Large scale dog population demography, dog management and bite risk factors analysis: A crucial step towards rabies control in Cambodia.

Cambodia is a rabid-endemic country. However, data on dog population characteristics are lacking, and there is no national dog vaccination program. We implemented the first extensive door-to-door longitudinal survey in 2 Cambodian provinces, namely Kandal and Battambang, to estimate dog population demographic parameters, identify dog ownership determinants, analyze dog management practices and estimate the yearly cumulative bite incidence and associated factors. During the first session, more than 5000 dogs were recorded and identified. Data on families, dogs and cats characteristics, as well as the number of bites experienced the year before in the family, were recorded. One year later, a second session was performed in both provinces to record missing dogs and the reasons for missing. Age-specific survival rates of the dog populations were computed using Kaplan-Meier estimates. Ownership determinants and bite risk factors were identified using a negative binomial regression model. Dog trade and dog meat consumption were often reported. We estimated high dog-to-human ratios (1:3.8 in Kandal, and 1:3.3 in Battambang). The mean age of dog populations was 26.4 months in Kandal against 24.3 in Battambang, with a survival rate of 52% at 24 months in Kandal (34% only in Battambang). They were no feral dogs, but the large majority of recorded dogs were free roaming. In both provinces, the number of dogs significantly increased in families with children younger than 15, and when the head of the family was a male. The estimated yearly cumulative bite incidences were 2.3 and 3.1% in Kandal and Battambang provinces respectively, and are among the highest in the world. Our survey provides valuable data to focus information programs, parametrize transmission models and identify efficient vaccination strategies to control rabies in Cambodia in the future.

Patients with centipede bites presenting to a university hospital in Bangkok: a 10-year retrospective study.

INTRODUCTION: Centipede envenomation occurs commonly in tropical and subtropical countries. In most cases, centipede envenomation causes benign clinical manifestations. Serious complications are reported occasionally. Clinical studies regarding centipede envenomation are limited to case reports and case series. This study aimed to determine the prevalence and clinical characteristics of centipede bites in Bangkok, Thailand. METHODS: This was a retrospective medical record review study. We included patients who were clearly envenomated by a centipede presenting to the emergency department of a tertiary university hospital in Bangkok from January 1, 2006, to December 31, 2015. Data were collected on demographics, details of the exposure, signs, symptoms, treatment, and complications of envenomation. RESULTS: A total of 245 cases were included. The prevalence of centipede bite was 0.0367%. The majority were female (56.7%). The median age was 34.6 years (range: 1 month to 90 years). The number of envenomations was highest from October through December. Feet (38.3%) and hands (19.1%) were the parts of the body most often envenomated. Local effects were common with 99.5% of patients having localized pain and 87% having local swelling at the bite site. In terms of systemic effects, urticarial rash (5.7%) and fever (4.1%) were most frequently observed. Twelve cases (5%) had clinical pictures compatible with anaphylaxis. For pain management, all patients who had pain received analgesic drugs, while 29.7% were injected with local anesthesia. Antibiotics, antihistamines, and steroids were prescribed in 53.9%, 20.4%, and 10.2% of cases, respectively. No deaths occurred in this study. CONCLUSIONS: Even though the location of our hospital is in a metropolitan city in Thailand, there were centipede bites every month, especially during the last three months of each year. Nearly all patients had local effects. In contrast, serious complications such as anaphylaxis and systemic infection only occurred occasionally.

Report of a severe Heloderma suspectum envenomation.

BACKGROUND: Heloderma bites are rare and generally mild, but a few cases can be life threatening. CASE REPORT: We report a case of Heloderma suspectum envenomation in a healthy 39-year-old herpetologist. The patient rapidly developed tongue and lip swelling associated with stridor. On arrival at ICU, he was hypotensive, and in shock with atrial fibrillation requiring electrical cardioversion. Blood tests showed hypokalemia (2 mmol·L-1), associated with moderate low blood electrolytes which were corrected rapidly. In addition, he presented hematological abnormalities (INR = 1.34 and fibrinogen levels at 80 mg·dL-1) without active bleeding. All clinical and biological signs normalized without specific intervention and was discharged 4 days post-bite. The patient discharged 3 days after hospital presentation and fully recovered in 2 months. DISCUSSION/CONCLUSION: The case presented here showed the three severe complications described after Heloderma bite: a) angioedema, b) fluid loss associated with hypokalemia and metabolic acidosis, and c) cardiac disorders simulating ischemia.

Severe Heloderma spp. envenomation: a review of the literature.

