‫بسم هللا الرحمن الرحيم‬
‫السبت ‪ 17‬محرم ‪1426‬‬
‫‪26 Feb 2005‬‬
‫عضة األسبوع‬
Bite of the Week
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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:

Growth: Ht: 120 cm ( 25 %)
Wt: 21 kg ( 25 %)
• Temp: 36.5
• RR: 30
• HR: 110
• BP: 106/53
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 vaccinations
Clean, minor
wounds
Give Td 2
All other wounds
1
Give TIG Give Td Give TIG
Unknown, uncertain, or fewer than 3
Yes
No
Yes
Yes
3 or more 3
No 4
No
No 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 pains
4. fever and chills
5. headaches lasting more than 24 hours
6. fatigue
7. muscular incoordination
8. 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/eddppbackup/monkeybite.html

B virus:
• http://www.cdc.gov/ncidod/eid/vol4no1/ost
rowsk.htm

RABIES CONTROL MANUAL
• http://www.lapublichealth.org/vet/procs/rabies.
htm#BITING
‫شكرا‬
Thank You
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