Same dog bite and different outcome in two cases - case report.

Capnocytophaga canimorsus Sepsis Following a Minor Dog Bite to the Finger: Case Report

BACKGROUND Rabies is a viral disease producing an almost uniformly fatal encephalitis in humans and other mammals. There is no established treatment for rabies once symptoms have begun. Rabies vaccination for prevention and PET is essential in the management of the illness. The purpose of present study was to describe the clinical profile and management of dog bite patients presenting to the tertiary care hospital in the Kumaun region of Uttarakhand. METHODS Patients presenting to the outpatient and emergency department with the complaint of dog bite were enrolled in the study. All particulars of patients, history and examination findings were recorded in the clinical proforma after taking proper informed consent. Wounds were categorized based on WHO guide to postexposure prophylaxis. Local treatment consisted of two parts: first aid and wound management. ARV was administered in category II and III exposures in accordance to the intradermal schedule. Data was analysed for clinical information such as age, sex, socioeconomic status, dog type, site of bite, categories of contact and treatment given. RESULTS In our study of 73 patients, 36 (49.32%) were males and 37 (50.68%) were females. Majority of the patients belonged to the age group of 11-40 years in both male (n=29; 80.5%) and female (n=26; 70.3%) patients. Mean age group of patients in the study was 30.50 years. Based on modified Kuppuswamy scale, most patients belonged to the class III (n=42; 57.6%) followed by class IV (n=14; 19.2%). Dog bites from both strays and pets were almost equal. However, only 50% pet dogs were partially vaccinated and remainder were not vaccinated. Thus, mandating the use of ARV immunization. All the patients sustaining bites from street dogs were vaccinated. Majority of the bites involved the lower extremities (n=31; 42.5%) followed by upper extremities (n=26; 35.6%). Based on WHO guidelines for wound categories, most patients belonged to category II (n=36; 49.3%) followed by category III (n=31; 42.5%). CONCLUSIONS In our study, we found that majority of patients sustaining dog bites were young adults and belonged to lower middle & upper lower class. There was no difference with respect to gender and dog type. Most common sites of dog bite were upper & lower extremities and belonged to WHO category II. No cases of rabies were observed in our study. KEY WORDS Dog, Animal, Bite, Rabies, Immunization, Prophylaxis, Treatment

BACKGROUND Monkeys are responsible for 2-21% of all animal bite injuries. Monkey bites are second only to the dog bites as represented in India. Control of animal rabies is central to the prevention of human disease. Thus, prophylaxis (for domestic animals and selected humans) and PET remain essential to the prevention of clinical rabies. METHODS Patients presenting to the outpatient and emergency department with the complaint of monkey bite were enrolled in the study. All particulars of patients, history and examination findings were recorded in the clinical proforma after taking proper informed consent. Wounds were categorized based on WHO guide to postexposure prophylaxis. Local treatment consisted of two parts: first aid and wound management. ARV was administered in category II and III exposures in accordance to the intradermal schedule. Data was analysed for clinical information such as age, sex, socioeconomic status, timing & site of bite, categories of contact and treatment given. RESULTS In our study of 68 patients, 24 (35.3%) were males and 44 (64.7%) were females. Majority of the patients belonged to the age group of 11-40 years in both male (n=20; 83.33%) and female (n=34; 77.27%) patients. Mean age group of patients in the study was 28.29 years. This generally reflects the greater exposure of young adults to the monkeys. Based on modified Kuppuswamy scale, most patients belonged to the class III (n=36; 52.9%) followed by class IV (n=16; 23.5%). All the patients sustaining bites from monkeys were vaccinated. Majority of the bites involved the lower extremities (n=31; 45.6%) followed by upper extremities (n=27; 39.7%). Based on WHO guidelines for wound categories, most patients belonged to category II (n=49; 72.1%) followed by category III (n=19; 27.9%). CONCLUSIONS In our study, we found that majority of patients sustaining monkey bites were young adults and belonged to lower middle & upper lower class. There was no difference with respect to gender. Most common sites of monkey bite were upper & lower extremities and belonged to WHO category II. No cases of rabies were observed in our study. KEY WORDS Almora, Monkey, Simian, Animal, Bite, Rabies, Immunization, Prophylaxis, Treatment

Part I Methods and case study1. Methods and Aquaduct Case Study. Part II Structure Model 2. Entity and Attribute. 3. Relationship. 4. Multiple Relationship. 5. Generalisation. Aggregation and Rule. 6....

