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الرحيم الرحمن الله بسم
1426محرم 17السبت
26 Feb 2005
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
