Pediatric emergency medicine trisk 2031 2031
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depressed skull fractures, intracranial lesions, major vascular injury, visceral
penetration, and chest trauma. Death is usually secondary to acute hemorrhagic
shock.
Although cat bites are usually less destructive, due to their sharp teeth that
cause deeper inoculation of bacteria, cat bites are more frequently complicated by
infections, which occur in as many as 30% to 50% of cases. P. multocida
infections characteristically present within 12 to 24 hours of the injury and
display rapid progression of erythema, significant swelling, and intense pain.
Local infections from other organisms usually present 24 to 72 hours after the
bite in a less fulminant manner. Viridans streptococcal infections are occasional
exceptions to this generalization and may resemble a P. multocida clinical course.
Cat scratches also commonly occur in the periorbital region and may involve
corneal abrasions. Cat-scratch disease, an uncommon complication of these
injuries, is characterized by a papule at the scratch site and a subsequent regional
lymphadenitis. The primary lesion is typically a crusted, erythematous papule, 2
to 6 mm in diameter, which develops 3 to 10 days after the scratch. A tender
regional lymphadenopathy occurs 2 weeks after the primary lesion. Malaise and
fever are associated symptoms in approximately 25% of patients. Rarely,
encephalopathy, exanthem, atypical pneumonia, and parotid swelling may occur.
The disease is self-limiting, with resolution of the symptoms within 2 to 3
months. Bartonella henselae is the causative organism. An indirect fluorescent
antibody test to Bartonella is useful in the diagnosis and is available through the
Centers for Disease Control and Prevention. Polymerase chain reaction assays are
available in some commercial labs.
Human bites in older children and adolescents are most commonly incurred
when a clenched fist strikes the teeth of an adversary. Wounds that overlie the
metacarpal–phalangeal joint may lead to bacterial penetration into the relatively
avascular fascial layers. Hand infections usually present with mild swelling over
the dorsum of the hand 1 to 2 days after injury. If there is pain with active or
passive finger motion, a more serious deep compartmental infection or tendonitis
should be suspected. Osteomyelitis occasionally occurs in hand infections. In
younger children, human bites are more often on the face or trunk than on the
hands. Often, a playmate inflicts the wound, but child abuse must always be
considered. Systemic diseases that may be spread by human bites include
hepatitis B, HIV, and syphilis.
Rodent bites usually occur in disadvantaged socioeconomic groups or among
laboratory workers and have a relatively low incidence of secondary infection
(10%). Ratbite fever is a rare disease that may present after a 1- to 3-week
