Human biteMANAGEMENT

INFECTIOUS DISEASE PRESENTATIONS · 12 SECTIONS

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611 items

☷ Legend

01Approach to the Critical Patient/attcp81

Immediate priorities

›Stabilization and escalation

›Airway compromise

›If stridor or inability to protect airway, airway team activation

›If facial bite with expanding hematoma, early airway planning

›Breathing compromise

›If hypoxemia or respiratory distress, resuscitation bay

›If aspiration risk from intoxication, continuous monitoring

›Circulation compromise

›If hypotension or septic shock physiology, sepsis pathway

›If uncontrolled hemorrhage, hemostasis and urgent surgical consultation

›Sepsis trigger set

›Fever or hypothermia

›Tachycardia

›Hypotension

›Altered mental status

›Analgesia plan

›Local anesthesia option

›Regional block option for hand injuries

›Non-opioid first line when feasible

›High-risk injury patterns

›Clenched fist injury over MCP

›Dorsal MCP laceration after punching teeth

›High risk extensor tendon and joint capsule violation

›Rapid progression to septic arthritis and tenosynovitis

›Hand bites

›High infection risk

›Deep space involvement risk

›Function-threatening complications

›Face bites

›Cosmetic and functional structure involvement

›Consider early specialty consultation

›Genital bites

›High contamination risk

›Urology or gynecology consultation threshold low

Key decision points

›Wound risk stratification

›Time from injury

›More than 12 hours since injury

›More than 24 hours since injury

›Depth and structure involvement

›Tendon sheath concern

›Joint involvement concern

›Bone exposure concern

›Contamination and devitalized tissue

›Crush component

›Necrotic edges

›Host risk

›Diabetes

›Immunosuppression

›Asplenia

›Peripheral vascular disease

›Consultation triggers

›Hand surgery or plastics

›Clenched fist injury pattern

›Any tendon dysfunction

›Any joint penetration concern

›Deep space infection concern

›Neurovascular compromise

›Infectious diseases

›Concern for HIV nPEP indication

›Hepatitis B prophylaxis decision support

›Severe infection with resistant pathogen risk

›Social work and safeguarding

›Assault and safety concerns

›Intimate partner violence concern

›Child protection involvement concern

Wound care essentials

›Bedside wound management bundle

›Copious irrigation

›High volume saline irrigation

›Avoid high-pressure injection into closed spaces

›Exploration

›Full depth visualization when feasible

›Tendon and joint capsule evaluation for hand injuries

›Debridement

›Devitalized tissue removal

›Foreign material removal

›Hemostasis and dressing

›Non-adherent dressing

›Bulky dressing for hand

›Splinting for hand bites

›Position of function

›Elevation plan

02History/hx73

Exposure and mechanism

›Bite event details

›Occlusive bite

›Direct tooth compression

›Location and number of bites

›Clenched fist mechanism

›Punch to mouth

›Dorsal MCP injury onset

›Time from injury

›Minutes to hours

›More than 12 hours

›More than 24 hours

›Wound care before arrival

›Irrigation performed

›Topicals applied

›Closure attempts

›Source person considerations

›Known or unknown source

›Identifiable source available for testing

›Unknown source

›Blood exposure description

›Blood in biter mouth

›Victim bleeding at time of bite

›Infectious risk history if available

›HIV status known

›Hepatitis B status known

›Hepatitis C status known

Symptoms and progression

›Local symptoms

›Pain severity and trend

›Increasing pain over hours

›Pain out of proportion

›Swelling progression

›Rapid swelling

›Spreading edema

›Redness and warmth

›Expanding erythema

›Lymphangitic streaking

›Drainage

›Purulence

›Serosanguinous drainage

›Functional symptoms

›Hand function

›Finger extension limitation

›Finger flexion limitation

›Grip weakness

›Joint symptoms

›Pain with range of motion

›Joint stiffness

›Neurovascular symptoms

›Numbness

›Tingling

›Coldness or color change

›Systemic symptoms

›Fever

›Chills

›Malaise

›Nausea or vomiting

Patient risk factors

›Comorbidities

›Diabetes

›Chronic kidney disease

›Chronic liver disease

›Peripheral vascular disease

›Immunocompromise

›Steroids

›Chemotherapy

›Transplant

›Advanced HIV

›Medication and allergy history

›Beta-lactam allergy details

›Previous MRSA colonization or infection

›Anticoagulant use

›Immunization status

›Tetanus vaccine timing

›Hepatitis B vaccination series status

03Physical Exam/exam67

Vitals and general

›Physiologic status

›Temperature

›Fever

›Hypothermia

›Heart rate

›Tachycardia

›Relative bradycardia

›Blood pressure

›Hypotension

›Hypertension with pain

›Respiratory status

›Tachypnea

›Hypoxemia

›Mental status

›Confusion

›Lethargy

