Cat Bite & Cat Scratch Disease - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

Cat Bite & Cat Scratch Disease - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the conditions of cat bite and cat scratch fever. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Find me on Instagram @OrthoInitiative Both cat bite and cat scratch disease are caused by cats, but they are two different entities. Cat bites will cause infection in about 30% - 50% of cases. Dog bites will cause infection in about 2% - 5% of cases. There are more dog bites than cat bites, or even human bites. Females are bitten more by cats. Males are bitten more by dogs. Animal bites are common in children. Cat and dog bites usually affect the upper extremity more than the lower extremity. There is always a delayed presentation. Usually the injury and the care is underestimated. Dog bites usually cause structural damage. CAT BITES Higher rate of infection more than dog bites. The cat has small, sharp (needle like) teeth that can puncture and cause deep wounds that can penetrate the bones, the joints and the tendon sheath, especially the flexor tendon sheath. The puncture wounds sometimes seal up immediately, becoming unnoticed or under-estimated (not obvious). It can cause septic arthritis, tenosynovitis, and can also cause osteomylitis. It may take longer to initiate the treatment in cat bites. What causes infection in cat bites? • Delayed treatment for more than 12 hours. • Older age. • Puncture wound. • Host conditions such as: Diabetes. Immunosuppressed patients. The most common bacteria isolated from cat bites is Pasturella and the culture takes about one week to grow. The infection in cat bites is usually polymicrobial with more than one anaerobe. Common Bacteria In Cat Bites • Pasturella • Streptococci • Staphylococci • Moraxiella • Corynebacterium Pasturella is present in about 80% of cat bites. Pasturella causes severe pain and swelling in 48 hours. TREATMENT • If the patient is seen early: Do irrigation in the emergency room if needed. Give tetanus toxoid vaccine. Splint. Give antibiotics. Do local wound care and observation. If the treatment is delayed, the patient may have infection such as an abscess, septic arthritis, tenosynovitis, or osteomyelitis. The patient will need surgery for incision, drainage and cleaning the wound. Give antibiotics in cat bites, especially in injury to the hand, to the face or if the injury is severe or deep down to the bone. Give the antibiotics for 3 - 5 days. Augmentin is the antibiotic that is commonly used for cat bites. All cat bites should be covered with Augmentin regardless of the wound size. In cat bites, 50% of the patients will need surgery. CAT SCRATCH DISEASE Sometimes it is called cat scratch fever. It is an infection that is transmitted by a cat's scratch. The lesion is small (less than 1 cm). It is normally a benign, self-limiting illness lasting for about 6 - 12 weeks. It is caused by exposure to Bartonella Henselae bacteria. Timeline of events leading to cat scratch disease: Begins with a scratch - Within one week, there is development of a skin lesion in about 50% of patients –Noticeably enlarged lymph nodes within the first two weeks. Swollen lymph nodes with no other etiology and a scratch from being in contact with a cat could suggest the presence of a cat scratch disease! The physician should check for elevated sedimentation rate and CRP. A positive skin test for cat scratch disease is important for establishing the diagnosis. SYMPTOMS The patient may have swollen or draining lymph nodes. Fever. Fatigue. Headache. Swollen, tender, or hard lymph nodes could be confused with a soft tissue tumor. Regional lymphadenopathy is a main clinical feature. It is a pseudotumor and it should be considered in the differential diagnosis of soft tissue lesions! These areas of lymph node concentration includes: Cervical lymph nodes Axillary lymph nodes Cubital lymph nodes around the elbow (epitrochlear lymph nodes) Inguinal lymph nodes around the hip Symptoms are self – limiting and can vary from mild to severe, lasting for several weeks. TREATMENT Antibiotics Doxycycline. Cipro. Azithromycin. No biopsy is necessary! Biopsy will show lymphoid tissue and necrotizing granulomas.