Emergency amputation necessitated within 24 hours by a human bite: a case report

We herein review and analyze the diagnosis, treatment, and outcome of a severe infection caused by a human bite. A 68-year-old man was bitten on the forearm by a 3-year-old child. Rapid progression of infection, severe local and systemic poisoning, and diverse clinical manifestations were observed at presentation. Based on the medical history, physical signs, imaging examinations (X-ray films, color Doppler ultrasound, and computed tomography), laboratory examinations, and multidisciplinary consultation, the patient was diagnosed with gas gangrene or gas gangrene-like changes. Twenty-four hours after the injury, an emergency amputation was performed (open amputation with wound closure after 1 week). After the operation, the patient was sent to the intensive care unit for isolation and further anti-infection and anti-shock treatments. His condition gradually improved after treatment and he was discharged without further complications. Bacteriological and pathological examinations indicated Aeromonas hydrophila infection leading to extensive necrotizing fasciitis of the limb and severe systemic poisoning. In addition, pre-existing myelodysplastic syndrome progressing to acute myeloid leukemia was identified as a possible predisposing factor. Human bites can cause serious infections requiring timely treatment, particularly in patients with predisposing comorbidities.

Human bite wounds as a portal of entry for infective endocarditis and purulent pericarditis: a very rare association

Human bites are an infrequent cause of emergency department visits and hospital admissions. There are rarely published cases of complicated infection, such as infective endocarditis. We present a rare case of a patient with acute infective endocarditis in a healthy native valve and purulent pericarditis from a human bite. A 40-year-old man with obesity suffered deep human bites by an adult woman, with two deep lesions in the anterior thorax and one superficial lesion in the upper abdomen and admitted in intensive care unit with septic shock and a persistent aortic murmur. Echocardiography described evidence of vegetation, perforation and severe regurgitation of aortic valve. Scanner described moderate pericardial effusion. Cardiac surgery was performed, with evidence of purulent pericardial effusion after pericardiotomy, and subsequently aortic valve replacement with a 25 mm bioprosthesis. The patient showed positive progress.

Evaluation of reproduction technique of bitemarks printed in chewing gum for human identification

Forensic Odontology is the science that correlates dental and legal principles, used for processes such as human identification. One of the possible acting fields for Forensic Odontologists is the analysis and study of patterns and injuries created by human bite marks. This study aimed to show the applicability of dental marks printed in chewing gum for human identification in forensic investigations. A transversal observational study was carried out. The data was collected from 20 volunteers over 18 years old. Each subject had their upper and lower dental casts and was asked to chew a piece of gum for one minute. The pieces of chewing gum were refrigerated at -20ºC for a week, and reproduced with addition and condensation silicones using an adapted reproduction technique. The analysis of the chewing gum was made by overlays. The ANOVA test showed no significant differences on width and length between the pieces of chewing gum and their reproductions (greatest width p=0.918, and the length p=0.981). The analysis of the reproductions with plaster mold showed that there was no difference when using addition silicone or condensation silicone. During the analysis, various suspects could be excluded from the investigation (up to 11, depending on the technique used), but it was not possible to confirm one of them as the main suspect. The study showed that the reproduction technique of chewing gum is efficient, viable and easily performed; and can be used in cases of human identification in forensic investigations. However, it is necessary to certify that the chewing gum effectively presents a bite mark and that it is correctly handled to avoid alterations. It also became evident that the process of refrigeration is essential for the analysis proposed in this study.

Seasonal Activity of Haemaphysalis longicornis (Acari: Ixodidae) in Southern New York State

The Asian longhorned tick, Haemaphysalis longicornis Neumann, is a species native to eastern Asia that has recently been discovered in the United States. In its native range, H. longicornis transmits pathogens that cause disease in humans and livestock. It is currently unknown whether H. longicornis will act as a vector in the United States. Understanding its seasonal activity patterns will be important in identifying which times of the year represent greatest potential risk to humans and livestock should this species become a threat to animal or public health. A study site was established in Yonkers, NY near the residence associated with the first reported human bite from H. longicornis in the United States. Ticks were collected once each week from July 2018 to November 2019. Haemaphysalis longicornis larvae were most active from August to November, nymphs from April to July, and adult females from June to September. This pattern of activity suggests that H. longicornis is capable of completing a generation within a single year and matches the patterns observed in its other ranges in the northern hemisphere. The data presented here contribute to a growing database for H. longicornis phenology in the northeastern United States. Potential implications of the short life cycle for the tick’s vectorial capacity are discussed.

HIV transmission by human bite: a case report and review of the literature—implications for post-exposure prophylaxis

We report a case of a probable HIV-1 transmission by human bite. The analyzed data from ten previously reported suspected or allegedly confirmed HIV transmissions revealed a deep bleeding bite wound as the primary risk factor. A high HIV plasma viral load and bleeding oral lesions are present most of the time during HIV transmission by bite. HIV post-exposure prophylaxis (PEP) should be recommended in case of a bleeding wound resulting from a bite of an HIV-infected person. PEP was missed in this presented case.