Bites, human and animal

Page last reviewed: 13/07/2011

Animal and human bites are a relatively common type of injury. In most cases, the wound that results from an animal bite is minor and can be treated with simple first aid techniques, such as:

  • cleaning the wound immediately by running it under warm water for 10 minutes
  • encouraging the wound to bleed by gently squeezing it, unless it is already bleeding freely
  • using painkillers, such as ibuprofen or paracetamol, to help relieve the pain and inflammation

See Animal Bites - treatment for more information and first aid advice.

Animal and human bites need medical attention, unless they are very minor. This is because the wound can become infected with bacteria.

See Animal bites - symptoms for more information and advice about when to seek medical attention.

How common are animal bites?

It is difficult to estimate exactly how common animal bites are in Ireland because many people do not seek medical treatment for minor bites. The most common types of animal bites are:

  • dog bites, which account for around 80% of cases
  • cat bites, which account for around 15% of cases
  • human bites, which account for around 5% of cases

Dog bites

Dog bites are most common in young children, particularly boys, who are five to nine years of age. It is estimated that around half of all children will be bitten by a dog at some point during their life. The dog involved is usually either a family dog or a dog that belongs to a friend or neighbour.

Human bites

Most human bites occur during a fight, usually when one person punches someone else in the teeth. These are often referred to as closed-fist bites or 'fight bites'. Men aged 16-25 years are most likely to experience these bites.

Outlook

Usually, the injuries from dog bites are minor and can be treated at home.

Cat bites and human bites also usually only cause minor injuries, although they do carry a higher risk of infection. Therefore, treatment with antibiotics may be required as a precaution.

Complications that arise from animal bites are uncommon, but if they do occur they can be serious. For example, one possible complication is a bacterial infection that spreads through the bloodstream, known as sepsis.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at:www.emitoolkit.ie

 

Dogs with no previous history of biting can sometimes bite. So you should never leave a child unsupervised with a dog, regardless of what type of dog it is or its previous behaviour.  

Page last reviewed: 13/07/2011

Dog bites

Dog bites typically cause a puncture wound (a narrow and deep hole) in the skin. They can also cause a laceration (a jagged wound or cut) and an abrasion (a scraped area of skin). This is because dogs use their front teeth to "pin" their victim, and their other teeth to bite and pull at the surrounding skin.

In adults, most animal bites are to their hands, arms, legs or feet. Due to children's smaller size, most bites are to their face and usually involve their lips, nose or cheek.

Cat bites

A cat bite is not as strong as a dog's, but their teeth are sharper and often cause very deep puncture wounds. A cat bite is capable of penetrating bones and joints. Lacerations and abrasions are less common, occurring in one-in-five cases.

In adults, most cat bites are to their upper limbs, particularly the fingers and hands. In children, as well as the upper limbs, the face and neck can also be bitten.

Human bites

Most human bites are the result of a closed-fist injury, where one person punches another person in the teeth and cuts their hand. Typical symptoms include small cuts to the hand, and red, swollen and painful skin. Recipients of these "fight bites" should always seek early medical attention because of the risk of serious infection from these injuries.

Toddlers often bite each other when playing together, but the resulting injuries are usually minor and do not usually pose a serious risk to their health.

Infection

The signs and symptoms that suggest that a bite wound has become infected include:

  • redness and swelling around the wound
  • the wound becomes more painful
  • discharge from the wound
  • swollen lymph glands (nodes)
  • a high temperature (fever) of 38C (100.4F) or above
  • shivers

When to seek medical advice

You should seek immediate medical attention for all but minor dog or cat bites. However, even some minor-looking cat bites can penetrate deeply and become infected.

Human bites have a much higher chance of causing infection, so always seek immediate medical attention before waiting for any symptoms of infection to appear.

Always seek immediate medical attention if you or your child receives a bite to the following areas:

  • the hands
  • the feet
  • a joint, tendon, or ligament
  • the scalp or face
  • the genitals
  • the ears or nose

You should also seek immediate medical attention if you have a pre-existing condition that increases your chances of infection, such as diabetes, liver disease or HIV, or you are undergoing medical treatment that is known to weaken the immune system, such as chemotherapy.

If the bite wound is minor, you should be able to receive treatment from your GP, walk-in centre or your Local Injury Unit (LIU). However, if the bite wound is more severe or involves bones, joints or tendons, you will probably require specialist care and should visit your local Emergency Department.

When to seek emergency medical advice

Dial 999 or 112 immediately to request an ambulance if your child receives bite wounds to their head, neck or face. These types of wound can cause high amounts of blood loss, particularly in young children aged 10 or under and babies, and may therefore require emergency treatment.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Page last reviewed: 13/07/2011

Dog bites

The majority of dog bites are unprovoked, usually by a family dog or a dog that belongs to a friend or neighbour.