ABSTRACTIntroduction: Rabies continues to be one of the most important viral diseases and remains a significant threat to public health across the globe. The World Health Organization (WHO) has determined that most rabies cases occur in children. Dog bites on humans are a major public-health problem. Poland has not achieved rabies free status yet. Post-exposure prophylaxis (PEP) in humans can effectively prevent death after exposure to a potentially infected animal.The aim: The main objective of this study was to estimate the frequency of PEP among children exposed to animals, who had attended consultations at the Department of Infectious Diseases for Children in the Jan Boży Hospital in Lublin.Patients and methods: We retrospectively analyzed the medical records from the period of 2010–2016 of all pediatric patients (0–17 years of age) who had been exposed to animals and attended consultations at the Department of Infectious Diseases for Children in the Jan Boży Hospital in Lublin.Results: During the studied period, 519 children who had been exposed to animals attended consultations, and a prophylactic procedure consisting of active immunization was applied to 32.8%. The male children accounted for 55.3%. The mean age was 9.2 years. The biggest group of children (406) had been exposed to dogs, 62 children to cats, and 15 to rats. Most children had upper-limbs injuries. During the studied period, i.e. 2010–2016, there were 1713 confirmed cases of rabid animals in Poland, and 60 cases were recorded in the Lublin Province. We did not observe any cases of rabies in our exposed and vaccinated patients.Conclusions: The number of rabid animals in the Lublin Province had decreased to low levels, but the expected decrease in the number of PEP's administered did not occur. Since all children were vaccinated in accordance with the recommendations, the possible reason for vaccination's being administered in the quantities greater than the number of rabid animals recorded in the Lublin Province are bites by animals unavailable for veterinary observations and also the lack of more frequent reports regarding the current epizootic situation of rabies. The use of rabies immunoglobulin (RIG) in children in the Lublin Province is at a very low level, i.e. at 0.58%. The yearly numbers of exposed pediatric patients were at similar levels, which indicates that education programs should be introduce to reduce the number of animal bites in children.

The prompt administration of post-exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. A delay in seeking the first dose of rabies PEP, or failure to complete the recommended dosage, may result in clinical rabies and death. We assessed the efficacy of short message system (SMS) phone texts in improving the adherence to scheduled PEP doses among bite patients in rural eastern Kenya. We conducted a single-arm, before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital between October and December 2018 (control) and between January and March 2019 (intervention). Data on their demographics, socio-economic status, circumstances surrounding the bite, and expenditures related to the bite were collected. A total of 186 bite patients were enrolled, with 82 (44%) in the intervention group, and 104 (56%) in the control group. The odds of PEP completion were three times (OR 3.37, 95% CI 1.28, 10.20) more likely among patients who received the SMS reminder, compared to the control. The intervention group had better compliance on the scheduled doses 2 to 5, with a mean deviation of 0.18 days compared to 0.79 days for the control group (p = 0.004). The main reasons for non-compliance included lack of funds (30%), and forgetfulness (23%) on days for follow-up treatment, among others. Nearly all (96%, n = 179) the bite patients incurred indirect transport costs, at an average of USD 4 (USD 0-45) per visit. This study suggests that the integration of SMS reminders into healthcare service delivery increases compliance with PEP, and may strengthen rabies control and elimination strategies.

Background: Until April 2023, it has been documented about 31,113 cases of animal rabies-borne bites, of which 23,211 cases were given Post Exposure Prophylaxis (PEP) Anti Rabies Vaccine and 11 death cases in Indonesia, and 95% of them were caused by dog bite. This case report was conducted to describe a rare case of an 8-year-old child presenting with the late complication of encephalitis in Borong General Hospital due to the delayed case finding, management, and proper prophylaxis for Rabies infection. Case Presentation: One day before admission, an 8-year-old girl with irritability, aggressive behavior, and severe speech abnormalities was reported to the emergency room. These symptoms quickly escalated to confusion and disturbed mental status. One month before to presentation, the patient's parents stated that his right arm had been bitten by a stray dog. Because there were no obvious bite marks and the family was not aware of the dog bite, PEP was not requested. In the previous five days, her parents described experiences of hydrophobia, photophobia, and aerophobia. The patient's health deteriorated two hours after admission, and palpating the carotid artery revealed that there was no pulse. Despite performing cardiopulmonary resuscitation, ROSC was not reached. Conclusion: Animal rabies control and surveillance are essential, particularly in locations where the disease is endemic. PEP is extremely effective and ought to be given as soon as possible following exposure to reduce the high fatality rate.

