Dog bite

A dog bite always carries the risk of wound infection. Read more about dog bite: symptoms, diagnosis, therapy and prognosis!

Dog bite

On dog bite is an injury to humans or other animals that a dog has inflicted. Most are minor injuries (minor trauma). However, a dog bite always carries the risk of wound infection. Therefore, every bite wound should be treated as quickly as possible. Read all important information about the dog bite here.

Product Overview

dog bite

  • description

  • symptoms

  • Causes and risk factors

  • Disease course and prognosis

  • treatment

  • Dog bite: Disease course and prognosis

Dog Bite: description

In a dog bite, the rounded teeth and strong jaw of the animal can sometimes inflict serious tissue injury to the victim. Deep dog bites may reach to the bone and can damage nerves, muscles or tendons. According to Rueff et al. Bite injuries are divided into three degrees of severity.

  • Grade 1: Superficial skin damage, tear, scratch, soreness, bite canal
  • Grade 2: The wound extends to the muscle (fascia), musculature or cartilage
  • Grade 3: Dog Bite Causes Tissue Death (Necrosis) and Greater Tissue Damage (Substance Defect)

Dog bite: frequency

In Germany, there are about 30,000 to 50,000 bites every year. The dog bite accounts for about 60 to 80 percent. Children are more affected than adults. A dog bite on the face or neck (about ten to thirty percent) is particularly dangerous. These suffer with about 60 to 70 percent, especially children under five years. Lackmann divides the open dog bite wounds in the facial area in a total of five stages:

  • Stage I: superficial bite wound
  • Stage II: deeper injury with muscle damage
  • Stage III: deeper injury with muscle damage and substance defect
  • Stage IV A: additional nerve and / or vascular injuries
  • Stage IV B: Stage III plus bone damage

A dog bite in adults usually affects arms (especially the right hand) or legs (70 to 80 percent).

As a result of a dog bite it comes in an average of 15 percent of cases to a wound infection. In rare cases, this can also lead to death. According to the Federal Statistical Office, one to six people die each year as a result of a dog bite.

Dog bite: symptoms

In principle, a dog bite can affect any area of ​​the body. The dog's jaw squeezes the tissue together. There are scratches, cracks or lacerations. Abrasions only affect the superficial skin layer (epidermis).

In case of cracking or cracking, the defects can go deeper. In some cases, the skin separates from the underlying tissue (such as fatty tissue of the subcutis). Doctors speak of removal (décollement). More serious dog bites also hurt muscles, nerves, vessels or bones.

Dog bite: bleeding and muscle or nerve breakdown

The edges of the bite wound (s) are usually shredded. Patients feel a lot of pain. In addition, it bleeds from the dog bite. Under certain circumstances it comes to bleeding in a so-called muscle box (compartment), then the compartment syndrome develops. Patients also have severe pain here. In addition, the affected area is clearly swollen. As a result, but also by a dog bite directly, muscle weakness and nerve damage may develop (sensory disturbances).

Dog bite especially dangerous for infants

A dog can bite or tear whole body parts, especially ears or the nose. Infants are particularly vulnerable. Your skull bones are still soft and malleable, so that the dog can bite off about the whole head with strong shaking (decapitation). A dog bite on the neck can also lead to life-threatening bleeding. Severe bite marks on the neck, neck and face are most common in children under the age of four.

Dog bite infection

Other symptoms are caused by a dog bite infection by viruses or bacteria. First signs can appear after only 12 to 24 hours, but in some cases only after a few days. The inflamed wound area is red and warm. In addition, there is a swelling (edema). As a rule, pus comes out of an infected dog bite.

If the inflammation spreads to the surrounding tissue, doctors speak of a phlegmon. In some cases, pus builds up in the deeper layers of the skin (abscess), and the lymph nodes are swollen.

A dog bite on the hands can lead to a painful tendonitis (Tendosynovitis). If the dog bite infection spreads to neighboring joints, pus can accumulate in the joint space (joint empyema). In addition, in some cases, the entire joint (arthritis) inflamed.

