composed of horses and cattle. Deaths attributable to Hymenoptera (hornets, wasps, and bees) account for 29.7% of the overall animal-related fatalities and have been steady over the last 20 years. Dog-related fatality frequencies are stable, although the fatality frequency of 4.6 deaths per 10 million persons among children 4 years of age or younger was nearly 4-fold greater than in the other age groups. CONCLUSIONS: Appropriate education and prevention measures aimed at decreasing injury from animals should be directed at the high-risk groups of agricultural workers and young children with dogs. Public policy and treatment pricing should align to ensure adequate available medication for those at risk of anaphylaxis from stings from Hymenoptera.

Whiptail Stingray Injury.

Stingray injuries to the chest are rare but potentially life-threatening. They may occur in remote areas where advanced emergency healthcare services are unavailable. We describe the case of a 24-year-old man with tension pneumothorax due to a Himantura fai stingray injury to the left chest. The chest wound was unremarkable, with no external bleeding or evidence of a foreign body. Decompression was performed at the scene with an improvised knife procedure and a hollow writing pen, which served as a chest tube. At the local hospital, a standard-sized chest tube was inserted, the wound cleaned, and the patient given antibiotics active against marine organisms. Computed tomography visualized the stinger and revealed hemopneumothorax and pneumomediastinum. The local hospital did not have a thoracic surgeon, and the patient was transferred to a larger hospital with a thoracic surgery center. After surgical removal of the stinger, segmental lung resection was required to control bleeding. Management of life-threatening stingray injuries to the chest should begin at the scene. After stabilization, the patient should be transferred to a hospital equipped for cardiovascular and thoracic surgery. Surgery may be required to remove the retroserrated stinger and can be challenging.

Management and Outcome of Maxillofacial Trauma in a 9-Week-Old Dog.

This case report describes diagnosis, treatment, and outcome of maxillofacial trauma in a 9-week-old shih tzu. In addition to an open left mandibular body fracture and a right condylar process fracture, there were several relatively stable and minimally displaced right maxillary fractures. The torn soft tissues associated with the left mandibular body fracture were sutured closed, and a tape muzzle was placed. Due to sufficient fracture healing at the 2-week recheck examination, the tape muzzle was removed. The 6-week reexamination confirmed continued healing and recovery. Anesthesia was performed at the 5.5-month reexamination when the dog was 8 months old, revealing the presence of persistent deciduous teeth, linguoverted, malformed, and partially erupted permanent teeth, and asymmetric skeletal malocclusion (in addition to the breed-specific mandibular mesioclusion). Persistent deciduous teeth and linguoverted and malformed permanent teeth were extracted to allow for normal opening and closing of the mouth without traumatic occlusion. Long-term follow-up is recommended in juvenile dogs with maxillofacial injuries in order to prevent, recognize, and treat dental complications resulting from the trauma.

Management and treatment of animal bites.

Animal bites account for 1% of ED visits and more than $50 million in healthcare costs annually in the United States. Managing bite wounds can be challenging and providers must consider the patient's tetanus status, species of animal inflicting the bite, and infection risk. This article describes treatment and care of bites and when rabies prophylaxis is indicated.

MONKEY BITES AND INJURIES IN THE ZAGREB ANTIRABIES CLINIC IN 2014.

- Travelling around the world and visiting distant places and countries (especially national parks, parks of nature, natural resorts, etc.) sometimes may result in animal bites and injuries from the species which are not usually represented as the source of human rabies cases, such as monkeys. In the last ten to fifteen years, monkey bites and injuries present an unpleasant experience and cause a lot of problems for travelers and tourists when travelling to India, Thailand, Indonesia or Bali because they have to seek a medical facility for wound treatment, tetanus prophylaxis, antimicrobial therapy and rabies postexposure prophylaxis (PEP). In 2014, 706 persons were registered at the Zagreb Antirabies Clinic as having sustained bites by various animals, ten of them reported to have been bitten or injured by monkeys. Nine of them sustained injuries during their travel to India, Thailand, Indonesia and Bali. All injuries occurred when they wanted to pet or tried to feed monkeys, or refused to give them food. Most of the monkeys were macaques, capuchins, or of unknown type. Only one monkey bite recorded in the city of Zagreb occurred in the Zagreb ZOO while a professional animal handler was feeding a capuchin monkey in the cage. He did not receive rabies PEP, but instead, the capuchin monkey was put under veterinary supervision. All other patients started with PEP in the countries where the injuries occurred and continued/completed it at the Zagreb Antirabies Clinic. They received antirabies vaccine only (PVRV, RABIPUR) upon 5-dose regimen (Essen scheme) and 2-1-1 (Zagreb scheme) regimen. None of them contracted rabies. After many years, monkeys were the animal species immediately following dogs and cats in the official report of the Zagreb Antirabies Clinic, which was quite surprising. Usually, monkey bites and injuries do not present a serious problem in daily routine because they occur sporadically.

Poison and alarm: the Asian hornet Vespa velutina uses sting venom volatiles as an alarm pheromone.

In colonial organisms, alarm pheromones can provide a key fitness advantage by enhancing colony defence and warning of danger. Learning which species use alarm pheromone and the key compounds involved therefore enhances our understanding of how this important signal has evolved. However, our knowledge of alarm pheromones is more limited in the social wasps and hornets compared with the social bees and ants. Vespa velutina is an economically important and widespread hornet predator that attacks honey bees and humans. This species is native to Asia and has now invaded Europe. Despite growing interest in V. velutina, it was unknown whether it possessed an alarm pheromone. We show that these hornets use sting venom as an alarm pheromone. Sting venom volatiles were strongly attractive to hornet workers and triggered attacks. Two major venom fractions, consisting of monoketones and diketones, also elicited attack. We used gas chromatography coupled to electroantennographic detection (GC-EAD) to isolate 13 known and 3 unknown aliphatic ketones and alcohols in venom that elicited conspicuous hornet antennal activity. Two of the unknown compounds may be an undecen-2-one and an undecene-2,10-dinone. Three major compounds (heptan-2-one, nonan-2-one and undecan-2-one) triggered attacks, but only nonan-2-one did so at biologically relevant levels (10 hornet equivalents). Nonan-2-one thus deserves particular attention. However, the key alarm releasers for V. velutina remain to be identified. Such identification will help to illuminate the evolution and function of alarm compounds in hornets.

Threatened limb from stingray injury.

We present the case of a 43-year-old female who suffered a stingray injury to her left ankle. The sting caused occlusion of the dorsalis pedis artery, causing dry gangrene of the medial forefoot. A below knee amputation was recommended but she was transferred for a second opinion. A Prostaglandin E1 infusion was commenced, resulting in alleviation of pain and improvement in perfusion. Amputation of great and second toes was performed, with the head of the first metatarsal preserved and covered via a cross-over skin flap raised from the contralateral leg. Achilles tendon lengthening was then performed to return the foot to a functional position. This case serves to highlight the utility of prostaglandin infusion, and the requirement for a multidisciplinary approach to critical limb ischemia in order to avoid major amputation.