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.

A Human Bite on the Scrotum: Case Report and Review of Management in the Emergency Department.

BACKGROUND: Human bites involving the genitalia rarely present to the emergency department (ED). They have the potential to cause life-threatening secondary infections as well as serious physical and functional damage. CASE REPORT: We report a case of an adult male who sustained a human bite to the scrotum, resulting in a ragged laceration on the anterior scrotum, with a devascularized flap and necrotic edges overlying the wound. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Human bites to the scrotum are rare and, hence, the experience of emergency physicians treating patients presenting with these injuries may be minimal. This puts patients at risk of underevaluation or suboptimal treatment. The rapid initiation of antibiotics in the ED and thorough wound debridement will prevent infections, aid healing, and lead to improved outcomes by preserving organ function and integrity. We therefore present a systematic approach to the management of patients with human bite to the scrotum in the ED.

Microvascular Replantation of the Avulsed Lip.

Traumatic facial soft tissue injury often creates both aesthetic and functional deficits. In complete lip avulsions, microvascular replantation is a reconstructive option that has the potential to fulfill both of these goals. However, lip replantations remain rare and there are few reports in the literature. The authors aim to present a clinical report of a young male who sustained a human bite injury and underwent microvascular replantation of a completely avulsed lower lip and to review the literature and management of these complex injuries.

Human and Animal Bites.

In the United States, nearly 56% of households owned a pet in 2011 according to the 2012 U.S. Pet Ownership & Demographics Sourcebook by the American Veterinary Medical Association. The survey also reports that approximately 70 million dogs and 74 million cats lived in households in the United States during the same year. (1)Human and animal bites are a frequent cause of primary care and emergency department visits for children. It is estimated that 250,000 human bites, 400,000 cat bites, and 4.5 million dog bites occur in the United States each year in both adults and children. (2) In the United States, approximately 10% of all human bites will become infected in a child with a bite wound. The infection rate of dog bites in children is 20%. Cat bite infection rates in children vary but can be up to 50%. Each type of bite wound has a predisposition for sex and/or age. Infected bite wounds manifest with swelling, erythema, and tenderness with or without drainage of the affected site and can lead to serious complications. Most animal bite wounds are polymicrobial in nature. Pasteurella species (spp.) is the most common organism isolated from both cat and dog bites. The microbiology of human bites consists of both aerobic and anaerobic bacteria.Basic medical management of bite wounds includes thorough cleansing and debridement. Irrigation, closure, and need to obtain culture depend on the type of bite wound, the appearance of the wound, the and timing of medical evaluation after the initial injury. Amoxicillin-clavulanate is the antibiotic of choice for prophylaxis and empirical therapy for children who are not allergic to penicillin. With most animal bites being preventable injuries, healthcare providers caring for children have an important role discussing pet safety with the child and the family.

[Earlobe reconstruction in one step by the Gavello's procedure: Surgical technique and a case report]. / Reconstruction du lobe d'oreille en un temps par la méthode de Gavello : technique opératoire et à propos d'un cas clinique.

The earlobe because of its anatomical position is subject of defects secondary to multiple and varied etiologies. Although its functional role appears negligible, its aesthetic and social importance makes its reconstruction a delicate surgery because it must be discreet but also the simplest possible. Many methods have been described but some require several operating times. The aim of this article is to present a simple procedure with a bilobed flap based on a reliable vascularization and which requires only one operative time. We describe the technique through a clinical case and review the literature to discuss the other methods described.

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.

Clenched fist injury complicated by septic arthritis and osteomyelitis treated with negative pressure wound therapy: One case report.

We reported a 30 years old man who suffered a bite wound of the right hand in a fight. Two days after the injury, he was admitted in emergency because of stab wound above the head of the third metacarpal bone. He presented the swelling, redness, pain and fever. Primary revision confirmed only partial lesion of the extensor apparatus. During the following days, we recorded a deterioration of local findings and magnetic resonance imaging revealed osteomyelitis and septic arthritis of the thirdmetacarpophalangeal joint. The wound was then revised several times using negative pressure wound therapy in combination with intravenous antibiotics. After resolution of clinical and laboratory findings, the wound was finally closed by delayed primary suture. Clenched fist injury is a medical emergency that requires immediate surgical revision. We treated clenched fist injury with the development of septic arthritis and osteomyelitis with negative pressure wound therapy and obtained good outcomes.

