Animal rabies: implications for diagnosis and human treatment

Postexposure rabies prophylaxis in an urban emergency department

The purpose of this retrospective study was to identify those patients presenting to an urban emergency department with animal-related wounds, define source animal demographics, and assess adequacy of wound care, rabies immunoprophylaxis, and follow-up. Sixty-three patients comprised the study population; dogs (76%) and cats (16%) were the principal source animals. Postexposure rabies prophylaxis was indicated in ten patients (16%) due to wounds inflicted by stray dogs and cats. Animal behavior and vaccination history were inconsistently addressed, but were documented significantly more often in patients who received prophylaxis. Inclusion of soap in wound care was not significantly more common in the treated group. Human rabies immune globulin was administered incorrectly at least one-third of the time. Appropriate follow-up was arranged in only 31% of cases; this occurred significantly more often with treated patients. An awareness of both regional epidemiological trends in animal rabies and local health department treatment recommendations will encourage optimal delivery of postexposure treatment in cases of potential rabies exposure.

Dog, cat, and human bites: a review

It is estimated that half of all Americans will be bitten by an animal or another human being during their lifetimes. The vast majority of the estimated 2 million annual mammalian bite wounds are minor, and the victims never seek medical attention. Nonetheless, bite wounds account for approximately 1% of all emergency department visits and more than $30 million in annual health care costs. Infection is the most common bite-associated complication; the relative risk is determined by the species of the inflicting animal, bite location, host factors, and local wound care. Most infections caused by mammalian bites are polymicrobial, with mixed aerobic and anaerobic species. The clinical presentation and appropriate treatment of infected bite wounds vary according to the causative organisms. Human bite wounds have long had a bad reputation for severe infection and frequent complication. However, recent data demonstrate that human bites occurring anywhere other than the hand present no more of a risk for infection than any other type of mammalian bite. The increased incidence of serious infections and complications associated with human bites to the hand warrants their consideration and management in three different categories: occlusional/simple, clenched fist injuries, and occlusional bites to the hand. This article reviews dogs, cat, and human bite wounds, risk factors for complications, evaluation components, bacteriology, antimicrobial susceptibility patterns, and recommended treatments. Epidemiology, clinical presentation, and treatment of infections caused by Pasteurella multocida, Capnocytophaga canimorsus, Eikenella corrodens, and rhabdovirus (rabies only) receive particular emphasis.

Human rabies: a review

Human rabies is a rarely observed but frequently prophylaxed disease in North America. Presented in this review is a typical emergency department case and a summary of the epidemiology of the rabies virus, its clinical appearances, diagnosis, and management. Emphasis is placed on issues pertinent to the emergency physician practicing in the United States. Current recommendations for the administration of both active and passive immunotherapy for preexposure and postexposure prophylaxis are discussed. A treatment algorithm to aid in the decisions faced by a practicing physician regarding proper animal management and patient therapy and future prospects for the control of rabies in wild animal populations are also included.