ANIMAL BITES AND STINGS

Animal bites and stings are not one of the most common reasons for an Emergency Department (ED) consult; in the United States, only one percent of ED visits are due to animal bites, 95% of which are due to cats and dogs. However, worldwide, at least ten million injuries are due to dog bites, while about five million injuries come from snake bites. Regardless, animal bites and stings may lead to serious medical conditions and should be promptly treated, or else significant complications can develop. Fortunately, there are only a few deaths due to dog bites (30-50 people per year).

Animal bites in general commonly come from pets and domestic animals as compared to wildlife. These include pet dogs and cats, mice and rats, squirrels, rabbits, hamsters, guinea pigs, raccoons, bats, snakes, and foxes. Sometimes, people can acquire human bites, usually from fighting. Serious animal (and human) bites can become infected and will typically need medical attention.

Animal stings are usually obtained from tropical marine wildlife, especially in salt water. People are exposed to these animals through recreational activities and water sports. Examples of animals that can cause stings are jellyfish, stingrays, sea urchins, sea anemone, and electric eels.

Animal Bites

Animal bites usually end up as wounds, but not all bites look the same. Some wounds don’t pass through all the layers of the skin and are called scrapes or scratches. If the wound cuts through the whole skin and reaches the underlying fat or muscle, this is called a laceration or a cut. Puncture wounds also go through the skin but are deeper and much narrower than cuts.

First aid

All animal bites should first be inspected properly. Remove any foreign objects if you can, like teeth, dirt, or fur. Next, gently clean the wound with soap and warm or tap water for around 5 minutes. Carefully dry the wound afterwards. Apply pressure on wounds that continuously bleed, using a clean cloth or dressing. If a body part has been cut off or severed, like a finger or toe, wash it with tap water, place in a clean tissue or cloth and then in a clean plastic bag. Immediately seek medical consultation since in some cases, there is a small chance that the severed body part can be surgically reattached. Even if the wound does not seem so serious, it’s still best to have it checked by a healthcare professional to rule out infection.

Types of animal bites

Dogs are the most common cause of animal bites; about 4.5 million per year experience dog bites. In the United States, 85-90% of animal bites are due to dogs. Adults are usually bitten on the arms and legs, while children sustain bites on the head and neck. Surprisingly, most of these bites come from dogs who are familiar to the patient.

Cats are the next common cause of animal bites, roughly 2-50% of animal bite injuries across the globe. In particular, cat scratches can cause a specific bacterial infection leading to cat-scratch disease.

Snake bites may become more complicated than other animal bites because of poisoning from snake venom. As much as 400,000 medical complications (such as amputations) and 125,000 deaths occur due to envenomations.

Infected bites

An animal bite is more likely to be infected if any of the following signs and symptoms appear:

• Worsening pain from the wound
• The wound is warm to touch
• The skin around the wound is red or swollen
• There is pus or liquid leaking from the wound
• Fever of at least 38°C (100.4°F)

How bites are managed

People who sustain animal bites may need medical treatment, depending on how severe the injury is and the type of animal that caused the bite. Antibiotics or vaccines may be given. These include the tetanus or rabies vaccines, and special medications called immunoglobulins that are also injected through the skin. If the wound is large or deep enough, stitching may be done. However, not all wounds should be stitched: those found in the face, hands might not be stitched at once or at all. This depends on a case-to-case basis.

Some snake bites may introduce venom into the wound. It’s best to clean the wound, then immobilize and avoid pressure on the affected body part or limb. Do not use tourniquets as much as possible. Seek urgent medical care so that the appropriate antivenom may be given.

Rabies is a viral infection that is essentially incurable once symptoms set in. Animals that may harbor the rabies virus are dogs, cats, bats, skunks, foxes, raccoons, coyotes and some large wild animals. Because rabies is potentially fatal, these types of animal bites should be managed immediately by a doctor in order to administer the correct medical treatment.

One way to determine if the biting animal has rabies is to place them under observation for a certain period of time, usually for 10 days. This is much easier to do if you acquired the bite from a pet. For stray or wildlife animals, it may be difficult to capture or observe the animal. If you are still able to identify and locate the animal, ask help from qualified individuals or local authorities in capturing the animal.

Tetanus is another serious infection that can be passed on from both animal and human bites. Depending on how serious the infection is and when the last tetanus vaccine was given, patients may be given a tetanus vaccine and/or a tetanus immunoglobulin shot.

Animal Stings

Animal stings usually involve bees, wasps, hornets, jellyfish, stonefish, sea urchins, scorpions, and centipedes. In general, stings can cause severe pain, hives, swelling of the eyes or lips, purple or red marks on the skin, puncture marks, diarrhea, abdominal cramps, nausea, vomiting, difficulty breathing, sweating, weakness, dizziness, paralysis, anxiety, loss of consciousness, or fever. In some cases, a severe allergic reaction, called anaphylaxis, can develop. This is life-threatening and should be managed in a hospital.

First aid and management

Position the affected limb or body part in such a way that it’s below the level of the heart. Wear gloves first before attempting to remove any spines, stingers or tentacles in the wound. You can try removing these first with a towel or a small card.

For marine animal stings, wash the affected area with salt water. If the wound was caused specifically by stonefish or a Portuguese man-of-war, rinse the area with hot water instead for 20 minutes. Take up to 90 minutes if this was due to a sea urchin. If it was due to a box jellyfish, rinse the area with vinegar for 30 seconds.

For bees and wasps, wash the area with soap and water, dry carefully, then apply a cold compress for 20 minutes. Over-the-counter medications for itchiness and pain may be applied. Serious symptoms, like difficulty breathing, swollen throat or lips or tongue, hives, or a low blood pressure should be evaluated and managed at a hospital.

Summary

Animal bites and stings are potentially serious injuries that can lead to medical complications if not managed properly. First aid treatment is essential for these types of wounds. If the extent of the injury is uncertain, it’s always best to seek medical advice first.

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References:

• Maniscalco K, Edens MA. Animal Bites. [Updated 2021 Sep 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430852/
• Ellis, R., & Ellis, C. (2014). Dog and cat bites. American family physician, 90(4), 239–243. Available from: https://pubmed.ncbi.nlm.nih.gov/25250997/
• Animal bites (5 Feb 2018). World Health Organization. Available from: https://www.who.int/news-room/fact-sheets/detail/animal-bites
• Stauffer, K., Wallace, R.M., Gale Galland, G., Marano, N. (2019). Animal Bites & Stings (Zoonotic Exposures) Available from: https://wwwnc.cdc.gov/travel/yellowbook/2020/noninfectious-health-risks/animal-bites-and-stings-zoonotic-exposures
• Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP) (2017). Domestic Animals. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/rabies/exposure/animals/domestic.html
• Schmitt Pediatric Guidelines LLC (2022). Human or Animal Bite. Seattle Children’s Hospital. Available from: https://www.seattlechildrens.org/conditions/a-z/human-or-animal-bite/
• Animal Bites and Rabies. Johns Hopkins Medicine. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/animal-bites-and-rabies
• Marine animal stings or bites (2022). Medline Plus. Available from: https://medlineplus.gov/ency/article/000032.htm
• Sea creature bites and stings (2021). healthdirect. Available from: https://www.healthdirect.gov.au/sea-creature-stings

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