Sandbox/Alejandro: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(22 intermediate revisions by the same user not shown)
Line 1: Line 1:
==Overview==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 
|+
A bite is a [[wound]] received from the [[mouth]] (and in particular, the [[teeth]]) of an [[animal]] or person. Most [[animal]] bites are from dogs or cats, and the pathogens in the wound are composed by the normal oral flora of the biting animal and human [[skin flora]].
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Tuberculin Rection}}
 
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Considered a Positive Result in:}}
Animals may bite in self-defense, in an attempt to predate food, as well as part of normal interactions. Other bite attacks may be apparently unprovoked, especially in the case of bites committed by psychologically or emotionally disturbed humans. Some disorders such as [[Lesch-Nyhan syndrome]] may cause people to bite themselves.
 
Bite wounds can be very complex and it is important to address the following aspects:
 
* Generalized tissue damage due to tearing and scratching.
* Serious [[hemorrhage]] if major blood vessels are pierced.
* [[Infection]] by [[bacterium|bacteria]] or other [[pathogen]]s, including [[rabies]].
* Introduction of [[Venom (poison)|venom]] into the wound by venomous animals such as some [[Snake bite|snakes]].
* Introduction of other irritants into the wound, causing [[inflammation]] and [[itching]].
 
==Common Pathogens==
Almost every bite would have a polimicrobial contamination, especially with [[bacteria]].  Some bites have characteristic pathogens associated to the oral flora of the animal that bit.
 