Wound and soft tissue exam

›Local wound assessment

›Location and size

›Face

›Hand

›Genital

›Depth indicators

›Visible tendon

›Visible fat

›Visible bone

›Infection signs

›Erythema border

›Warmth

›Induration

›Fluctuance

›Purulence

›Necrosis indicators

›Dusky tissue

›Bullae

›Crepitus

›Foreign body indicators

›Tooth fragment concern

›Embedded debris concern

Hand focused exam

›Neurovascular and function

›Perfusion

›Capillary refill

›Distal pulses when applicable

›Sensation

›Median nerve distribution

›Ulnar nerve distribution

›Radial nerve distribution

›Motor

›Extensor tendon function

›Flexor tendon function

›Joint assessment

›MCP tenderness

›Pain with passive motion

›Deep infection flags

›Flexor tenosynovitis indicators

›Fusiform digit swelling

›Tenderness along flexor sheath

›Pain with passive extension

›Finger held in flexion

›Septic arthritis indicators

›Effusion

›Severe pain with range of motion

›Marked motion limitation

PITFALLS

›Common misses

›Dorsal MCP laceration treated as superficial

›Joint penetration not recognized on initial exam

›Primary closure of contaminated hand bite

›Clindamycin monotherapy for human bite pathogens

04Differential Diagnosis/ddx37

Infectious and inflammatory

›Soft tissue infection spectrum

›Cellulitis

›ICD-10 L03.1

›Rapidly spreading erythema and warmth

›Abscess

›ICD-10 L02

›Fluctuance or focal tenderness

›Necrotizing soft tissue infection

›ICD-10 M72.6

›Pain out of proportion

›Lymphangitis

›ICD-10 I89.1

›Proximal streaking

›Deep structure infections

›Septic arthritis

›ICD-10 M00

›Severe pain with motion

›Osteomyelitis

›ICD-10 M86

›Persistent pain and systemic signs

›Flexor tenosynovitis

›ICD-10 M65.1

›Kanavel sign cluster

Traumatic and structural

›Trauma related

›Tendon laceration

›Extensor tendon injury

›Flexor tendon injury

›Fracture

›Phalanx fracture

›Metacarpal fracture

›Retained foreign body

›Tooth fragment retention

›Debris retention

Exposure related

›Bloodborne pathogen exposure

›HIV exposure

›Hepatitis B exposure

›Hepatitis C exposure

05Laboratory Tests/lt36

Infection and sepsis evaluation

›Systemic infection labs

›Complete blood count for systemic infection concern

›Leukocytosis

›Neutrophilia

›C reactive protein for inflammatory burden

›Rising trend support for deep infection

›Normal value does not exclude early infection

›Serum lactate for sepsis physiology

›Elevated value supports hypoperfusion

›Normal value does not exclude serious infection

›Blood cultures for systemic toxicity

›Fever

›Hypotension

Metabolic and medication safety

›Baseline chemistry

›Electrolytes and kidney function for antibiotic dosing

›Dose adjustment need

›IV therapy planning

›Glucose for diabetes screening and infection risk

›Hyperglycemia worsens outcomes

›Undiagnosed diabetes consideration

Microbiology and exposure baseline

›Cultures and exposure testing

›Wound culture only for established infection

›Purulent drainage

›Deep tissue specimen preferred if operative management

›HIV baseline test when nPEP considered

›Rapid HIV test or lab based antigen antibody

›Baseline result before nPEP when feasible without delaying start

›Hepatitis B baseline tests when prophylaxis considered

›HBsAg if source testing available

›Anti HBs if patient immunity uncertain

›Hepatitis C baseline test for significant blood exposure

›Anti HCV or HCV RNA based on local protocol

Pregnancy related

›Pregnancy testing

›Urine or serum pregnancy test when pregnancy possible

›Antibiotic selection safety

›HIV nPEP regimen safety

06Diagnostic Tests/dt52

Scoring Systems

›Systemic illness scoring

›qSOFA for sepsis risk flag

›Altered mentation

›Respiratory rate 22 per minute or more

›Systolic blood pressure 100 mmHg or less

›SIRS screening for inflammatory response

›Temperature abnormality

›Heart rate 90 per minute or more

›Respiratory rate 20 per minute or more

›White blood cell count abnormality

›Necrotizing infection support scores

›LRINEC as adjunct only

›Low sensitivity in early disease

›Not a rule-out tool

MRI

›Deep infection delineation

›Osteomyelitis evaluation when plain films nondiagnostic

›Persistent pain and swelling

›Failure of therapy

›Tenosynovitis and deep space infection evaluation

›Equivocal exam

›High-risk hand bite with severe pain

›Contraindications and limitations

›Delays in time-critical surgical infections

›Implanted devices constraints

›Cross-sectional imaging indications

›Facial bites with deep structure concern

›Orbital involvement concern

›Sinus involvement concern

›Deep abscess evaluation when ultrasound limited

›Gas concern

›Complex anatomy

›Foreign body detection adjunct

›Radiolucent foreign body concern

›Complex wound tract

Ultrasound (or US)