Rarely does the infection spread or its pathogens spread to other organs. However, isolated dog bite cases led to one

  • Bone marrow inflammation (osteomyelitis)
  • Meningitis (meningitis)
  • Inflammation of the endocardium (endocarditis)
  • Pus accumulation in the liver, lungs or brain

Blood poisoning by dog ​​bite

It is particularly dangerous if the dog bite infection spreads to the entire body (bacterial toxemia, sepsis). Affected people feel very ill and often develop a high fever. Sepsis is a life threatening condition. It can lead to consciousness and coagulation disorders, organ failure and even cardiovascular shock.

Dog Bite: Causes and Risk Factors

Dogs cause about 60 to 80 percent of all bites. In about 90 percent of cases, one's own or at least one known dog bites.

Why a dog bites can have different reasons. Frequently, the dog bite is due to a fear reaction of the animal. For example, some dogs feel threatened by gazing, fast movements (such as approaches), or noise (such as screaming children). The dog bite is also a form of defense of territory, puppies and / or mum or master. This behavior may even be directed against new family members, such as a newborn.

Dog Bite by "Fighting Dogs"

Bad education and attitude can increase the strength of the dog. Some breeds of dogs have been selectively bred in the past for excessive aggressiveness, combat readiness, and sharpness. Depending on the state, different dog breeds are considered to be particularly dangerous. These include above all:

  • bullterrier
  • (American) Pit Bull Terrier
  • Staffordshire Bull Terrier
  • American Staffordshire Terrier

Dog bite by sick animals

However, not all dogs of these breeds are dangerous and always bite. Ultimately, the dog bite can also be the result of an illness of the animal. Pain-afflicted dogs are often particularly sensitive and may bite when (rough) touches. Diseases such as epilepsy or rabies can also lead to aggressive behavior, increasing the risk of dog bite.

Dog Bite Infection: How it arises

Five to 25 percent of dog bites get infected. In the process, pathogens such as bacteria colonize the wound area. They can spread from there to surrounding tissue or even throughout the body.

The risk of dog bite infection depends on several factors. Deep and / or dirty wounds are particularly vulnerable. Also injuries on hands, feet, face or genitals tend to the infection. The hands are at about 18 to 36 percent the highest risk of dog bite infection. An increased risk of infection also has heavily bitten tissue, especially if it is poorly supplied with blood.

Dog bite infection: Who is particularly at risk

Patients with a weak immune system develop more common dog bite infection than people with a healthy immune system. These include, in particular, patients with AIDS, chronic liver disease, diabetes, diabetes, malignancies (especially chemotherapy), artificial heart valves or distant spleen (asplenia). But also in people who take cortisone or other immunosuppressants, the body's defense is weakened.

Older people and children under the age of two also have an increased risk of dog bite infection.

Cat bites infect more often than dog bites

Compared to other bites, a dog bite is less risky. Here it comes increasingly to abrasions or Hautablederungen, which go only rarely into the depth.

Much more dangerous are bites from humans, monkeys or cats. This is partly due to special pathogens (especially monkey and human), on the other hand, the bite itself. For example, cat bites rich thanks to the long, thin teeth deeper into the tissue, similar to a puncture wound. For this reason, the risk of infection is 30 to 50 percent higher than that of a dog bite.

Pathogen of a dog bite infection

Inflammation of a bite injury is usually caused by bacteria. In about half of all dog bites, experts can detect two to five different pathogens in the bite wound. Some of these bacteria need oxygen to multiply (aerobic strains), some do not (anaerobic strains). Therefore, physicians also often speak of an aerobic-anaerobic mixed dog bite infection.

The higher the number of pathogens, the more serious the consequences are usually. In festering wounds are on average five bacterial strains, in non-festering only about two. On the other hand, larger accumulations of pus (abscesses) occur due to over seven proven pathogen species.

Typical dog bite infectious agents are mainly staphylococci, streptococci and Pasteurella. Other possible germs of a dog bite infection include Neisseria, Capnocytophaga canimorsus and the anaerobic fusobacteria, Bacteroides, Porphyromonas and Prevotella. In most cases, the bacteria come from the dog's mouth and less from the skin of the bitten or from the environment.

Dog bite infection: infestation of the whole body

After some dog bites, the germs affect the entire body. Doctors speak in this case of a systemic infection.These dangerous agents include leptospira, Clostridium tetani, rabies virus and Francisella tularensis.