{| class="wikitable"
|+''Most common pathogens according to the type of bite''
! style="width: 120px;background: #20538D"|{{fontcolor|#FFF| Bite}} !!style="width: 450px;background: #20538D"|{{fontcolor|#FFF| Most Common Pathogens}}
|-
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC"|Human|| ''[[Viridans streptococci]], [[S. epidermidis]], [[Corynebacterium]], [[S. aureus]], [[Eikenella]], [[Bacteroides]], Peptostreptococci ''
| style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 5 mm '''
| style="padding: 5px 5px; background: #F5F5F5;" | 
*HIV-positive person
*Recent contacts of TB case
*Persons with nodular or fibrotic changes on CXR consistent with old healed TB
*Patients with organ transplants and other immunosuppressed patients
|-
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC"|Dog || ''[[Pasteurella|Pasteurella canis]], [[S. aureus]] , [[Streptococci]] , [[Anaerobes]] ([[Bacteroides|Bacteroides spp]], [[Fusobacterium]], Prevotella heparinolytica, Proprionibacteria, and Peptostreptococci) ''
| style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 10 mm  '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Recent arrivals (less than 5 years) from high-prevalent countries
*Injection drug users
*Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
*Mycobacteriology lab personnel
*Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc)
*Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories
|-
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC"|Cat ||''[[Pasteurella multocida]], [[S. aureus]], [[Streptococci]] , [[Anaerobes]] ([[Bacteroides|Bacteroides spp]], [[Fusobacterium]], Prevotella heparinolytica, Proprionibacteria, and Peptostreptococci)''
| style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 15 mm '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Persons with no known risk factors for TB
|-
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC"|Pig ||  ''[[Pasteurella|Pasteurella spp]], [[Gram-negative bacilli]], [[Gram-positive bacteria|Gram-positive cocci]], [[Anaerobes]]''
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC"|Monkey || ''[[Herpesvirus simiae]] ([[Monkey B virus|B Virus]])''
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC"|Rat ||''[[Spirillum|Spirillum minus]], [[Streptobacillus|Streptobacillus moniliformis]]''
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC"|Seal||''[[Mycoplasma|Mycoplasma spp]]''
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC"|Camel || ''[[S. aureus]], [[S. epidermidis]], [[Moraxella catarrhalis]], [[Klebsiella pneumoniae]], [[S. pyogenes]],[[E. coli]], [[Pseudomonas aeruginosa]], [[Bacillus spp]].''
|}
==Treatment==
*All bite [[wounds]] should be cleaned profusely with iodide soap and water.
*Bites are contaminated by a polimicrobial flora and antibiotic prophylaxis treatment is recommended to avoid subsequent infection.
*The [[route of administration]] depends on the depth and severity of the [[wound]], as well as the time that has passed since the bite.
==Antibiotic Therapy==
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></small>
{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Antibiotic Prophylaxis'''
</font>
</div>
<div class="mw-customtoggle-table00" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Any Type of Bite'''
</font>
</div>
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Specific Therapy'''
</font>
</div>
<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Bat Bite'''
</font>
</div>
<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Camel Bite'''
</font>
</div>
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Cat Bite'''
</font>
</div>
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Dog Bite'''
</font>
</div>
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Human Bite'''
</font>
</div>
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Monkey / Primate Bite'''
</font>
</div>
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Pig (Swine) Bite'''
</font>
</div>
<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Racoon Bite'''
</font>
</div>
<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Rat Bite'''
</font>
</div>
<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Seal Bite'''
</font>
</div>
<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Skunk Bite'''
</font>
</div>
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table00" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Antibiotic Prophylaxis}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Preferred Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 500-875/125 PO q8-12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Alternative Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 300 mg q8h'''''<br> OR <br> ▸ '''''[[Metronidazole]] 500 mg PO q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg q12h'''''<br> OR <br> ▸ '''''[[TMP-SMX]] 160/800 mg PO q12h'''''<br> OR <br> ▸ '''''[[Penicillin VK]] 500 mg PO q6h'''''<br> OR <br> ▸ '''''[[Cefuroxime]] 500 mg PO q12h'''''<br> OR <br> ▸ '''''[[Moxifloxacin]] 400 mg PO q24h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Human Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin sulbactam]] 1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Cefoxitin]] 2 gm IV q8h'''''<BR> OR <BR> ▸ '''''[[Ticarcillin clavulanate]] 3.1 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Piperacillin-tazobactam]] 3.375 g IV q6-8h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen (beta-lactam allergy)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 300 mg PO q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 500-750 mg IV q12h''''' <br> OR <br> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' <br> OR <br> ▸ '''''[[TMP-SMX]] 160/800 mg q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Dog Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 500-875/125 PO q8-12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen (beta-lactam allergy)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸  '''''[[Clindamycin]] 300 mg PO q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 500-750 mg IV q12h''''' <br> OR <br> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' <br> OR <br> ▸ '''''[[Gatifloxacin]] 400 mg q24h'''''
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cat Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 500-875/125 PO q8-12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen (beta-lactam allergy)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefuroxime]] 500 mg q12h''''' <br> OR <br>▸ '''''[[Doxycycline]] 100 mg q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Pig (Swine) Bite }}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg PO q12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin sulbactam]] 1.5 to 3 g IV q6-8h'''''<BR> OR <BR> ▸ '''''[[Imipenem cilastatin]] 1 g IV q6-8h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 1 g q12 h''''' <BR> OR <BR> ▸ '''''[[Cefotaxime]] 2 g q6 h''''' <BR> OR <BR> ▸ '''''[[Ticarcillin clavulanate]] 3.1 g IV q6hr'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Monkey / Primate Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Profilaxis
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Valacyclovir]]  1 g PO q8h x 14 days'''''<BR> OR <BR> ▸ '''''[[Acyclovir]] 800 mg PO 5 times/day'''''
|-