›Point-of-care applications

›Abscess versus cellulitis

›Fluid collection identification

›Guidance for drainage planning

›Tendon integrity adjunct for superficial tendon concern

›Dynamic evaluation support

›Not a substitute for operative exploration when high suspicion

›Doppler assessment adjunct

›Perfusion concern in swollen digit

›Reduced flow support for urgent consultation

›Normal flow does not exclude compartment process

Plain radiography

›X-ray indications

›Hand bites and clenched fist injuries

›Fracture detection

›Tooth fragment detection

›Any bite with foreign body concern

›Radiopaque debris detection

›Subcutaneous gas detection

07Disposition/dispo35

Level of care

›Discharge criteria

›Superficial wound without deep structure concern

›No tendon dysfunction

›No joint involvement concern

›No systemic illness features

›Afebrile

›Hemodynamically stable

›Reliable follow-up within 24 to 48 hours

›Hand recheck arranged for hand bites

›Wound care instructions understood

›Admission criteria

›Established infection requiring IV therapy

›Rapidly progressive cellulitis

›Significant edema or pain limiting function

›Deep structure infection concern

›Septic arthritis concern

›Tenosynovitis concern

›Osteomyelitis concern

›High-risk host factors

›Immunocompromised state

›Poor outpatient reliability

›Transfer criteria

›Hand bites needing operative capability

›Clenched fist injury with MCP involvement concern

›Tendon laceration requiring repair

›Face bites needing specialty repair

›Vermillion border involvement

›Eyelid or canal involvement

Follow-up timing

›Reassessment planning

›Hand bite recheck within 24 hours

›Function reassessment

›Infection progression check

›Other bites recheck within 48 hours when prophylaxis given

›Dressing change guidance

›Antibiotic tolerance check

08Treatment/t119

Wound management

›Local therapy

›Irrigation and debridement strategy

›High volume saline irrigation

›Debridement of devitalized tissue

›Closure strategy

›Hand bites left open

›Delayed primary closure consideration when clean and improving

›Face bites primary closure consideration after irrigation and debridement

›Immobilization and elevation

›Splint for hand bites

›Elevation above heart level

Antibiotics

›Empiric coverage targets

›Typical flora

›Streptococcus species

›Staphylococcus aureus

›Eikenella corrodens

›Oral anaerobes

›Coverage cautions

›Clindamycin monotherapy inadequate for Eikenella

›First generation cephalosporins inadequate for Eikenella

›Oral regimens

›Amoxicillin clavulanate

›Adult dose 875 mg 125 mg by mouth every 12 hours

›Duration prophylaxis 3 to 5 days

›Duration treatment 5 to 7 days

›Penicillin allergy non-anaphylaxis

›Cefuroxime by mouth

›Add metronidazole by mouth for anaerobes

›Avoid if immediate hypersensitivity history

›Cefpodoxime by mouth

›Add metronidazole by mouth for anaerobes

›Avoid if immediate hypersensitivity history

›Penicillin allergy immediate hypersensitivity

›Doxycycline by mouth

›Adult dose 100 mg every 12 hours

›Add metronidazole 500 mg every 12 hours

›Moxifloxacin by mouth

›Adult dose 400 mg daily

›Avoid in pregnancy

›IV regimens

›Ampicillin sulbactam

›Adult dose 3 g IV every 6 hours

›Transition to oral when improving

›Total duration commonly 7 to 14 days for deep infection based on source control

›Piperacillin tazobactam

›Adult dose 4.5 g IV every 6 to 8 hours

›Severe infection with polymicrobial risk

›Penicillin allergy immediate hypersensitivity

›Levofloxacin IV