Dogs are territorial creatures. Many innocent actions will be perceived by a dog as an invasion of its territory, and may be interpreted as a hostile act, resulting in a bite.

Actions that can provoke a dog include:

  • disturbing a dog when it is sleeping
  • disturbing a dog when it is eating
  • disturbing a dog when it is caring for its puppies
  • people running, screaming, or shouting in the presence of a dog
  • being petted by somebody they do not know (always let a dog smell your hand before you stroke it)

Some dogs, particularly ones that are young, can get over-excited when playing, and they may accidently give humans what they perceive to be a friendly nip.

Dogs that are sick or in pain can react unpredictably when they are touched and mistake the person touching them as the source of the pain. They may respond to this with a bite.

The dog breeds that are most likely to cause more severe bites are the larger and stronger dogs. These include:

  • German shepherds (Alsatians)
  • pit bulls
  • rottweilers
  • dobermans
  • chows

However, any breed of dog should be regarded as being potentially dangerous, and smaller dogs such as Jack Russells, dachshunds and chihuahuas are often more aggressive than larger dogs.

Cat bites

It is estimated that the majority of cat bites involve stray, female cats. All cats are predators, so they can react unpredictably, and this is particularly true of cats that are not domesticated (used to living in a house with people).

Around one-in-five cat bites are inflicted by a person's own cats. It is thought that there are four main reasons why your pet cat might bite you:

  • fear-based aggression - where your cat mistakes a sudden action for an aggressive act
  • playful aggression - like dogs, cats or kittens can get over-excited when they are playing, and can jump at and bite any moving object, such as your hand
  • redirected aggression - if your cat cannot attack its intended target, such as another cat, it may lash out at the nearest target
  • petting-evoked aggression - for reasons that are unclear, an apparently content cat can suddenly bite their owner after being petted for a few minutes

Human bites

The majority of fight-bites (bites that occur when one person punches another person in teeth) occur in young males who have been drinking alcohol.

Intentional bites can be common in very young children, and in people with severe learning difficulties, as they are often unaware that such behaviour is socially unacceptable.

Accidental bites can occur during contact sports, such as rugby and football, when a person accidentally knocks into another person's teeth.

Accidental bites can also occur during vigorous sexual activity, particularly oral sex. Although you may feel embarrassed, you should always seek medical treatment for an accidental bite that has occurred in this way, because this type of bite has a high risk of becoming infected.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Page last reviewed: 13/07/2011

If you are bitten by an animal or human, your GP or the healthcare professional - who is treating you at the Emergency Department (ED) or local Injury unit (LIU) - will ask you how and why the bite occurred.

Careful examination

They will carefully examine the bite wound, checking for any signs of damage to underlying structures such as your arteries, nerves, tendons or joints. They will also check for any evidence that the bite wound is infected, such as redness, swelling or a discharge of fluid or pus from the wound.

You will be asked whether your tetanus vaccinations are up to date. Tetanus is a serious bacterial infection that can be spread by animal bites. See Bites, animal and human - Complications for more information.

Blood tests

If you have been bitten by a human, you will be asked if you know if either you or they could have a blood-borne virus, such as hepatitis B, hepatitis C or HIV, that could have been spread by the bite.

If this information is uncertain and it is thought that there may be a high risk of infection, you may be referred for blood tests. For example, you may need to have blood tests if you were bitten by a person who is known to inject illegal drugs, as this increases your risk of contracting a blood-borne virus.

Although cases have been reported, the risk of spreading hepatitis B, hepatitis C or HIV during a bite is thought to be low. 

If you have a closed-fist bite (a bite to your hand resulting from contact with someone else's teeth), you may be referred for an X-ray. This is because in this type of injury it is common for a small fragment of tooth to end up embedded in your fist.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Page last reviewed: 13/07/2011

First aid

If you have been bitten, the most important thing to do is to clean the wound immediately. You should remove any foreign bodies such as teeth from the bite, and run warm tap water over the wound for 10 minutes.

You should encourage the wound to bleed by gently squeezing it, unless it is already bleeding freely. If you require pain relief, over-the-counter (OTC) painkillers such as ibuprofen or paracetamol are recommended.

Children under 16 should never be given aspirin because there is a small risk that aspirin could trigger a serious condition called Reyes syndrome that can damage the liver and brain.

In cases of serious bites, where a body part such as a finger or ear has been bitten off, you should wash the body part with tap water and place it in a plastic bag or a sealed container. Put the bag or container into a tub of iced water (but not frozen) to keep it cool, so that it can be transported to hospital. It may be possible to reattach the body part using reconstructive surgery.