Human and other mammalian bite injuries of the hand: evaluation and management.

The hand is the most common site for bite injuries. Because of specific characteristics of hand anatomy, bite mechanics, and organisms found in human and animal saliva, even small wounds can lead to aggressive infections. Failure to recognize and treat hand bites can result in significant morbidity. Human and animal bites most commonly lead to polymicrobial bacterial infections with a mixture of aerobic and anaerobic organisms. Pasteurella species are commonly found in dog and cat bite wounds, and Eikenella is characteristic of human wounds. Staphylococcus, Streptococcus, and anaerobic bacterial species are common to all mammals. Although public health measures in developed countries have been highly effective at reducing rabies transmission, dog bites remain the most common source of rabies infection worldwide. Human bites can transmit HIV, hepatitis B, or hepatitis C, especially when contaminated blood is exposed to an open wound. Appropriate management of any mammal bite requires recognition, early wound cleansing, evaluation of injured structures, and infection prophylaxis. Structural repair is performed as indicated by the severity and contamination of the injury, and wounds may require delayed closure. Wound infections typically require débridement, empiric antibiotics, and delayed repair or reconstruction.

Acquired macrolide-resistant Treponema pallidum after a human bite.

Syphilis is a systemic disease caused by the spirochete Treponema pallidum that is usually acquired through sexual exposure.

Acute hand infections.

The continued emergence of antibiotic-resistant bacteria and the development of only a few new classes of antibiotics over the past 50 years have made the treatment of acute hand infections problematic. Prompt diagnosis and treatment are important, because hand stiffness, contractures, and even amputation can result from missed diagnoses or delayed treatment. The most common site of hand infections is subcutaneous tissue and the most common mechanism is trauma. An immunocompromised state, intravenous drug abuse, diabetes mellitus, and steroid use all predispose to infections.

"Fight-bite": not just a hand problem.

Human bite wounds around the knee are rarely seen, yet may require the same urgent attention as a fight bite to the hand. Two cases of polymicrobial septic arthritis of the knee secondary to a human bite wound are described. In both the cases, the diagnosis of the septic arthritis was delayed because the intra-articular wound was unrecognized. The injuries were initially deemed superficial and managed with local wound care. In each case, the knee was flexed at the time of injury and the quadriceps tendon was penetrated by a tooth which inoculated the knee joint. Septic arthritis of the knee presented, in both cases, 72 hours after the injury. These infections proved challenging to treat and required multiple surgeries and prolonged antibiotic therapy. The "fight bite" phenomenon of the hand is widely recognized and the same phenomenon can occur at the knee.

Using an unconventional perfusion pattern in ear replantation-arterialization of the venous system.

Ear amputation is a devastating injury characterized by a conspicuous deformity that is not easily concealed and can result in tremendous psychological trauma in addition to the physical insult. While numerous different approaches have been proposed, microvascular replantation is widely considered to deliver the best esthetic outcome. In this article, the authors report a case in which an unconventional perfusion pattern (i.e., arterialization of the venous system) was chosen, as intraoperative anatomic conditions precluded conventional vascular reconstruction. A 25-year-old male patient sustained a human bite resulting in subtotal amputation of his left ear. In the setting of an adequate arterial donor vessel, that is, branch of the posterior auricular artery, and a single suitable recipient vein (0.4 mm), the decision was made to perform an end-to-end arterio-venous anastomosis without the use of vein grafts. Medicinal leeches were applied postoperatively to provide for venous drainage. The ear survived and the patient was discharged after 14 days. To the best of our knowledge, this is first case of a subtotal ear amputation that was successfully replanted by arterialization of the venous system without the use of vein grafts and with preservation of the superficial temporal vessels.

[Trauma surgical relevance of bite injuries by animals and humans]. / Unfallchirurgisch Relevantes zu Bissverletzungen von Mensch und Tier.