Leptospira lead to the clinical picture of leptospirosis (mostly flu-like symptoms with a strong fever). The bacterium Clostridium tetani can cause a tetanus in the absence of vaccine - a disease that is often fatal. Heaviest brain damage with lethal outcome causes the rabies virus in humans. A dog bite infected with Francisella tularensis can lead to tularemia. This condition shows a variety of symptoms, such as diarrhea and severe abdominal pain in a case of intestinal involvement. About one third of all untreated Tularämien end fatally.

Dog Bite: Diagnosis and Examination

Many bitten people ask themselves the question: "dog bite, what to do?" Since the injury always carries the danger of a dog bite infection, you should definitely consult a doctor. In addition to specific questions and examinations, he can also check the vaccination status (for example with regard to tetanus). Slight bites can be supplied by the family doctor. Heavy or deep dog bites should, however, be treated by a surgeon or in a clinic.

Dog Bite: Anamnesis Talk

The collection of medical history (anamnesis) is crucial in a dog bite. It not only provides the doctor with information on the circumstances of the bite injury (time, place, affected area and causes of the dog bite). The medical history also indicates potential risk factors for dog bite infection.

In children, in addition to the parents or caregivers, the persons should also be present at the anamnesis interview, who have observed the dog bite. The doctor can ask the following questions:

  • Where and when were you (or your child) bitten?
  • Has the look of the wound changed since the dog bite? If yes how?
  • Do you experience pain, swelling or redness at the bite site? Does the dog bite wound fester?
  • Are pre-existing conditions such as the diabetes diabetes?
  • What medications do you or your child take (possibly supplements that suppress the immune system)?
  • Is there or was a fever?
  • Do you experience any other symptoms, such as numbness of the skin or movement disorders of the affected body part?

In addition, information about the animal that caused the dog bite is important. Therefore, give the contact details of the dog owner. Important questions that you should clarify are:

  • Which breed does the animal belong to? (especially important for dogs classified as dangerous)
  • What is the health of the animal?
  • Did the animal show conspicuously aggressive, biting behavior? Did the dog overly salivate or did he even have foam in front of his mouth?
  • Is the vaccination status of the animal complete?

Physical examination

After the detailed questioning follows the physical examination. First, the doctor examines the dog bite wound accurately and may take photographs. Thereby he documents the exact localization and extent of the bite wound. In addition, he pays attention to bleeding (vascular injury), contamination or foreign bodies (broken teeth or food remains).

Furthermore, the doctor looks for signs of inflammation (redness, swelling, pain, overheating, pus and oozing the bite wound). He also touches the surrounding lymph nodes to determine any enlargements.

In addition, the doctor examines the affected part of the body. For example, in the case of a dog bite on his arm, he checks the mobility in the wrist and elbow joint. He also checks the muscle power and reflexes as well as the feeling of the skin (sensitivity). In this way, the doctor can detect damage to muscles, tendons or nerves.

A markedly swollen limb that feels hard to the touch indicates a compartment syndrome and severe circulatory problems. This disease requires a quick treatment, which can initiate the doctor immediately (cooling, high camps, painkillers, possibly surgery).

Blood test for a dog bite

After a detailed examination of the bite wound, the doctor takes some blood samples. Their analysis helps to detect anemia or the first signs of an incipient infection. Thus, in a dog bite inflammation, for example, increasingly white blood cells (leukocytosis) can be found. Inflammation in the body is also indicated by C-reactive protein (CRP).

Smear of dog bite wounds

In addition, the doctor takes a smear from the bite wound or obtains samples of the wound secretion. He then sends these materials to a laboratory. There, the employees create a so-called bacteriological culture: on special nutrient media, potential pathogens propagate in a dog bite. This procedure is important to identify the triggers of a dog bite infection. So suitable medicines can be selected for the treatment.

imaging

If the doctor suspects that the dog bite has caused a fracture (fracture), he performs an x-ray examination. If the dog bite affects the face or skull, it also causes computer (CT) or magnetic resonance imaging (MRI).In these pictures, not only can he detect broken bones, but he can also detect possible damage or bleeding within the skull, for example.

Dog Bite: Treatment

Wash the dog bite wound carefully (water + soap solution) and then seek out a doctor - even with a small bite wound. Injuries can be more profound, especially with sharp dog teeth, than can be seen superficially. In addition, the risk of dog bite infection is not negligible. In addition, you should check your vaccine protection and if necessary have your doctor refreshed.