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen (without CNS symptoms)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]]  12.5–15 mg per kg IV q8h'''''<BR> OR <BR> ▸ '''''[[Ganciclovir]] 5 mg per kg IV q12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen (with CNS symptoms)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left | ▸ '''''[[Ganciclovir]] 5 mg per kg IV q12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | <small> Adapted from Prevention of and Therapy for B Virus Exposure • CID 2002:35<ref name="CohenDavenport2002">{{cite journal|last1=Cohen|first1=Jeffrey I.|last2=Davenport|first2=David S.|last3=Stewart|first3=John A.|last4=Deitchman|first4=Scott|last5=Hilliard|first5=Julia K.|last6=Chapman|first6=Louisa E.|title=Recommendations for Prevention of and Therapy for Exposure to B Virus (Cercopithecine Herpesvirus1)|journal=Clinical Infectious Diseases|volume=35|issue=10|year=2002|pages=1191–1203|issn=1058-4838|doi=10.1086/344754}}</ref></small>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Uncomplicated Rat Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg orally q12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen (beta-lactam allergy)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg orally q12h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Rat Bite Fever}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 400,000 - 600,000 IU/day IV x 10-14 days (dose should be increased to 1.2 M if no clinical response)'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Streptomycin]] 15 mg/kg/day IM divided q12-24h x 10-14 days'''''<BR> OR <BR> ▸ '''''[[Tetracycline]]  250 to 500 mg orally q6h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |<small> Adapted from Clin. Microbiol. Rev. January 2007 vol.20 no.1 13-22 <ref name="Elliott2007">{{cite journal|last1=Elliott|first1=S. P.|title=Rat Bite Fever and Streptobacillus moniliformis|journal=Clinical Microbiology Reviews|volume=20|issue=1|year=2007|pages=13–22|issn=0893-8512|doi=10.1128/CMR.00016-06}}</ref></small>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Seal Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Preferred Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Tetracycline]] 1.5 g 1 dose, then 0.5 g q6h x 4-6 weeks'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Alternative Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg q12h x 4-6 weeks'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5;align=left |<small> Adapted from Journal of Infection (2002) 45: 71±75 <ref name="HartleyPitcher2002">{{cite journal|last1=Hartley|first1=J.W.|last2=Pitcher|first2=D.|title=Seal Finger—Tetracycline is First Line|journal=Journal of Infection|volume=45|issue=2|year=2002|pages=71–75|issn=01634453|doi=10.1053/jinf.2002.1027}}</ref></small>
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Camel Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Preferred Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Dicloxacillin]] 250–500 mg PO q6h      '''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 750 mg PO q12h      '''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Alternative Regimen '''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cephalexin]] 500 mg PO q6h      '''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 750 mg PO q12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left | <small>Adapted from ''Eur J Clin Microbiol Infect Dis. 1999;18(12):918-9.''<ref name="BadejoO. Komolafe &#134;, &#135; , D. L.1999">{{cite journal|last1=Badejo|first1=O. A.|last2=O. Komolafe &#134;, &#135; , D. L.|first2=O.|title=Bacteriology and Clinical Course of Camel-Bite Wound Infections|journal=European Journal of Clinical Microbiology & Infectious Diseases|volume=18|issue=12|year=1999|pages=918–919|issn=0934-9723|doi=10.1007/s100960050433}}</ref></small>
      |-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bat Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg orally q12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg orally q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Racoon Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg orally q12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg orally q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Skunk Bite}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg orally q12h'''''
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg orally q12h'''''
|-
|}
|}
|}
==Vaccination==
===Tetanus Prophylaxis===
===Rabies Prophylaxis===
Animal bites inflicted by [[carnivore]]s (except rodents) are considered possible cases of [[rabies]]. The animal is caught alive or dead with its head preserved, so the head can later be analyzed to detect the disease.
If the animal lives for ten days and does not develop [[rabies]], then it is probable that no [[rabies]] infection has occurred.
If the animal is gone, prophylactic [[rabies treatment]] is recommended.
Signs of animal [[rabies]] include:
* Foaming at the mouth
* Self-mutilation
* Growling
* Jerky behavior
* Red eyes.
{| class="wikitable"
! style="width: 200px;background: #20538D"|{{fontcolor|#FFF| Animal Type}}
! style="width: 200px;background: #20538D"|{{fontcolor|#FFF| Evaluation of the Animal}}
! style="width: 400px;background: #20538D"|{{fontcolor|#FFF| Prophylaxis Recommendation}}
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC" rowspan=3|Dog, cat, ferret
| Healthy and available for observation for 10 days
| Prophylaxis should not be started unless the animal develops symptoms <br> If rabies symptoms develop, immediately begin rabies prophylaxys
|-
|Confirmed or suspected rabies infection
|Immediately begin rabies prophylaxis
|-
| Unknown
| Immediately begin rabies prophylaxis
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC"| Skunk, raccoon, bat, fox, coyote, other carnivores
| Considered as rabies infection
| Immediately begin rabies prophylaxis
|-
|  style="width: 120px;font-weight: bold;background: #DCDCDC"|Livestock, rodents, rabbit, squirrels, hamster, guinea pig, gerbil, chipmunk, rat, mouse, woodchuck
|
| Almost never require anti-rabies prophylaxis, but consult public health officials
|-
|colspan="3"|<small> '''†Rabies symptoms: Foaming at the mouth, self-mutilation, growling, jerky behavior, red eyes.'''  </small>
|}
{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 260px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Rabies Prophylaxis'''
</font>
</div>
<div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 260px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Patient Previously Vaccinated'''
</font>
</div>
<div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 260px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Patient Not Previously Vaccinated'''
</font>
</div>
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Patient Previously Vaccinated}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Prophylactic Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Wound cleansing'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Human rabies immune globulin]]† (HRIG) 20 IU/kg ''''' <br> <small>If anatomically feasible, the full dose should be infiltrated around and into the wound, and any remaining volume should be administered IM </small>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Human diploid cell vaccine (HDCV) 1.0 mL IM'''''<br> OR <br> ▸ ''''' Purified chick embryo cell vaccine (PCECV) 1.0 mL IM'''''  <br>  1 dose on days 0 3, 7 and 14
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5"| <small>†HRIG should not be administered in the same syringe as vaccine.</small>
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Patient Not Previously Vaccinated}}
|-
|  style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center  | Prophylactic Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[['''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[
|-
|}
|}
|}
|}
==References==
{{reflist|2}}

Latest revision as of 13:10, 4 September 2014

Tuberculin Rection Considered a Positive Result in:
≥ 5 mm
  • HIV-positive person
  • Recent contacts of TB case
  • Persons with nodular or fibrotic changes on CXR consistent with old healed TB
  • Patients with organ transplants and other immunosuppressed patients
≥ 10 mm
  • Recent arrivals (less than 5 years) from high-prevalent countries
  • Injection drug users
  • Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
  • Mycobacteriology lab personnel
  • Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc)
  • Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories
≥ 15 mm
  • Persons with no known risk factors for TB
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox/Alejandro&oldid=1016700"