Bite injuries require differentiated treatment due to the deeply inoculated polymicrobial pathogen spectrum, possible concomitant injuries and pronounced soft tissue damage. Dog bites are the most common bite injuries but are less complicated to heal than human and cat bites. The location of the bite greatly depends on the age and the size of the bite victim as well as the type of bite perpetrator. In every case detection of the pathogen should be carried out to provide the best possible adapted treatment in the event of an exacerbation. The primary antibiotic treatment should be empirical with amoxicillin + clavulanic acid or ampicillin + sulbactam and, if necessary, adjusted according to the antibiogram. Depending on the findings, surgical treatment includes excision of the bite canal and a customized wound debridement. It is important to check the vaccination status of those involved and if indicated, to carry out postexposure prophylaxis for tetanus and rabies.

Inguinal syndrome secondary to Prevotella bivia after accidental bite in orogenital sex.

The authors report a case of an inguinal bubo in a young man caused by an anaerobe, Prevotella bivia, which was acquired during oral sexual intercourse. As far as the authors know, this is the first reported case of a sexually transmitted infection by Prevotella. Prevotella spp. inhabit the oral cavity and are highly prevalent in bacterial vaginosis, a polymicrobial syndrome resulting from replacement of the normal vaginal Lactobacillus spp. flora by high concentrations of anaerobic microorganisms such as Prevotella spp., Mobiluncus spp., Gardnerella vaginalis and other uncultivated anaerobes.

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.

Oral mucosa in children with Prader-Willi syndrome.

UNLABELLED: Prader-Willi syndrome is a genetic disorder. Abnormal saliva secretion, emotional and behaviour problems, may affect the health status of the oral mucousa. OBJECTIVES: To assess the impact of self-destructive behaviour and abnormal saliva secretion on the oral mucosa in children with Prader-Willi syndrome (PWS). MATERIALS AND METHODS: Fifteen PWS's children (mean age 9.8 ± 4.4 years) and 15 healthy children (mean age 11.5 ± 3.5 years) were assessed for self-destructive behaviours, such as picking at the skin, physical and chemical saliva characteristics, mycology, and the clinical status of the oral mucosa. RESULTS: Picking at the skin was only in children with PWS (n = 12). In contrast to the control group, the moistening rate of the lower lip mucosa was slower, and the mean pH of the resting saliva was reduced in the affected subjects. Sticky frothy or frothy saliva, decreased secretion rate of the stimulated saliva, and a reduced buffer capacity were more frequently in PWS's children; Candida spp. and oral candidiasis were also more common. Injurious lesions in the oral mucosa were found in one control child, and in eight PWS's subjects. In affected children, the lesions were concurrent with picking at the skin. A statistical correlation was noted between the presence of Candida spp. and oral candidiasis, and unfavourable saliva properties, and between injurious lesions and a slow moistening rate of the lower lip mucosa, and oral candidiasis. CONCLUSIONS: Abnormal saliva secretion and self-destructive behaviours in children with Prader-Willi syndrome predispose them to injurious lesions in the oral mucosa, and possibly, to oral candidiosis.

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.

Facial necrotizing fasciitis secondary to accidental bite of the upper lip.

We describe a case with facial wounds over the left upper lip that became contaminated with saliva. A facial necrotizing fasciitis developed 2 days after injury. This produced a serious and almost fatal infection.

Biting for attention: a case of dental discomfort manifesting in behavioural problems.

There is a dearth of literature describing behaviour that expresses discomfort caused by poor dentition in patients with dementia. In this paper, we report on a patient whose behaviour only abstrusely pointed to his teeth as the source of discomfort. Although changes to his medication over a 2-year period had little effect, eventual extraction of his caries brought about an almost immediate resolution of all antisocial behaviour. Clinicians must be mindful that poor dental care is easily meliorated but remains endemic in patients suffering from dementia.

Spinal Accessory and Suprascapular Nerve Injury After Human Bite.

ABSTRACT: This is a unique clinical case of spinal accessory and suprascapular nerve injury related to a human bite not yet described elsewhere. The case emphasizes the importance of considering local trauma of the posterior triangle of the neck in case of shoulder weakness with electrophysiologic evidence of combined spinal accessory and suprascapular nerve injury.