›Adult dose 750 mg daily

›Add metronidazole 500 mg IV every 12 hours

›Doxycycline IV

›Adult dose 100 mg every 12 hours

›Add metronidazole 500 mg IV every 12 hours

›MRSA risk additions

›MRSA risk features

›Prior MRSA infection

›Purulent infection

›High local prevalence

›Oral MRSA add-on options

›Trimethoprim sulfamethoxazole

›Add to regimen that covers Eikenella and anaerobes

›Not adequate as monotherapy for human bite flora

›Doxycycline

›Add to regimen that covers anaerobes when needed

›IV MRSA add-on options

›Vancomycin IV per local dosing protocol

›Add to beta-lactam bite coverage

›Trough or AUC monitoring per protocol

Tetanus prophylaxis

›Immunization and TIG decisions

›Wound management principles

›Wound cleaning and debridement

›Antibiotics not used to prevent tetanus

›Vaccine update thresholds

›If incomplete primary series, tetanus vaccine indicated

›If last tetanus vaccine more than 5 years for dirty wounds, booster indicated

›TIG considerations

›Unknown or incomplete immunization with dirty wound

›Immunocompromised with uncertain immunity

Hepatitis B and HIV exposure management

›Hepatitis B post-exposure approach

›Patient immunity assessment

›Completed hepatitis B vaccine series

›Anti HBs known protective

›Source status assessment

›HBsAg positive

›Unknown source

›Prophylaxis options

›Hepatitis B vaccine series initiation if non-immune

›HBIG consideration per local protocol if high-risk source and non-immune

›HIV nPEP considerations

›Exposure features for consideration

›Bite with blood exposure

›Source known HIV positive with viremia risk

›Significant tissue injury with blood present

›Timing window

›Most effective when started as soon as possible

›Usual outer window 72 hours based on guideline frameworks

›Baseline labs for nPEP

›HIV test

›Kidney function

›Liver enzymes

›Pregnancy test when applicable

›Regimen selection

›Local protocol first line regimen

›Drug interaction and renal dosing check

Procedural and surgical management

›Operative indications

›Clenched fist injury with suspected joint penetration

›Operative irrigation and debridement

›Joint capsule exploration

›Tendon injury

›Repair planning

›Early hand surgery involvement

›Deep infection

›Abscess drainage

›Tenosynovitis washout

›Bedside procedures

›Incision and drainage for clear abscess

›Ultrasound confirmation when uncertain

›Culture from purulence when indicated

09Special Populations/sp36

Pregnancy

›Pregnancy considerations

›Antibiotic selection

›Amoxicillin clavulanate acceptable option in pregnancy when indicated

›Avoid doxycycline

›Fluoroquinolone use risk benefit discussion

›HIV nPEP regimen selection

›Pregnancy-safe regimen per local protocol

›Obstetrics involvement for medication counseling

›Imaging selection

›Ultrasound preferred when adequate

›X-ray when needed with shielding per local protocol

Geriatric

›Older adult considerations

›Higher risk of severe infection

›Delayed presentation common

›Blunted fever response

›Medication safety

›Renal dosing adjustments common

›Higher adverse effect risk with fluoroquinolones

›Disposition threshold lower

›Admission consideration for hand bites with swelling or function change

›Early follow-up reliability assessment

Pediatrics

›Pediatric considerations

›Weight-based antibiotics

›Amoxicillin clavulanate

›22.5 mg amoxicillin per kg per dose by mouth every 12 hours

›Maximum 875 mg amoxicillin per dose

›Ampicillin sulbactam

›50 mg ampicillin per kg per dose IV every 6 hours

