Management of necrotizing fasciitis due to a human bite: case report
DOI:
https://doi.org/10.18203/2349-2902.isj20241744Keywords:
Necrotizing fasciitis, Human bite, Case report, Skin graft, DebridementAbstract
Human bites, often underestimated, present significant risks of infection, with necrotizing soft tissue infections (NSTIs) posing a severe threat due to their rapid progression. We present a case of a 72-year-old diabetic male with a human bite on his forearm, leading to NSTI. Despite initially superficial symptoms, including fever and localized pain, the condition rapidly deteriorated, necessitating surgical intervention. The patient underwent multiple debridement procedures and antibiotic therapy, resulting in wound healing. Human bites predominantly affect young males and can occur in various anatomical regions. Microbial flora in the oral cavity increases infection risk, with diabetic individuals being particularly vulnerable due to compromised immunity and delayed wound healing. Prompt diagnosis, antibiotic therapy, and surgical intervention are crucial in managing NSTIs, emphasizing the importance of early medical attention and vigilance in human bite injuries to prevent adverse outcomes like sepsis and mortality.
Metrics
References
Stevens MR, Emam HA, Cunningham L. Chapter 23 - Management of Human and Animal Bites. In: Fonseca RJ, Walker RV, Barber HD, Powers MP, Frost DE, editors. Oral and Maxillofacial Trauma (Fourth Edition). St. Louis: W.B. Saunders. 2013: 615-632.
Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Braz J Infect Dis. 2014;18(2):137-43.
Brook I. Management of human and animal cock wounds: an overview. Adv Skin Wound Care. 2005;18:197-203.
Freeman AJ, Senn DR, Arendt DM. Seven hundred seventy eight bite marks: analysis by anatomic location, victim and biter demographics, type of crime, and legal disposition. J Forensic Sci. 2005;50(6):1436-43.
Merchant RC, Zabbo CP, Mayer KH, Becker BM. Factors associated with delay to emergency department presentation, antibiotic usage and admission for human bite injuries. Can J Emerg Med. 2007;9:441-8.
Kennedy SA, Stoll LE, Lauder AS. Human and Other Mammalian Bite Injuries of the Hand: Evaluation and Management. J Am Acad Orthop Surg. 2015;23(1):47-57.
Patzakis MJ, Wilkins J, Bassett RL. Surgical findings in clenched-fist injuries. Clin Orthop Relat Res. 1987;220:237-40.
Dewhirst FE, Chen T, Izard J. The human oral microbiome. J Bacteriol. 2010;192(19):5002-17.
Talan DA, Abrahamian FM, Moran GJ, Citron DM, Tan JO, Goldstein EJC, et al. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis Off Publ Infect Dis Soc Am. 2003;37(11):1481-9.
Merriam CV, Fernandez HT, Citron DM, Tyrrell KL, Warren YA, Goldstein EJ. Bacteriology of human bite wound infections. Anaerobe. 2003;9(2):83-6.
Talan DA, Abrahamian FM, Moran GJ, Citron DM, Tan JO, Goldstein EJ, et al. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis. 2003;37(11):1481-9.
Smith DK, Grohskopf LA, Black RJ. U.S. Department of Health and Human Services: Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep. 2005;54(RR-2):1-20.
Lohiya GS, Tan-Figueroa L, Lohiya S, Lohiya S. Human bites: Bloodborne pathogen risk and postexposure follow-up algorithm. J Natl Med Assoc. 2013;105(1):92-5.
Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(1):13-5.
Oehler RL, Velez AP, Mizrachi M, Lamarche J, Gompf S. Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis. 2009;9(7):439-47.
Goldstein EJC, Citron DM, Merriam CV, Warren YA, Tyrrell K, Fernandez H. Comparative in vitro activity of ertapenem and 11 other antimicrobial agents against aerobic and anaerobic pathogens isolated from skin and soft tissue animal and human bite wound infections. Antimicrob Chemother. 2001;48:641-51.
Goldstein EJC, Citron DM, Merriam CV, Warren YA, Tyrrell KL, Fernandez H. In vitro activity of the des-fluoro(6)quinolone BMS-284756 against aerobic and anaerobic pathogens isolated from skin and soft tissue animal and human bite wound infections. Antimicrob Agents Chemother. 2002;46:866-70.
Puvanendran R, Huey JC, Pasupathy S. Necrotizing fasciitis. Can Fam Physician. 2009;55(10):981-7.
Tsang CLN, Cao J, Gunanayagam P, Feitosa R, Bullen A. Necrotizing Soft Tissue Infections in the Vasculopathic Patient: Review of Literature. Int Surg. 2019;104(1–2):75-88.
Giaccari A, Sorice G, Muscogiuri G. Glucose toxicity: the leading actor in the pathogenesis and clinical history of type 2 diabetes - mechanisms and potentials for treatment. Nutr Metab Cardiovasc Dis. 2009;19(5):365-77.
Gürlek A, Fırat C, Öztürk AE, Alaybeyoğlu N, Fariz A, Aslan S. Management of necrotizing fasciitis in diabetic patients. J Diabetes Complications. 2007;21(4):265-71.
Downloads
Published
How to Cite
Issue
Section