Context: Heloderma bites are rare and generally mild, but a few cases can be life threatening. Methods: Description of Heloderma bite was searched in medical literature. Discussion: We present a synthesis of clinical and biomedical effects of envenomation by Heloderma sp. based on 22 well identified cases described in medical literature. Three life-threatening syndromes, concomitant or not, may be involved: (a) angioedema which can lead to respiratory tract obstruction, (b) significant fluid losses due to diarrhea, vomiting and sweating, associated with hypokalemia and sometimes metabolic acidosis, and (c) atrioventricular conduction disorders simulating cardiac ischemia. Conclusion: Heloderma bite are quite rare and generally mild. However, few severe cases may require emergency resuscitation. There is no antivenom, and the treatment is only symptomatic and supportive.

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.

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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.

Spectrum of skin diseases in Amerindian villages of the Upper Oyapock, French Guiana.

BACKGROUND: Due to their genetic characteristics, their isolation in rainforest areas, and their traditional way of life, Amerindian populations are likely to suffer from a specific spectrum of dermatoses. However, there are few available data on such skin disorders. Our aims were to describe all skin disorders in two Amerindian villages of French Guiana. METHODS: This retrospective study concerned all patients who consulted in the Health Centres of Camopi and Trois-Sauts between July 1, 2017, and December 31, 2018. We included all patients classified with an ICD code linked to a skin disorder. All medical records were cross-checked by two dermatologists to correct misclassifications. RESULTS: A total of 639 patients formed the study population, for 866 different skin disorders. Non-sexually transmitted infections represented 57.6% of all skin disorders, followed by eczema (11.5%) and bites/envenomations (9.1%). Bacteria were responsible for 238 skin infections, followed by fungi (141 cases) and parasites (69 cases, including 43 scabies, nine cutaneous leishmaniasis, and two tungiasis). We reported a low prevalence of sexually transmitted infections (10 cases) and an absence of skin cancers. CONCLUSIONS: This study revealed the absence of skin cancer in the Amerindian population of the Upper Oyapock and the important burden of infectious and animal-related diseases. Future studies should assess a possible underestimation of sexually transmitted diseases in this area. Public health policies should target neglected diseases such as cutaneous leishmaniasis, tungiasis, scabies, and envenomations. Atopic dermatitis was a significant and unexpected cause of consultations.

Seal bites at sub-Antarctic Marion Island: Incidence, outcomes and treatment recommendations.

Seal biologists at Marion Island (Southern Ocean) are in frequent contact with seals. During research activities, biologists may be bitten by seals, yet no standardised protocol for treating such bites is in place. Information on 22 seal bite cases at Marion Island was collected. Treatment of these bites varied, reflecting a need for standardised protocols for the treatment of bites. Recommendations for the in-field treatment of bites are presented. Five of the 22 cases had some symptoms which resembled 'seal finger' - a zoonotic infection, usually of the hands, that is contracted after a person comes into contact with tissues of seals or is bitten by one. However, in four of these cases, symptoms subsided within 4 days without antibiotic treatment; in the fifth case antibiotics were administered and symptoms subsided in 4 days. There is little evidence of the occurrence of seal finger at Marion Island, but this deserves further investigation.

Estimation of dog population and dog bite risk factors in departments of San Pedro and Bouake in Côte d'Ivoire.

Rabies is endemic in Côte d'Ivoire and was identified in January 2017 as a priority zoonosis by all stakeholders in public health. A well-designed integrated national rabies control is essential to attain the objective of zero human deaths from dog rabies by 2030. The current study describes the complementary elements of dog bite risk factors and the dog population estimate that are relevant for planning sustainable interventions. We conducted a transverse survey in 8'004 households in the departments of San Pedro (4'002) and Bouaké (4'002), covering both rural and urban areas. The dog-household ratio was estimated at one dog for three households (0.33) or one dog for 20 people (0.05). The owned canine population on a national level was estimated at 1'400'654 dogs (range 1'276'331 to 1'535'681). The main dog bite risk factors were dog ownership, being male, and living in urban San Pedro Department. The results lay a foundation for public engagement and further steps for mass vaccination of the household dog population to reach vaccination coverage of at least 80%. Stakeholders further recommend raising awareness of dog owners, reinforcing knowledge in school children and young boys, and behavior changes towards domestic animals.

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.

Rat Bites in the Diabetic Foot: Clinical Clues.