Medical treatment

If your bite wound is severe enough to require medical treatment, the wound will be cleaned, and any damaged or dead tissue will be removed (debridement).

If there is a risk that the wound may become infected, it will be left open. This makes it easy to keep the wound clean. If the risk of infection is thought to be low, the wound can be stitched up.

To prevent blood loss, wounds that bleed excessively will also be closed, despite the risk of infection.

Antibiotics

Antibiotics are given as a precaution when it is thought that there is an increased risk of the wound becoming infected. Antibiotics are usually recommended for:

  • all cases of cat bites
  • all cases of human bites
  • animals bites to the hands, feet, or face
  • any bites that have caused puncture wounds
  • wounds that required closure due to excessive bleeding
  • wounds that required debridement
  • wounds that involved joints, ligaments or tendons
  • people with prosthetic (artificial) joints or valves
  • people with a weakened immune system (immunosuppression) due to a health condition such as diabetes or HIV, or as a side effect of treatments such as chemotherapy

You will usually be given a seven-day course of oral antibiotics (tablets). This is usually penicillin, unless you are allergic to it.

Additional treatment

Additional treatment may be required if:

  • You receive a deep puncture wound that may have damaged bones, joints, muscles, tendons or nerves.
  • You received a facial wound.
  • You received a bite where this is a possibility of a foreign body, such as a tooth, being embedded in the wound.
  • You receive a wound to areas of your body that have a reduced blood supply, such your nose or ears (wounds to these areas could take longer to heal and have a higher risk of infection).
  • You have an infected wound that does not respond to treatment.

Further reconstructive surgery may be required for serious or complex wounds. Serious infections, or infections that do not respond to oral antibiotics, can be treated with injections of antibiotics (intravenous antibiotics).

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Page last reviewed: 13/07/2011

Infection is the main complication that arises from animal bites and bites from humans. Infected bites rarely cause any serious problems, as long as they are promptly treated using antibiotics. However, if left untreated, an infection can cause serious complications including:

  • blood poisoning (sepsis)
  • swelling and stiffening of the joints
  • tissue damage

Tetanus

It is possible to catch tetanus from an animal bite. Tetanus is a potentially fatal infection of the muscles and nervous system.

If you are bitten by an animal, your GP will check your tetanus vaccination history. A full course of tetanus immunisation consists of five doses of a tetanus vaccine. You should have received a full course of vaccinations when you were a child. However, if you have not received a full course, you will be given an additional vaccination.

Rabies

Rabies is a potentially fatal infection of the nervous system. It is possible to catch rabies from an animal bite and, in rare cases, the disease can be caught if you have a scratch or an abrasion, or from licking open wounds.

Rabies is common in Africa, Asia, and central and southern America. It is less common in Europe, although some cases have been reported, mostly in Eastern Europe. You may need immunisation for rabies if you are visiting these areas. See the Bites, human and animal - Prevention section for more details on vaccinations.

It was thought that rabies had been eradicated in all animals. However, some bats have been found to carry the disease. If you are bitten by a bat your bite should be immediately assessed and, as a matter of urgency, you should be given the rabies treatment to prevent rabies developing. The same advice applies if you have received a bite from an animal while you are abroad in a country where rabies is widespread.

Treatment to prevent rabies developing is known as post-exposure prophylaxis. You will be given one dose of rabies immunoglobulin (a blood product that contains antibodies against rabies) and five doses of the rabies vaccine. If exposure to rabies is uncertain, the vaccination on its own may be considered.

Serious infection

Although uncommon, infected animal bites can give rise to more serious secondary infections. These can include:

  • blood poisoning (sepsis)
  • meningitis (infection of the outer layers of the brain)
  • endocarditis (infection of the inner lining of the heart)

Signs and symptoms that a more serious secondary infection may be under way include:

  • a high temperature (fever) of 38C (100.4F) or above
  • chills
  • muscle pain
  • vomiting
  • diarrhoea
  • abdominal pain
  • malaise
  • shortness of breath
  • mental confusion
  • headache

Immediately contact your GP if you think that you may be developing a more serious secondary infection.

Post-traumatic stress disorder (PTSD)

It is estimated that around half of children who require hospital treatment for a dog bite will develop some degree of post-traumatic stress disorder (PTSD).

PTSD is a psychological condition where a person relives a past traumatic event. In children, this usually takes the form of repeated nightmares and becoming very nervous and frightened around dogs.

Other symptoms of PTSD in children may include:

  • refusing to go outside unless accompanied
  • becoming unusually shy with friends and family or becoming unusually aggressive
  • a lack of interest in games or school activities
  • fear of the dark
  • fear of being left alone

PTSD may resolve within one to two months without the need for treatment. However, if the symptoms persist or worsen your child may require additional treatment.