If you do not want to see a doctor for minor skin abrasions, clean the wound thoroughly and see if the bite injury changes. Warning signs include redness, overheating, swelling and increasing pain.

Dog Bite: That's what the surgeon does

Bite wounds usually supplies a specialist in surgery. Before examining and treating a dog bite wound, the doctor may administer painkillers and anesthetics in some cases, and especially in children. As a result, he keeps the affected part of the body calm and can examine the bite injury on the painless patient more closely.

First, it disinfects and cleans the wound and the surrounding skin area. He gently rinses deeper dog bites with antiseptic and / or saline solutions. In this way, it removes even deeper contaminants or foreign substances such as food residues. Possible accumulations of pus are emptied.

debridement

The surgeon then cuts away crushed, torn or dead (necrosis) tissue (debridement). This is especially good on the arms and legs, whereas the doctor in the face and skull area is very cautious. Location and extent of the dog bite influence the further treatment.

Closure of the dog bite wound by suture

If the dog bite does not return for more than twelve hours, the doctor closes the wound with a suture. If the time interval is greater or the dogs bite on the hands, the surgeon sutures the wound usually only after a few days, if the wound condition is unremarkable.

Injuries on the face are immediately closed. The doctor sews smaller bites. In case of major damage, transplants (such as those affected by the earlobe) may be used.

Several days old dog bite wounds on the face of the doctor closes immediately after thorough review and cleansing. In large wounds, the doctor may put a so-called drainage (for example, in a dog bite on joints). Wound secretions can be derived via this system.

Severed parts of the body, the doctor sews again (replantation).

Sterile dressing and immobilization

After the dog bite treatment the doctor connects the wound sterile. The affected body part should be as calm as possible in the following days. This is especially true for inflamed bites. In addition, the doctor checks the supplied dog bite regularly. In severe and infected injuries or signs of systemic dog bite infection, in-patient monitoring is necessary.

Extensive tissue damage may be treated by the doctor with special bandaging techniques, such as vacuum therapy (wound closure and drainage with a sponge and a special pump with suction), before he can completely close the bite wound.

antibiotics

The doctor prescribes antibiotics in a proven dog bite infection with bacteria. In addition, these drugs are used for deep and fresh bite injuries and dog bites in certain body regions (face, feet, hands, genitals, joint proximity). Patients with an increased risk of infection or implants such as a heart valve are given precautionary antibiotics for about three to five days. However, experts do not recommend general antibiotic precautions for all dog bite wounds. Even with an inconspicuous dog bite wound, which is older than a day, do doctors on antibiotics.

In the beginning, the doctor prescribes broad-spectrum antibiotics (calculated antibiotic therapy, such as aminopenicillin + beta-lactamase inhibitors) for dog bite infection. Meanwhile, a laboratory uses the wound swab (or blood cultures) to determine the exact pathogens (antibiogram). Thereafter, the doctor can select those antibiotics for the therapy that act specifically against the detected dog bite germs.

Tissue infections or abscesses require antibiotic intake of about one to two weeks. Patients with inflamed tendons should take the medication for about two to three weeks. Arthritis or bone marrow inflammation (osteomyelitis) after dog bite, the doctor treated with antibiotics for about a month.

vaccinations

After each dog bite, the doctor checks the vaccine protection of the person affected against tetanus and rabies. Patients should bring their vaccination pass for a doctor's visit.

Insufficient or insufficiently vaccinated dog bite patients (as well as patients with other wounds) recommend the Robert Koch Institute a tetanus immunoprophylaxis (precautionary vaccine).The type of vaccination the doctor performs depends on the vaccination status and wound condition. An active immunization is done with a dead toxoid vaccine (Tdap in combination with diphtheria): It stimulates the body to produce antibodies against the tetanus pathogen.

In passive vaccination, the patient receives ready tetanus antibodies (tetanus immunoglobulins, TIG) to support the body's defense system.

Number of previous vaccinations

Minor, clean wounds

All other wounds (polluted, large, infected,...)