Introduction. A significant number of nosologies can result in long-term non-healing wounds that mostly have similar principles of local treatment. However, positive clinical outcomes are not always obtained in the management of such wounds. The authors have developed a personalized technology for local treatment of chronic wounds depending on their etiology. Aim. Was to investigate the effectiveness of the proposed methods and personalized approaches for local treatment of long-term nonhealing wounds. Materials and methods. Innovative methods of cleaning and stimulating regeneration of non-healing wounds have been developed in the study; their effectiveness was tested in 3 blocks of the study. The first block of the study included patients with long-term non-healing wounds of venous etiology, the second and third blocks included patients with long-term non-healing arterial and neurotrophic wounds, respectively. Each block involved two series of tests studying the developed methods of cryodestruction and stimulation of regeneration, respectively. In the 1st block, the 3rd series of tests was additionally conducted; it included patients with wounds larger than 20 cm2 in size. Results. The developed methods of cryodestruction accelerate the course of phase I of the wound process by 12% in patients with longterm non-healing wounds of venous etiology, by 27% in patients with critical ischemia of the lower extremities, by 70% in patients with neurotrophic etiology (p ≥ 0.05). The use of the proposed methods of stimulating regeneration significantly reduced the average area of wounds in the study blocks. The main components of treatment stimulating regeneration in long-term non-healing wounds have been identified considering wound etiology. Conclusion. The use of the developed algorithm for local personalized treatment of long-term non-healing wounds considering underlying disorders contributes to an earlier cleaning of the wound surface, elimination of inflammation and an increased activity of regeneration processes when compared with conventional approaches.

BackgroundAdhering to post-exposure prophylaxis (PEP): wound treatment, vaccine, and rabies immunoglobulin (RIG) is a crucial step in preventing rabies mortality. When PEP is widely available, a lack of adherence to the recommended treatment guidelines can also lead to death. Our objective was to understand characteristics associated with adherence to the vaccine regimen and RIG in Vietnam. MethodsWe obtained individual-level data on PEP adherence from registries at 10 sites located in five provinces. From these registries, we extracted epidemiologic characteristics of patients including the timing of PEP initiation and completion. We used descriptive analyses and logistic regression to examine patient characteristics associated with initiation and completion of RIG and vaccine. Based on reported rabies mortality, the government defined provincial rabies burden as medium-burden (<5 and >2 deaths) and high-burden (≥5 deaths). ResultsDuring 2014–2016, 15,646 patients received PEP in our study. Among 14,296 vaccinated patients, only 41.4% (5847) completed their five-dose intramuscular (IM) injections and 81.6% (133) of patients completed their eight-dose intradermal (ID) injections. Approximately 26% of patients received RIG. Patient characteristics associated with vaccine completion were females (44%), <15 years of age (44%), category 1 exposure (68%, bite location on leg (46%), bite from bat (56%), bite from a healthy animal (45%), high-burden province (86%), and district preventive center (49%). Disparities were revealed among provinces, with high-burden provinces having highest (86%) and lowest (7%) vaccine completion rates. Conclusions and relevanceVietnam has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control.

Rabies is a lethal encephalitis caused by a lyssavirus and transmitted from animals to humans via bite wound, scratch wound, or licking of mucous membranes. It is preventable by timely administration of post-exposure prophylaxis (PEP) consisting of four or five doses of rabies vaccine combined, in the most severe cases of exposures, with anti-rabies immunoglobulin (RIG). Although the rabies incidence in humans remains low, rabies is still present in some European countries. Moreover, rabid animals imported from enzootic areas are reported every year in rabies-free areas. These importations threaten the rabies-free status of terrestrial animals in western European countries and challenge the public health surveillance system and the health structures responsible for rabies prophylaxis and control. The importations frequently result in the prescription of a large number of PEP including RIG, especially in western European countries. The situation is inverted in some central and eastern European countries where RIG is underprescribed. Only a limited number of rabies vaccines and particularly of RIG are licensed for use in Europe. Their availability is also limited, a situation that may become worse in the future. It therefore seems important to study the possibility of comparing and unifying national PEP guidelines in Europe, if needed, and to generate effective solutions in the event of a shortage of anti-rabies biological products and RIG in particular, such as rationing these products.

