بسم الله الرحمن الرحيم السبت 17 محرم 1426 26 Feb 2005.

الرحيم الرحمن الله بسم

1426محرم 17السبت

26 Feb 2005

األسبوع عضة

Bite of the [email protected]

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Bite of the Week

7 year-old Saudi boy C/O Monkey bite 14 hours prior to

admission

History

Monkey bite to Rt hand Another Hospital:

• X ray => normal

• Suturing

• Velosef & Metronidazole IV

• Anti-Rabies vaccination was started

Cont. Hx

Parents took child DAMA & brought him to our A/E

Patient remained well, afebrile, with normal systemic review

PMHx

Asthma, mild intermittent, Salbutamol nebulizer PRN

Vaccination: Up-to-date Development: Normal Nutrition: Family diet Family Hx: uneventful

On Examination

Vital signs:• Temp: 36.5

• RR: 30

• HR: 110

• BP: 106/53

Growth: Ht: 120 cm ( 25 %)

Wt: 21 kg ( 25 %)

Cont. P/E

Local exam: Rt hand with laceration over thenar eminence with mild swelling & 9 sutures in place

Hand movements & sensation: normal

System exam: Normal

Management Issues

Management Issue # 1

Need for debridment:• Cleansing of the wound with a vigorous 15

minute scrub

Primary closure: ?? As edema developed => exploration to

be done today under GA => secondary healing

Management Issue # 2

Need for antibiotics:

• Amoxicillin + Clavulanate IV

• More edema + redness of hand: Penicillin / Cloxacillin

Management Issue # 3

Tetanus Prophylaxis:

Number of previous tetanus vaccinationsClean, minor woundsAll other wounds 1

Give Td 2 Give TIGGive TdGive TIG

Unknown, uncertain, or fewer than 3YesNoYesYes

3 or more 3 No 4 NoNo 5 No

Management Issue # 4

Rabies:• Any mammal can get rabies.

• The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes.

• Domestic mammals can also get rabies. Cats, cattle, and dogs are the most frequently reported rabid domestic animals in the United States.

Management Issue # 4

Need for anti-rabies vaccine on days:

0, 3, 7, 14, 28

Management Issue # 5

Herpesvirus-1 (B-Virus) Infection• Occurs naturally in Macaque monkeys and possible in

other Old World monkeys

• Most have no obvious evidence of infection

• The most likely routes of transmission are bites and scratches or splashes.

• There has been a report of person to person transmission.

• first reported over 50 years ago, yet only about 22 cases of human infection have been described till 1999

B-Virus related disease

Of the 22 reported cases, 20 infected individuals developed encephalitis and 15 of these patients died as a result of their infection.

A variety of signs and symptoms which generally occur within one month of exposure.

http://dcminfo.wustl.edu/occhealth/factsheet_herpesb.html

B-Virus related disease

1. vesicular skin lesions at or near the site of injury.2. localized neurological symptoms such as pain, numbness or itching near the wound site.3. flu-like aches and pains4. fever and chills5. headaches lasting more than 24 hours6. fatigue7. muscular incoordination8. shortness of breath.

http://dcminfo.wustl.edu/occhealth/factsheet_herpesb.html

B-Virus related disease

Guidelines recommend treatment of a symptomatic patient with oral or intravenous acyclovir.

Asymptomatic exposed persons should be treated with oral acyclovir or valacyclovir for two weeks.

Further Readings

Monkey Bite Policy:• http://www.med.umich.edu/em/em/eddpp-backu

p/monkeybite.html

B virus:• http://www.cdc.gov/ncidod/eid/vol4no1/ostrows

k.htm

RABIES CONTROL MANUAL• http://

www.lapublichealth.org/vet/procs/rabies.htm#BITING

شكرا:

Thank [email protected]

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