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Category: Nelson’s Textbook of Pediatrics

Marine Envenomation The most commonly encountered venomous marine creatures are the jellyfish (Cnidaria), stingrays (Chondricthyes), and members of the family Scorpaenidae—the lionfish, scorpionfish, and stonefish. Although most injuries occur when a child ventures into the animal’s natural environment, lionfish (Pterois spp.) are commonly kept in private aquariums and children may be stung if they attempt […]

Bibliography Auerbach PS: Envenomation by aquatic invertebrates.   In: Auerbach PS, ed. Wilderness medicine,  ed 5. St Louis: Mosby; 2007:1691-1729. Auerbach PS: Envenomation by aquatic vertebrates.   In: Auerbach PS, ed. Wilderness medicine,  ed 5. St Louis: Mosby; 2007:1730-1749. Bawaskar HS, Bawaskar PM: Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial.  BMJ  2010; 341:c7136. Boyer LV, Theodorou AA, Berg RA, et al: Antivenom for critically ill children with neurotoxicity from scorpion stings.  N Engl J […]

Chapter 706 – Envenomations Bill J. Schroeder,Robert L. Norris Few experiences are more frightening for patients than being bitten or stung by a venomous animal or insect. Most bites and stings by spiders, snakes, scorpions, and other venomous animals cause little more than local pain and do not require medical attention. There are thousands of species of potentially harmful […]

Snake Bites Most snake bites are inflicted by nonvenomous species and are of no more consequence than a potentially contaminated puncture wound (Fig. 706-1). Venomous snakes, however, kill many tens of thousands of people in the world each year. The precise number is difficult to ascertain, because the toll in human suffering is far greatest […]

Spider Bites More than 20,000 venomous spiders have been identified, but most lack either potent venom or fangs long enough to penetrate human skin, and are therefore of no medical significance. No spiders can be considered truly deadly, meaning that an untreated bite in a human would be expected to cause death. The spiders of […]

Scorpion Stings Of the more than 1,200 species of scorpions worldwide, only a few cause more than a painful sting. In the USA, there is one medically significant scorpion, the bark scorpion (Centruroides sculpturatus [formerly Centruroides exilicauda]). Though this scorpion has caused death in children in the past, such an outcome is exceedingly rare. It […]

Bibliography Benson L, Edwards S, Schiff A, et al: Dog and cat bites to the hand: treatment and cost assessment, J Hand Surg 31:468–473, 2006. Broder J, Jerrard D, Olshaker J, et al: Low risk of infection in selected human bites treated without antibiotics, Am J Emerg Med 22:10–12, 2004. Centers for Disease Control and […]

705.1 Rat Bite Fever Charles M. Ginsburg Etiology Rat bite fever is a generic term that has been applied to at least two distinct clinical syndromes, each caused by a different microbial agent. Rat bite fever due to Streptobacillus moniliformis is most commonly reported in the USA as well as Brazil, Canada, Mexico, Paraguay, Great Britain, and […]

705.2 Monkeypox Charles M. Ginsburg Etiology Monkeypox virus, causing the disease monkeypox, is the most important member for humans of the genus Orthopoxvirus since the eradication of smallpox, caused by variola virus. The disease was first described in monkeys in a zoo in Denmark more than a half century ago. Monkeys are the predominant host for the […]

Diagnosis Management of the bite victim should begin with a thorough history and physical examination. Careful attention should be paid to the circumstances surrounding the bite (e.g., type of animal [domestic or sylvatic], whether the attack was provoked or unprovoked, location of the attack); a history of drug allergies; and the immunization status of the […]

Complications Infection is the most common complication of bite injuries, regardless of the species of biting animal. The decision to obtain material for culture from a wound depends on the species of the biting animal, the length of time that has elapsed since the injury, the depth of the wound, the presence of foreign material […]

Treatment (Table 705-3) After the appropriate material has been obtained for culture, the wound should be anesthetized, cleaned, and vigorously irrigated with copious amounts of normal saline. Irrigation with antibiotic-containing solutions provides no advantage over irrigation with saline alone and may cause local irritation of the tissues. Puncture wounds should be thoroughly cleansed and gently […]

Prevention It is possible to reduce the risk of injury with anticipatory guidance. Parents should be routinely counseled during prenatal visits and routine health maintenance examinations about the risks of having potentially biting pets in the household. All patients should be cautioned against harboring exotic animals for pets. Additionally, parents should be made aware of […]

Chapter 705 – Animal and Human Bites Charles M. Ginsburg Besides dogs and cats, many animals inflict bites, including large cats (tigers, lions, leopards) wild dogs, hyenas, wolves, crocodiles, and other reptiles. The profile of bites varies by country and region. Among an estimated 3-6 million animal bites per year in the USA, approximately 80-90% are from dogs, 5-15% […]

Clinical Manifestations Dog bite–related injuries can be divided into three, almost equal categories: abrasions, puncture wounds, and lacerations with or without an associated avulsion of tissue. Dog bites may be crush injuries. The most common type of injury from cat and rat bites is a puncture wound. Cat bites often penetrate to deep tissue. Human […]

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