Cat Bite

Casebank History
1

Who are you:
FY2 in GP

Who the patient is:
16 year old boy came with cat bite. Has taken 12 doses of tetanus vaccine, and last dose was taken 12 months back.

Data Gathering

  • When did the cat bite you?
  • How did it happen?
  • Was it a domestic or wild cat?
  • Did the cat look healthy or did it have any unusual symptoms?
  • Was the attack provoked?
  • Did you bleed a lot?
  • Where did it bite you?
  • What first aid did he do?
  • Vaccination Hx of tetanus mobility ofithe hand
  • Systemic review
  • Fever, nausea, vomiting
  • Enlargement of any gland, in the armpit or neck?
  • Headache? Muscle pain?
  • PMAFTOSA
  • ICE
  • Effects of Symptoms
  • Examination of hand and glands- picture given.

Management

  • Diagnosis: Animal bite
  • If presentation is > 6 hours - Risk of infection.
  • Offer analgesic (Paracetamol, ibuprofen)
  • Clean the wound.
  • Prescribe prophylactic oral antibiotics (Co- Amoxiclav for the 3days)
  • Safety Netting; Any pus, fever, severe swelling, then you need to come back.
  • Leaflet for Animal bite
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About

  • Serious complication occur only in 30% of patients with infected wounds
  • CAT SCRATCH DISEASE: Can follow a bite or scratch
  • Caused by Bartonella henselae
  • Typically presents with erythematous papule ( 3-10 days after injury), regional lymphadenopathy, and prolonged non-specific systemic symptoms, such as fever, headache and fatigue.
  • Generally, the condition is mild and resolves within 2 months- however sometimes it may complicated pneumonia, encephalitis or hepatitis or rarely ocular complication.

Management

  • Clean the wound with running water and soap
  • Disinfect the wound with alcohol or Povidone-Iodine
  • Squeeze the wound so that it bleeds slightly- unless already bleeding.
  • Remove any foreign objects such as hair, teeth or dirt.
  • Any penetrating injury should be explored. Wound excision, irrigation and delayed closure may all be necessary.
  • Treatment with antibiotics is necessary.
  • Radiography for foreign body if needed.
  • Tetanus prophylaxis should be given if booster was not within last 10 years.
  • Nice recommendation for antibiotics prescription for cat bite. Antibiotics prophylaxis is not needed if a cat bite has not broken the skin.
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