Treatment options for PTSD in children include cognitive behavioural therapy (CBT), which is a type of talking therapy that aims to change patterns of unrealistic and negative thinking or behaviours.  See the Health A-Z topic about  Post-traumatic stress disorder - Treatment for more information.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Page last reviewed: 13/07/2011

Dog bites

Never leave a child unsupervised with a dog, regardless of what type of dog it is, or its previous behaviour.

Dogs with no previous history of biting can sometimes bite. A breed's reputation, or appearance, is also no guarantee of a dog's behaviour. Family dogs such as labradors, collies and terriers are all known to have been involved in fatal attacks.
 
The advice outlined below will help you and your children to prevent dog bites.

  • Avoid making your dog too important within the family by letting it sleep on the furniture, beg for food at the table or by kissing or cuddling it. This can sometimes confuse a dog, making it think that it has a higher status within the family group. If someone, for example a young child, challenges that status, the dog may react aggressively.
  • Dogs love to chase things so you and your children should avoid running or screaming in the presence of a dog.
  • Respect a dog's boundaries because, like many animals, dogs have a sense of personal space. If you suddenly approach a dog, it can react unpredictably. Do not greet a dog with an outstretched hand. Do not suddenly interrupt a dog when it is eating, sleeping or playing with a toy. And do not pet a dog without letting it sniff you first.
  • Socialise your dog by allowing it to experience many different kinds of people, situations and environments. This will help stop your dog becoming frightened or nervous if it finds itself in unfamiliar circumstances or when meeting new people.

Signs that a dog is becoming aggressive and may be about to bite include:

  • the hairs on the dog's back rising up
  • the dog bearing its teeth
  • the dog's ears moving either forward or back against their head
  • the dog stares directly at you
  • the dog's legs stiffen

If you are presented with an aggressive dog, you should stand still, with your feet together, your arms placed against your chest, and your fists folded below your neck. Avoid direct eye contact because the dog may interpret it as an aggressive act.

You should not attempt to run away from the dog. By standing still it should lose interest, allowing you to back away slowly.

If a dog jumps on you and knocks you to the ground, you should try to lie still, face down, with your legs together and your fists behind your neck with your forearms covering your ears. Once the dog realises that you are not moving, it should lose interest and move away.

Cat bites

As many cat bites are from strays, avoid disturbing or stroking a cat that you do not know.

If you cat is attempting to bite or jump at your hands and feet while it is playing (playful aggression), do not attempt to push them away with your hands as this can reinforce the pattern of behaviour. Instead, use a water spray to discourage them.

Using a sock or small felt toy on an end of a string that you can drag around the room is a good way of letting your cat play without reinforcing bad behaviour.

Human bites

Most human bites are the result of alcohol-related violence and disorder. Therefore, the most effective way to avoid taking part in this type of incident is to moderate your alcohol consumption and avoid binge-drinking.

See the Health A-Z topic about Alcohol misuse for more information about the risks that are associated with heavy drinking and how to avoid them.

Tetanus

Immunisation is the best way to prevent tetanus. The complete course of the tetanus vaccination consists of five doses. In Ireland, all children are routinely offered the tetanus vaccination as part of the childhood immunisation programme.

As an adult, if you are unsure about whether or not you have been fully immunised against tetanus, you should speak to your GP or practice nurse. They will be able to advise you about having a booster injection.

Rabies

Immunisation is also available for rabies. However, the vaccine is not given routinely in childhood because there are virtually no recorded cases of rabies in Ireland.

A rabies vaccination is usually only recommended if:

  • You have a job that involves coming into contact with animals from abroad, such as working as a customs officer, or in a zoo or an animal quarantine centre.
  • You work as an animal inspector.
  • You regularly handle bats.
  • You are planning to work abroad in an occupation that may bring you into contact with rabid animals, such as working as a zoologist or vet.
  • You are planning to travel and live in an area for more than a month where native animals are known to be affected by rabies, and where access to high quality emergency medical care may not be available.
  • You are planning to travel for less than a month in an area where native animals are known to be affected by rabies, and your travel activities are likely to increase your exposure to animals, and access to medical care may be unavailable.

Parts of the world known to have an increased risk of rabies include:

  • Central America
  • South America (except Argentina and Chile)
  • Asia (except Australia, Japan, New Zealand and Papa New Guinea)
  • Africa
  • some parts of Eastern Europe, such as the Balkan states, including Serbia and Croatia, Russia, the Ukraine and the Baltic States, such as Estonia and Lithuania

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

 

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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