Rising global dog ownership increases the risk of rabies, a viral disease with an almost 100% fatality rate. Current post-exposure prophylaxis (PEP) methods involving injections of human rabies immunoglobulin (HRIG) are invasive and painful, resulting in reduced compliance. Furthermore, delays associated with traditional methods can undermine their effectiveness during emergencies, highlighting the need for more efficient alternatives. This study explored microneedle (MN) patches as a less painful and more patient-friendly method for delivering HRIG. We developed a bilayer MN patch composed of a hyaluronic acid (HA) tip containing HRIG and a polyvinylpyrrolidone (PVP) base incorporating tazarotene (TA). The tip dissolved within two minutes, releasing effective doses of HRIG, while the base released TA to promote wound healing. The patch can be stored in blister packaging, maintaining stability without the need for cold-chain storage. Characterization confirmed the patch's biocompatibility and its ability to enhance cell migration in vitro. In vivo testing using a rabies-infected mouse model demonstrated effective prevention of rabies and improved tissue repair following patch application. The patch's portability, stability, and efficacy make it ideal for emergency scenarios, offering reduced discomfort compared to traditional methods. This approach also broadens the potential applications of microneedles in emergency care and vaccination.

Snake bite remains major public health problem worldwide. We present our experience with cases of snake bites managed in our tertiary care teaching center of South India. The details of all patients with snake bite admitted to a tertiary teaching care hospital from 2010 to 2012 were retrospectively retrieved and reviewed. The details regarding age, gender, first aid received or not, time elapsed between the bite, emergency care management and ASV (Anti Snake Venom) administration, site of snake bite, clinical features at the time of presentation, local examination findings at the site of bite, duration of hospital stay, need for elective ventilation, details of investigations and outcome were reviewed. The data were analyzed in PSPP software (Free Software Foundation, Inc.) for window for statistical analysis, while standard deviation (SD) was applied for the continuous variables, and proportions were applied for the categorical variables. Mean age was 38.4 ± 14.8 years (range 4-70 years). Majority [72 (82.8%)] were farmers. In 86.2% patients, the site of bite was in lower limbs. Snake could be identified in only 20 cases [Cobra-12 (60%), Krait-2 (10%), and Viper-6 (30%)]. Mean time to reach to hospital was 12.1 ± 21.4 hours (range 1-120 hours). Mean anti-venom therapy duration was 3.2 ± 2.0 days (range 1-14 days). Mean hospital stay was 4.7 ± 3.1 days (range 1-15 days). Majority (72.4%) made good recovery; mortality was in 4.6% cases, and 20 (23%) patients left against medical advice. This study identified major epidemiological and management variables related to snake bite. There is a need for a well-planned data collection and information dissemination system to avoid this potentially preventable disease.

Rabies postexposure prophylaxis in international travellers: Results from a Spanish travellers referral unit

Disappointing results from HIV vaccine and microbicide trials (AIDS Clin Care Aug 4 2008 and Jul 30 2008) have led to increasing interest in other potential prevention strategies, such as the use of antiretroviral agents as preexposure prophylaxis (PrEP) or postexposure prophylaxis (PEP). Neither strategy is anticipated to be 100% effective, and, when PEP or PrEP fails, little is known about the course of subsequent HIV infection. In this case report, investigators describe a young man who seroconverted after multiple serial …

Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of &lt;0.05. A total of 338 dog bite cases were captured in the World Veterinary Service (WVS) application, and most cases (n = 226, 85.6%) were reported in December 2019 with a male-to-female ratio of 2:1. Most cases were reported from the age group of 22 to 31 years (n = 178, 53%). Out of the total number of cases, 263 (78%) presented with a single anatomical location, and 174 (51%) had Category II wounds. All dog bite patients were given only the first dose of the anti-rabies vaccine at the hospital level. Real-time dog bite surveillance via a mobile-based application proved to be effective for the timely recording and management of dog bite cases. Young people were reported to be mostly affected by dog bites, and nearly half of the cases were managed in hospitals. Refresher training was conducted for medics and paramedics for mobile-based applications, dog bite management, and proper referral of cases to tertiary care hospitals.