Paeds · infectious-diseases
Animal bites, arthropod bites and zoonoses
Also known as Dog and cat bites · Mammalian bite wounds · Cat scratch disease · Rabies and Australian bat lyssavirus · Tick-borne disease and Lyme disease · Scabies · Snakebite and envenomation · Brucellosis, Q fever and leptospirosis
Fellowship guide to animal and arthropod bites and zoonoses in children: the exposure history that drives risk stratification, dog and cat bite microbiology with Pasteurella and Capnocytophagus, the irreplaceable role of wound irrigation and the hand-bite rule, rabies and Australian bat lyssavirus post-exposure prophylaxis with immunoglobulin and vaccine, cat scratch disease and Bartonella, tick-borne Lyme and rickettsial disease, scabies, snakebite pressure-immobilisation and antivenom, and the systemic zoonoses leptospirosis, Q fever and brucellosis.
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Target exams
Red flags
- Any bat bite, scratch, or mucous-membrane contact in Australia is presumed Australian bat lyssavirus exposure until proven otherwise
- A bite that crosses a joint, tendon sheath, or bone, or involves the hand, carries high risk of deep infection and functional loss
- Progressive spreading erythema, pain out of proportion, systemic toxicity, or crepitus suggests necrotising infection or sepsis
- Neurological symptoms after a snakebite or tick attachment signal neurotoxic envenomation or tick paralysis
- An unvaccinated or immunocompromised child bitten by a wild or unowned animal needs urgent rabies risk assessment
- Bleeding, bruising, or coagulopathy after snakebite indicates haemotoxic envenomation needing antivenom
- Prolonged fever, hepatosplenomegaly, arthralgia, or aseptic meningitis after animal exposure suggests systemic zoonosis
Life stages
Care settings
Clinical exam formats
Board mappings
- Takes a structured exposure history covering animal, mechanism, geography, and immune status after any bite
- Cleans and irrigates bite wounds and explains the hand-bite and no-primary-closure rules
- Initiates rabies and Australian bat lyssavirus post-exposure prophylaxis when indicated
- Selects empiric antibiotics by bite source, targeting Pasteurella, anaerobes, and Capnocytophagus
- Distinguishes local bite infection from necrotising soft tissue infection and systemic zoonosis
- Manages tick-borne disease, scabies, snakebite envenomation, and systemic zoonoses in children
- Recognition and management of an infected mammalian bite in a child
- Rabies and Australian bat lyssavirus risk assessment and post-exposure prophylaxis decision
- Snakebite first aid with pressure-immobilisation and the antivenom decision
- Bedside assessment and wound care of a paediatric bite injury
- Communication of the antibiotic, rabies, and tetanus decisions to the family
- Safety-netting advice on wound review and signs of spreading infection
- Level 1: Recognises the child with a bite wound and the need for wound care and risk assessment
- Level 2: Manages uncomplicated bites, initiates prophylaxis, and requests help for deep hand infections
- Level 3: Leads management of rabies exposure, envenomation, and systemic zoonosis
- Microbiology of dog, cat, and human bites and the role of amoxicillin-clavulanate
- Rabies and Australian bat lyssavirus pathogenesis and post-exposure prophylaxis regimens
- Lyme disease, scabies, and the systemic zoonoses leptospirosis, Q fever, and brucellosis
- History, examination, and wound assessment of a child with a bite
- Communication of the management plan and safety-netting advice
- Structured assessment of a child with suspected envenomation
- Wound care and antibiotic prophylaxis for mammalian bites in children
- Post-exposure prophylaxis for rabies and tetanus after an animal bite
- Recognition and management of tick-borne disease and scabies
- Recognition and resuscitation of the envenomated or septic child after a bite
- Rational use of prophylactic antibiotics for bite wounds
- Public health responsibilities in rabies and zoonosis notification
- Mammalian bite management and rabies risk in the Canadian child
- Lyme disease diagnosis and treatment by the IDSA guideline framework
- Pressure-immobilisation first aid and antivenom use for paediatric snakebite
Overview & Definition
A child who has been bitten by an animal or insect, or who has a fever after contact with animals, sits at a busy crossroads of wound care, microbiology, toxinology, and public health. The unified skill the examiner wants is the ability to extract a precise exposure history and then convert it into three simultaneous decisions: how to clean and dress the wound, whether to give antimicrobial prophylaxis, and whether the encounter carries a rabies or tetanus risk. Most bites are minor and heal with irrigation alone, but a small minority hide deep structure injury, necrotising infection, or a fatal neurotropic virus, and recognising that minority is the whole game. [12]
The clinical terrain spans three families of problem that share only the mechanism of animal contact. Mammalian bites inject oral flora such as Pasteurella, anaerobes, and Capnocytophagus into tissue and cause cellulitis, abscess, or sepsis. Arthropod bites and infestations range from immediate hypersensitivity reactions through vector-borne infections such as Lyme disease and rickettsial illness to the intense pruritus of scabies. Zoonoses and envenomation, including snakebite, rabies, leptospirosis, Q fever, and brucellosis, produce systemic disease whose link to the animal encounter may not be obvious unless the history is taken. [1]
The single most load-bearing principle is that the exposure history, far more than any investigation, determines management. Knowing the species, mechanism, geography, child's immune and vaccination status, and the time elapsed turns a generic bite into a specific risk profile and dictates every downstream decision from antibiotic choice to pressure-immobilisation to rabies prophylaxis. [12]
References12ShowHide
- [1]Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med, 1999.PMID 9887159
- [2]Cummings P Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med, 1994.PMID 8135429
- [3]Florin TA, Zaoutis TE, Zaoutis LB Beyond cat scratch disease: widening spectrum of Bartonella henselae infection. Pediatrics, 2008.PMID 18443019
- [4]Jackson AC Rabies. Can J Neurol Sci, 2000.PMID 11097515
- [5]Lewis T, Baack K, Gomez L, et al. Rabies post-exposure prophylaxis in the emergency department. Am J Emerg Med, 2024.PMID 38330834
- [6]Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter Y, Aguero-Rosenfeld ME, Auwaerter PG, et al Clinical Practice Guidelines by the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology: 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Neurology, 2021.PMID 33257476
- [7]Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY Ectoparasites: Scabies. J Am Acad Dermatol, 2020.PMID 31310840
- [8]España PP, Uranga A, Cillóniz C, et al. Q Fever (Coxiella Burnetii). Semin Respir Crit Care Med, 2020.PMID 32629489
- [9]Tullu MS, Karande S Leptospirosis in children: a review for family physicians. Indian J Med Sci, 2009.PMID 19770531
- [10]Tanir G, Tufekci SB, Tuygun N Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int, 2009.PMID 19371290
- [11]Iliyasu G, Dajel TB, Abubakar SB, et al. Comparison of snakebite in children and adults in Nigeria. Toxicon, 2023.PMID 37062344
- [12]Aloi M, Coley T, Geren KI, et al. Mammalian bite wounds in children: evidence-based management in the emergency department. Pediatr Emerg Med Pract, 2023.PMID 37646652