Dog Bite Complications

Dogs are “man’s best friend,” but those dogs aren’t always friendly to strangers.  85-90% of reported animal bites in the United States are from dogs.  According to CDC (Center for Disease Control) data, dog bite complications are the leading causes of nonfatal emergency department visits for the 5-9-year-old age group, in the United States in 2018, is unintentional dog bites. Dog bites rank at #9 with 31,552 cases for 2018 in this young population. This number only covers this specific age group, and there are countless more cases where an injury originated from a canine attack. Most often, these incidents affect innocent children, as they have little fear and hesitation. Potential obvious injuries include lacerations, avulsions, and bleeding stemming from the initial injury. Unfortunately, there may be complications that arise later that cause further trauma to the body.

Infection and dog bite complications can affect the skin, muscles, and bones. If an infection is extensive, it can reach the bloodstream and cause a condition called sepsis. If the infection is not detected in time and treated quickly, the victim may end up in the ICU as bacteria spreads throughout the body.

Signs of infection of a wound include:

• Pain and tenderness at site: Any initial break in the skin will hurt, but further pain that increases 24 hours after injury may indicate infection.
• Increased redness and warmth around site: It is important to notice the initial swelling and redness around a dog bite. If the redness and swelling begins to grow further away from the wound, a re-evaluation of the injury may be needed. The redness, from the infection, may grow in an even circle around the bite wound, or it may appear as red streaks away from the injury.
• Drainage with a white, or puss-like, appearance is a noticeable sign that the wound is not healing properly. Infected wounds tend to have increased drainage and sometimes a foul odor.
• As an infection worsens, the pain tends to increase. When the infection starts to affect the body as a system, an injured person may experience fever. The body may respond with a fast heart beat and low blood pressure (presenting in lightheadedness or fainting). Consult a doctor if these signs get worse. Intravenous fluids and antibiotics may be necessary for healing.

Expected Care

When presenting a dog bite complication to an emergency room or urgent care, any open wound, from a dog bite, should be swabbed and sent for a culture, to determine if a specific bacteria is involved that may cause an infection.  The wound should be thoroughly cleaned and covered, in an appropriate dressing, and kept clean and dry. The healthcare provider may order a tetanus shot and a broad-spectrum antibiotic, to cover many common bacteria that can easily be killed by a common antibiotic. The culture will result after a few days, and the provider can determine if the injured person needs a more a specific antibiotic that matches the drug that will kill the alleged bacteria. If the wound requires stitches, the injured person should be evaluated by the medical provider quickly, as the best practice for closing the wound is less than 24hours for a laceration to the face, and less than 12 hours for other areas of the body. Other areas of the body may be opted out for closure, to decrease the risk for infection and promote healing from the bottom of the wound toward the surface.

Dog Bite Complications:

• Pasteurella infection: This infection can come from a dog bite or lick. This family of bacteria can be found in the oral cavity and respiratory tract of dogs (and other animals). This infection can present in any of the following ways:

inflammation of the skin; arthritis; sepsis (blood infection); infection in the bone; meningitis; respiratory infection; abdominal infection; endocarditis; eye infection; necrotizing fasciitis; fetal death in pregnant infected woman; inflammation of the thyroid; urinary tract infection; and infection of surgical grafts.

• Capnocytophaga: This infection is rare but severe when spread to humans. The majority of those who contract this infection have experienced a dog bite, but a few may contract it from a scratch from, or exposure to, a dog (or cat). This infection is from a group of different bacteria that live in the oral cavity of the mouth of a human, dog, or cat. This infection can present in any of the following ways:

skin infection; fever; pneumonia; endocarditis; arthritis; gall bladder inflammation; severe sepsis (fever; disseminated purpuric lesions, as pictured below; low blood pressure; kidney insufficiency or failure; change in mental status; blood clotting abnormalities; ); and meningitis (with potential hearing loss).

(Disseminated Purpuric Lesions)

• MRSA: Methicillin-resistant staphylococcus aureus is a bacteria that is found on the skin and in the nose of humans. When this bacteria is introduced into the skin, or the blood stream, it may be very difficult to treat as it has built a resistance to antibiotics. When a person is bitten by a dog, the puncture can introduce the bacteria under the skin and produce problems such as cellulitis (infection and inflammation in a certain area of the skin) or develop into sepsis if spread to the bloodstream (which may affect multiple organs).
• Rabies: Rabies is caused by a virus, as opposed to the previously noted bacterial infections. Rabies is transmitted through the saliva in an animal bite (in this case dog bite). Rabies in humans is not common in the United States, but these infections happen occasionally. It is important to be treated early with the vaccination if potentially exposed. The period between exposure and symptoms can be days to years if untreated. Once symptoms appear, they are quite vague and can include fever, chills, body aches, fatigue, decreased appetite, sore throat, nausea, vomiting, headache, and light sensitivity. After a few days or a week of these symptoms, the complications become much more dramatic including abnormal sensations (tingling, numbness, itching, and burning), encephalopathy, paralysis (unable to move or breathe), abnormal movements, seizures, throat spasms, sweating, drooling, increased or decreased body temperature, agitation, and hallucinations.
• Bone fracture:Larger dogs, such as Pitbull terriers, German shepherds, and Rottweilers can cause fractures in bones. If a dog is strong or the child small, the strength of the dog can pull the person to the point of straining a joint, or the dog’s jaw may crush a bone.  The mechanism of how the attack happens is crucial in evaluating injuries. If the person is pulled to the ground, any part of the body could be injured depending on how the person fell and what area of the body was hit or bitten.

**The bacterial infections discussed are treated with antibiotics and symptomatic treatment of symptoms. The probability of recovery depends on the body’s response to antibiotics, and how quickly the assessment and interventions were started.

What Can I do If I Am Injured?

In some instances, the healing or repair process may be extensive from dog bite injuries. From multiple surgeries, to changing antibiotics, to physical therapy, the list of treatments can grow and become quite overwhelming. Multiple follow up visits with plastic surgery may be required, especially for children who are still growing, to ensure proper repair for long term appearance.  Any psychiatric trauma from the attack, should be addressed by a qualified professional, as many suffer from post-traumatic stress disorder (PTSD). Every year inpatient medical costs incurred are about $53.9 million from approximately 4.5 million dog bite injuries.  If you, or a loved one, have been injured from a dog attack and have dog bite complications, you may qualify for assistance. The attorneys and Premier Law Group are available to help obtaining financial assistance for such a traumatic time.

Written by: Courtney Tolin, RN, BSN, CEN