›Maximum 2000 mg ampicillin per dose

›Safeguarding

›Bite from peer

›Bite from caregiver or adult

›Documentation of circumstance and safety plan

›Follow-up planning

›Next day hand recheck for hand bites

›Low threshold for admission if unreliable follow-up

10Background/b31

Epidemiology

›Human bite epidemiology

›High infection risk compared with many other lacerations

›Hand bites highest risk group

›Clenched fist injuries high complication rate

›Common contexts

›Fights and assaults

›Sports and playground injuries

›Behavioral bites

Pathophysiology

›Microbiology and injury mechanics

›Polymicrobial inoculation

›Aerobes and anaerobes mixed flora

›Eikenella corrodens common organism

›Hand anatomy vulnerability

›Tendon sheath continuity supports spread

›MCP joint capsule risk in clenched fist injuries

›Delayed presentation worsens outcomes

›Early signs may be subtle

›Rapid progression to deep infection possible

Therapeutic Considerations

›Treatment rationale

›Early irrigation and debridement reduces bacterial load

›Mechanical cleansing is key intervention

›Source control prevents deep infection

›Antibiotic strategy

›Broad coverage for aerobes and anaerobes

›Avoid agents with Eikenella gaps

›Closure strategy rationale

›Hand wounds often left open due to contamination

›Face wounds may be closed selectively due to vascularity and cosmetic needs

›Guideline alignment

›IDSA support for amoxicillin clavulanate for bite wound infections

›CDC wound management guidance for tetanus prevention

11Patient Discharge Instructions/pdi27

copy discharge instructions

›Discharge instructions bundle

›Wound care

›Keep dressing clean and dry for 24 hours

›Gentle wash with soap and water after 24 hours

›Elevation as much as possible for the first 48 hours

›Medications

›Take antibiotics exactly as prescribed

›Do not stop early even if feeling better

›Pain control plan with dose limits

›Activity

›Avoid heavy use of affected hand

›Keep splint on if provided

›Follow-up

›Recheck within 24 hours for any hand bite

›Recheck within 48 hours for other bites when antibiotics prescribed

›Return to emergency signs

›Fever

›Increasing redness or swelling

›Red streaks up the arm or leg

›Pus drainage

›Worsening pain

›New numbness or weakness

›Trouble moving fingers or joint

›Hand becoming pale, cold, or blue

›Bloodborne exposure follow-up when applicable

›Follow lab testing schedule provided

›Start nPEP immediately if prescribed and do not miss doses

12References/r17

Guidelines and key sources

›Evidence base

›Infectious Diseases Society of America practice guideline for skin and soft tissue infections including bite wounds

›Recommendation for agent active against aerobes and anaerobes such as amoxicillin clavulanate

›Guidance framework for bite wound infection management

›CDC clinical guidance for wound management to prevent tetanus

›Wound cleaning and debridement

›Antibiotics not recommended to prevent tetanus

›CDC HIV post-exposure prophylaxis clinical guidance

›Time-sensitive initiation framework

›Baseline testing and follow-up structure

Practical antimicrobial references

›Antimicrobial selection support

›Reference tables for bite wound antibiotics

›Outpatient oral regimen options

›Inpatient IV regimen options

›Eikenella susceptibility considerations

›Resistance patterns relevant to clindamycin and first generation cephalosporins

›Need for appropriate agent selection

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Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.