1. بسم الله الرحمن الرحيم السبت 17 محرم 1426 26 Feb 2005

2. عضة الأسبوع Bite of the Week Pedia@yahoogroups.com Pedia © 2005

3. Bite of the Week 7 year-old Saudi boy C/O Monkey bite 14 hours prior to admission

4. History Monkey bite to Rt hand Another Hospital: X ray => normal Suturing Velosef & Metronidazole IV Anti-Rabies vaccination was started

5. Cont. Hx Parents took child DAMA & brought him to our A/E Patient remained well, afebrile, with normal systemic review

6. PMHx Asthma, mild intermittent, Salbutamol nebulizer PRN Vaccination: Up-to-date Development: Normal Nutrition: Family diet Family Hx: uneventful

7. On Examination Vital signs: Temp: 36.5 RR: 30 HR: 110 BP: 106/53 Growth:Ht: 120 cm ( 25 %) Wt: 21 kg ( 25 %)

8. Cont. P/E Local exam: Rt hand with laceration over thenar eminence with mild swelling & 9 sutures in place Hand movements & sensation: normal System exam: Normal

10. Management Issues

11. Management Issue # 1 Need for debridment: Cleansing of the wound with a vigorous 15 minute scrub Primary closure: ?? As edema developed => exploration to be done today under GA => secondary healing

12. Management Issue # 2 Need for antibiotics: Amoxicillin + Clavulanate IV More edema + redness of hand: Penicillin / Cloxacillin

13. Management Issue # 3 Tetanus Prophylaxis: All other wounds 1 Clean, minor wounds Number of previous tetanus vaccinations Give TIGGive TdGive TIGGive Td 2 Yes NoYesUnknown, uncertain, or fewer than 3 NoNo 5 NoNo 4 3 or more 3

14. Management Issue # 4 Rabies: Any mammal can get rabies. The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes. Domestic mammals can also get rabies. Cats, cattle, and dogs are the most frequently reported rabid domestic animals in the United States.

15. Management Issue # 4 Need for anti-rabies vaccine on days: 0, 3, 7, 14, 28

16. Management Issue # 5 Herpesvirus-1 (B-Virus) Infection Occurs naturally in Macaque monkeys and possible in other Old World monkeys Most have no obvious evidence of infection The most likely routes of transmission are bites and scratches or splashes. There has been a report of person to person transmission. first reported over 50 years ago, yet only about 22 cases of human infection have been described till 1999

17. B-Virus related disease Of the 22 reported cases, 20 infected individuals developed encephalitis and 15 of these patients died as a result of their infection. A variety of signs and symptoms which generally occur within one month of exposure. http://dcminfo.wustl.edu/occhealth/factsheet_herpesb.html

18. B-Virus related disease 1. vesicular skin lesions at or near the site of injury. 2. localized neurological symptoms such as pain, numbness or itching near the wound site. 3. flu-like aches and pains 4. fever and chills 5. headaches lasting more than 24 hours 6. fatigue 7. muscular incoordination 8. shortness of breath. http://dcminfo.wustl.edu/occhealth/factsheet_herpesb.html

19. B-Virus related disease Guidelines recommend treatment of a symptomatic patient with oral or intravenous acyclovir. Asymptomatic exposed persons should be treated with oral acyclovir or valacyclovir for two weeks.

20. Further Readings Monkey Bite Policy: http://www.med.umich.edu/em/em/eddpp- backup/monkeybite.html http://www.med.umich.edu/em/em/eddpp- backup/monkeybite.html B virus: http://www.cdc.gov/ncidod/eid/vol4no1/ost rowsk.htm http://www.cdc.gov/ncidod/eid/vol4no1/ost rowsk.htm RABIES CONTROL MANUAL http://www.lapublichealth.org/vet/procs/rabies. htm#BITING http://www.lapublichealth.org/vet/procs/rabies. htm#BITING

21. شكراً Thank You Pedia@yahoogroups.com Pedia © 2005