BACKGROUND: Ulcers in patients with diabetic neuropathy in their feet are quite common but should be differentiated from the distinctive but rare ulceration resulting from rat bites in these insensate feet. We describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight 8 clinical features that should raise suspicion and alert the clinician to this possibility. METHODS: We describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight the distinctive clinical features of this condition. RESULTS: The following features were noted: 1) blood on bed sheets on waking; 2) painless, nonsuppurating ulceration; 3) multiple ulcers that are linear, sharp, or with serrated edges; 4) varying depths within the ulcer; 5) sudden onset (was not noted the day before but found in morning); 6) ulcers not contiguous; 7) often bilateral; and 8) the sole of the foot is not involved. Early recognition and prompt treatment resulted in digit and limb salvage. CONCLUSIONS: We describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight 8 clinical features that should raise suspicion and alert the clinician to this possibility.

Nonfatal Bites by a Sicklefin Lemon Shark Negaprion acutidens on a Surfer in Makemo Atoll (French Polynesia).

Identifying the species and size of sharks responsible for biting humans is essential for developing strategies to prevent these incidents. Here, we use bite wound characteristics and genetic analysis of a tooth fragment extracted from the wounds to identify a sicklefin lemon shark Negaprion acutidens as the perpetrator of nonfatal bites on the legs of an adult male surfer at Makemo atoll (French Polynesia) in January 2018. The bite was superficial, and N. acutidens are fish predators not known to feed on large prey; hence, foraging is an unlikely explanation for this incident rather linked to territoriality. Lemon sharks are occasionally aggressive toward humans and are site attached with relatively small home ranges; hence, avoiding surfing in the area of a previous bite incident is recommended to decrease the risk of future injuries.

Effectiveness of novel fabrics to resist punctures and lacerations from white shark (Carcharodon carcharias): Implications to reduce injuries from shark bites.

Increases in the number of shark bites, along with increased media attention on shark-human interactions has led to growing interest in preventing injuries from shark bites through the use of personal mitigation measures. The leading cause of fatality from shark bite victims is blood loss; thus reducing haemorrhaging may provide additional time for a shark bite victim to be attended to by emergency services. Despite previous shark-proof suits being bulky and cumbersome, new technological advances in fabric has allowed the development of lightweight alternatives that can be incorporated onto traditional wetsuits. The ability for these fabrics to withstand shark bites has not been scientifically tested. In this report, we compared two types of recently developed protective fabrics that incorporated ultra-high molecular weight polyethylene (UHMWPE) fibre onto neoprene (SharkStop and ActionTX) and compared them to standard neoprene alternatives. We tested nine different fabric variants using three different tests, laboratory-based puncture and laceration tests, along with field-based trials involving white sharks Carcharodon carcharias. Field-based trials consisted of measuring C. carcharias bite force and quantifying damages to the new fabrics following a bite from 3-4 m total length C. carcharias. We found that SharkStop and ActionTX fabric variants were more resistant to puncture, laceration, and bites from C. carcharias. More force was required to puncture the new fabrics compared to control fabrics (laboratory-based tests), and cuts made to the new fabrics were smaller and shallower than those on standard neoprene for both types of test, i.e. laboratory and field tests. Our results showed that UHMWPE fibre increased the resistance of neoprene to shark bites. Although the use of UHMWPE fibre (e.g. SharkStop and ActionTX) may therefore reduce blood loss resulting from a shark bite, research is needed to assess if the reduction in damages to the fabrics extends to human tissues and decreased injuries.

Small Animal Veterinarians' Perceptions, Experiences, and Views of Common Dog Breeds, Dog Aggression, and Breed-Specific Laws in the United States.

Dog aggression directed towards humans is a common and serious behavioral and public health issue. This cross-sectional study was designed to gain insights into U.S. small animal veterinarians' views and experiences with the most common dog breeds in the U.S., dog aggression, and breed-specific legislation. An electronic survey was distributed via email to an online veterinary community, and responses were summarized and compared by means of χ2 and Cochran-Mantel-Haenszel tests. Most respondents were concerned about the risks of dog bite injuries, but the majority were not in favor of banning specific breeds of dogs in order to enhance public safety. When participants rated the perceived bite risk associated with popular dog breeds, Chow Chows were perceived as the highest risk, with pit bull types categorized as a moderate risk. Golden Retrievers were seen as the most appropriate for families with children. Public education about animal behavior was the most frequently endorsed policy intervention to increase public safety. These findings suggest that most veterinarians feel that banning an entire dog breed is not an effective way to ensure human safety. Instead, most respondents endorsed alternative initiatives, such as public education and stricter leash laws, to reduce the risk of dog bites.

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.