Dis
Cat bites are the second most frequent animal bites. About 45-63% of
cat bites cause injuries to the hand.2 Compared with
dog bites, cat bites have an incidence rate of less than 1/6. However,
the infection rate is more than doubled when a cat bite
occurs.3Review리뷰consideration고려DISCUSSION토론전체
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In animal bites, the occurrence of direct wounds by teeth and direct
inoculation of bacteria occur more frequently than secondary infections
by wounds.4 In the case of cat bites, the sharper and
thinner teeth are the reason for this high rate of infection. Since cat
tooth is easy to penetrate the joint capsule and bone, deep infections
such as infectious arthritis and osteomyelitis can easily occur. Even if
an infection occurs, it is often not detected early.
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In case of a cat bite injury, strong cellulitis usually occurs locally
within 12-24 hours after the bite and an abscess may occur. Johnson et
al. have reported that local osteomyelitis may also
occur.5 It has also been reported that 37% of cat
bite patients require hospitalization and 12% of patients require
surgical treatment.6 In addition, Veitch et al. have
reported that 1% of all hospitalized patients for hand infections are
caused by complications of cat bites.7
Pasteurella multocida is the most identified in results of
culture for patients with cat bite wounds.8 This is
because Pasteurella multocida is present in the normal flora of
the oral cavity in more than 90% of felines.9Westling et al. have performed a study on 78 cat bite patients and
reported that Pasteurella multocida is identified in 70% of
cases.10 Mitnovetski et al. have reported thatPasteurella multocida is found most frequently in culture of cat
bite wounds.6,7 Pasteurella multocida can
easily cause death. There are cases where it shows false negatives
during culture. Serology itself cannot differentiate between current
infection and past exposure. The fastest and most accurate
identification method is polymerase chain reaction (PCR). However, even
if there is a deep infection caused by a cat bite, 7-8% of cases might
not be culturable.11 In the present case, no bacteria
were identified in the culture test performed for samples collected
during surgery. However, false negatives cannot be ruled out. Talan et
al. have reported that a bite wound can be considered to be infected if
it meets one or more of three main criteria (fever, abscess, and
lymphangitis) and if it meets 4 or more of five sub-criteria (erythema
more than 3 cm from the margin of the wound, tenderness, edema, purulent
discharge, and a white blood cell count of 12,000 /ml or
more.11 Hospitalization should be considered for
patients with severe cellulitis, systemic symptoms of infection (fever,
vomiting, confusion), clear evidence of bone, joint, ligament, or nerve
involvement, rapid spread of infection within 24-48 hours, or
unresponsive to oral medications.2 However, there are
cases with an incubation period for months or years without symptoms. In
the case of our patient, there was no fever. In addition, ESR and CRP
were normal. However, symptoms such as erythema, tenderness, and edema
were found.
Mitnovetski et al. have reported that early and appropriate treatment is
very important for patients with cat bites.9 If it is
determined that an infection is present, immediate treatment is
required. If osteomyelitis is suspected as in the present patient,
surgical treatment and appropriate antibiotic treatment should be
combined to remove the infected tissue. Treatment can be largely divided
into treatment of wounds caused by direct damage and treatment of
infection by the causative strain. It is based on opening the wound at
an early stage. After that, whether to suture should be decided while
observing the progress at intervals of 1-2 days. Early disinfection of
the wound, keeping it open, and administering appropriate antibiotics
usually yield good results. In order to use appropriate (accurate)
antibiotics, a bacterial culture test is required. Since it takes 24-48
hours to know the result of bacterial culture, prophylactic antibiotic
treatment is necessary. Prophylactic antibiotic treatment after 48 hours
will result in poor prognosis. As a prophylactic antibiotic, penicillin
is mainly used. It is more effective to prescribe the
2nd and 3rd generation cephalosporin
class antibiotics than the 1st generation.6 In most
patients, treatment is completed with only 10-14 days of antibiotic
administration for superficial wounds. Intravenous administration of
antibiotics for 6 weeks is required for wounds that have invaded bones
or joints. The use of prophylactic antibiotics for small wounds can
reduce the frequency of infection from 28% to 2%.12We administered the second-generation cephalosporin intravenously for up
to 2 weeks after the surgery followed by oral antibiotics for 4 weeks.
For cat bite patients, it is effective to prescribe appropriate
antibiotics before results of culture, even for wounds that are
considered insignificant. It is also important to actively implement
surgical incisions and debridement resections if infection is suspected.
Talan은 다음과 같은 경우에 물린 상처가 감염되었다고 판단했습니다.
Talan was determined that following the bite wound is infected if: 0.8
Talan은 다음과 같은 경우 물린 상처가 감염된 것으로 확인되었습니다. 0.8
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It was also suggested that hospitalization should be considered for
patients who do not respond to oral medications.2
또한 경구 약물에 반응하지 않는 환자의 경우 입원을 고려해야 한다고
제안되었습니다.2
In addition, patients unresponsive to oral medications suggested that
the hospital consider 0.2
또한 경구 약물에 반응하지 않는 환자는 병원에서 0.2를 고려할 것을
제안했습니다.
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Conclusion
In the case of a cat bite patient, even if the external wound is small,
it is necessary to observe it closely while prescribing an appropriate
antibiotic. If symptoms persist and infection is present, aggressive
treatment including debridement may be effective for a cat bite patient.
References
1. Marr J, Beck A, Lugo J. An epidemiologic study of the human bite.
Public Health Rep.1979; 94:514-21.
2. Goldstain EJC. Bite wounds and infection. Clin. Infect. Dis.
1992;14:633 -40
3. Dire DJ. Emergency management of dog and cat bite wounds. Emerg Med
Clin North Am 1992;10:719e36.
4. Aziz H, Rhee P, Pandit V, Tang A, Gries L, Joseph B. The current
concepts in management of animal (dog, cat, snake, scorpion) and human
bite wounds. J Trauma Acute Care Surg. 2015;78:641-8.
5. Johnson RH, Rumans LW. Articular and skeletal infections caused by
pasterurella multocida. JAMA 1977;237:146-7
6. Mitnovetski S, Kimble F. Cat bites of the hand. Anz J Surg
2004;74:859-62
7. Veitch JM, Omer GE. Case report: treatment of cat bite injuries of
the hand. J. Trauma 1979; 19:201-2.
8. Lloret A, Egberink H, Addie D, Belák S, Boucraut-Baralon C, Frymus T,
et al. Pasteurella multocida infection in cats: ABCD guidelines on
prevention and management. J Feline Med Surg. 2013;15:570-2.
9. Freshwater A. Why your housecat”s trite little bites could cause you
quite a fright: a study of domestic felines on the occurrence and
antibiotic susceptibility of Pasteurella multocida. Zoonoses Public.
Health 2008;55:507-13.
10. Westling K, Farra A, Cars B, Ekblom AG, Sandstedt K, Settergren B,
et al. Cat bite wound infections: a prospective clinical and
microbiological study at three emergency wards in Stockholm, Sweden. J
Infect. 2006;53:403-7.
11. Talan DA, Citron DM, Abrahamian FM, moran GJ, Goldstain EJ.
Bacteriologic analysis of infected god and cat bites. N Engl J Med.
1999;340:85-92
12. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites.
Cochrane Database Syst Rev. 2001;2:CD001738.