Active vaccination

Passive vaccination

Active vaccination

Passive vaccination

unknown

Yes

No

Yes

Yes

1

2

Yes, if dog bite is older than 24 hours

≥ 3

Yes, if last refresh over five years ago

Yes, if last refresh over five years ago

Yes, if last refresh over ten years ago

In addition, dog bite victims should also be vaccinated as a precaution against rabies (post-exposure rabies immunoprophylaxis). The decisive factor is the type of animal contact:

Type of animal contact

Precautionary immunization

Touch, feed, lick on healthy skin

unnecessary

Bloodless scratches / abrasions, to be licked on irritated skin

active vaccination

Dog bite, bloody scratch marks, licked on sore skin or mucous membranes

active and passive immunization

In addition to dog bites and any contact with bats

If you (or your relatives) experience wound complications or entire body reactions (fever, diarrhea, neurological symptoms such as cramps, etc.) following a dog bite, you should immediately go to a hospital or contact the emergency physician. In particular, in life-threatening diseases such as tetanus is a rapid dog bite treatment with intensive monitoring mandatory.

Dog bite: Disease course and prognosis

Overall, dog bite injuries have a good prognosis. An early and correct treatment as well as a complete vaccination protection contribute decisively to this. Life-threatening consequences are rare. In 2007, a man in Germany became ill with rabies. He was bitten in Morocco by a stray dog. On average, fewer than 15 people have been infected with tetanus in recent years. And: dog bites are avoidable. The decisive factor is:

  • Proper holding of dogs including veterinary examinations and vaccinations
  • Proper handling of dogs including the responsible education and upbringing of children

Provide dog bite

There are a number of measures to avoid a dog bite. These include behaviors that do not irritate a dog unnecessarily. On the other hand, there are also some tips that can prevent a dog bite by an aggressive animal.

  • Do not leave child and dog alone! Even out of the game, the dog can suddenly feel the child as a threat and bite. Clarify your child about the correct and loving handling of dogs.
  • Pay attention to warning signals and teach them to children! Dog bite warnings are the animal's backsliding, tugging and flicking teeth, growling, burrowing ears, ruffled fur, erect or pinched tail.
  • Do not disturb the dog while eating or sleeping! If you take your food away from a feeding dog, he might bite. If you touch a sleeping dog suddenly (and roughly), you may also face a dog bite.
  • Especially mother animals with their puppies should be treated carefully.
  • Do not separate dogs running to each other.
  • Do not make loud noise! Dogs often hear noise like screaming loudly as a threat and are afraid. These situations can make it easier to get a dog bite.
  • Do not run to a stranger dog or past him! Hectic movements irritate some dogs, especially if you move quickly to the dog or press him. In addition, dogs like to hunt. So give the dog no reason for it.
  • Strange dogs should not be caressed without owner, harassed, touched from behind or somehow irritate! First ask the owner what you are allowed to do. Always let the dog take a sniff before stroking it.

If a foreign dog approaches without owner, follow these rules if you want to prevent a dog bite:

  • Keep calm and stay still!
  • Do not panic and do not scream!
  • Avoid staring at the dog!
  • Say "No!" In a deep voice (or "Go home!", Etc.)!
  • In the best case, stand sideways to the animal! Direct confrontation could irritate the animal to a dog bite.
  • Wait until the dog loses interest and goes away!

What to do at dog bite risk?

If you are attacked by a dog, try to bring a bag, coat or similar between yourself and the dog. Ideally, you can offer him an "alternative" bite object, such as a stick. If the dog has thrown you down, it is best to hit it. Protect your face and neck with your hands and arms in front of a dog's bite (for example, raise your arms, place hands on your neck and place your head between your elbows).

If the dog has bitten, follow the movements of the dog. Do not try to tear your arm away, for example. The dog bite could cause even more damage.

What can dog owners do?

In principle, every dog ​​can cause a dog bite. Holders of dogs should behave in a particularly responsible manner as a race considered to be dangerous. However, every dog ​​should be properly educated. If you do not trust the dog's training yourself, you can ask your veterinarian, at the shelter or in dog schools for advice.

If your own dog has bitten someone, dog owners should behave as follows:

  • Keep the dog immediately after the dog bite. Tie it tight!
  • Ask how the bitten is. If necessary, call the ambulance (for example in the case of severely bleeding wounds or injured children)!
  • Exchange name, address and phone number with the dog bite victim.
  • Inform the affected person or his doctor about the health and vaccination status of your dog.
  • Look for the dog bite on your vet. Clarify any suspicious behavior patterns of the animal!


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