Search

West Nile virus (WNV) primarily infects birds and mosquitoes but has also caused over 2,000 human deaths, and >50,000 reported human cases in the United States. Expected numbers of WNV neuroinvasive cases for the present were described for the Northeastern United States, using a negative binomial model. Changes in temperature‐based suitability for WNV due to climate change were examined for the next decade using a temperature‐trait model. WNV suitability was generally expected to increase over the next decade due to changes in temperature, but the changes in suitability were generally small. Many, but not all, populous counties in the northeast are already near peak suitability. Several years in a row of low case numbers is consistent with a negative binomial, and should not be interpreted as a change in disease dynamics. Public health budgets need to be prepared for the expected infrequent years with higher‐than‐average cases. Low‐population counties that have not yet had a case are expected to have similar probabilities of having a new case as nearby low‐population counties with cases, as these absences are consistent with a single statistical distribution and random chance. Plain Language Summary: West Nile virus (WNV) is a virus spread to humans by mosquitoes that had previously bitten an infected animal, usually a bird. We described the chance of one human case over the next one or next 5 years, and the chance of five human cases in any single year over the next 5 years. These chances were broadly similar, and highlight known locations with high numbers of cases of WNV. We also looked at how WNV suitability is expected to change in the near future due to climate change using established methods. We found that suitability for West Nile is expected to increase over most of the northeast, but decrease in some locations. Some locations identified as suitable based on temperature have had relatively few cases. Key Points: Small increases in temperature‐based suitability for West Nile virus (WNV) are expected over most of the northeastern US in the next decadeYears with high and low cases are consistent with the same underlying statistical distributionTemperature‐based suitability for WNV in some of the most populous counties is expected to decrease under climate change [ABSTRACT FROM AUTHOR]

Tick-borne pathogens such as species of Borrelia, Babesia, Anaplasma, Rickettsia, and Ehrlichia are widespread in the United States and Europe among wildlife, in passerines as well as in domestic and farm animals. Transmission of these pathogens occurs by infected ticks during their blood meal, carnivorism, and through animal bites in wildlife, whereas humans can become infected either by an infected tick bite, through blood transfusion and in some cases, congenitally. The reservoir hosts play an important role in maintaining pathogens in nature and facilitate transmission of individual pathogens or of multiple pathogens simultaneously to humans through ticks. Tick-borne co-infections were first reported in the 1980s in white-footed mice, the most prominent reservoir host for causative organisms in the United States, and they are becoming a major concern for public health now. Various animal infection models have been used extensively to better understand pathogenesis of tick-borne pathogens and to reveal the interaction among pathogens co-existing in the same host. In this review, we focus on the prevalence of these pathogens in different reservoir hosts, animal models used to investigate their pathogenesis and host responses they trigger to understand diseases in humans. We also documented the prevalence of these pathogens as correlating with the infected ticks' surveillance studies. The association of tick-borne co-infections with other topics such as pathogens virulence factors, host immune responses as they relate to diseases severity, identification of vaccine candidates, and disease economic impact are also briefly addressed here. [ABSTRACT FROM AUTHOR]

Research has shown effectiveness of redistribution procedures for decreasing packing and increasing swallowing. Redistribution has been done using lower manipulated-texture foods on an infant gum brush in specialized U.S. hospitals. We extended this by using regular texture bites of food in a short-term (1–2 weeks) home-based program in Australia, showing decreased then absent use of the procedure, and following up. Two children with autism spectrum disorder participated. We used a modified withdrawal/reversal design. Latency to swallow decreased. Participants increased variety to 90 and 122 regular texture foods across food groups. All goals were met including increasing independence in self-feeding. Both parents were trained. Gains maintained to 6 months and redistribution was no longer needed. [ABSTRACT FROM AUTHOR]

Arthropods, including insects and arachnids, significantly affect humans as vectors for infectious diseases. Arthropod bites and stings commonly cause minor, usually self-limited reactions; however, some species are associated with more severe complications. Spider bites are rarely life-threatening. There are two medically relevant spiders in the United States. Widow spider (Latrodectus) envenomation can cause muscle spasm and severe pain that should be treated with analgesics and benzodiazepines. Antivenom is not widely available in the United States but may be considered for severe, refractory cases. Recluse spider (Loxosceles) bites are often overdiagnosed, should be treated supportively, and only rarely cause skin necrosis. Centruroides scorpions are the only medically relevant genus in the United States. Envenomation causes neuromuscular and autonomic dysfunction, which should be treated with analgesics, benzodiazepines, supportive care, and, in severe cases, antivenom. Hymenoptera, specifically bees, wasps, hornets, and fire ants, account for the most arthropod-related deaths in humans, most commonly by severe allergic reactions to envenomation. In severe cases, patients are treated with analgesia, local wound care, and systemic glucocorticoids. Diptera include flies and mosquitoes. The direct effects of their bites are usually minor and treated symptomatically; however, they are vectors for numerous infectious diseases. Arthropod bite and sting prevention strategies include avoiding high-risk areas, covering exposed skin, and wearing permethrin-impregnated clothing. N,N-diethyl-m-toluamide (DEET) 20% to 50% is the most studied and widely recommended insect repellant. [ABSTRACT FROM AUTHOR]

Humans increasingly invade the environments of venomous creatures. The authors provide a review of venomous creatures and what acute care providers need to manage the patients affected by them. [ABSTRACT FROM AUTHOR]

The article presents a photo quiz asking readers to make a diagnosis on 2-year-old boy with a 3-day history of fever associated with a bug bite-like lesion on his left knee.

While an increasing number of households are keeping rodents as pets, rats and mice are considered pests and efforts are undertaken to control rodent populations to avoid human--rodent encounters. Tracking the burden of rodent bite injuries can guide prevention efforts. Data for this study were from the 2001-2015 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a stratified probability sample of U.S. hospitals. Records included information about age, body part affected, cause, diagnosis, case disposition, and sex. We coded narrative descriptions for the source of the bite. Every year, an estimated 12,700 injuries from rodent bites are treated in emergency departments, amounting to roughly one rodent bite injury treated every hour. Rats, mice, and squirrels were the most frequently reported rodents that bit people. The largest percentage of bites, approximately 27%, occurred in individuals <10 years and most bites occurred during the summer months. Injuries, zoonotic diseases, allergies, mental health adverse effects, and the environmental impact of rodent exposures exemplify the need for a multisectoral approach to prevention. [ABSTRACT FROM AUTHOR]

Objectives: Errors and misreporting on death certificates are common, along with potential inaccuracies in cause-of-death coding. We characterized and compared fatalities by animal-encounter mentions reported as underlying cause of death (UCD) with animal-encounter mentions reported as multiple cause of death (MCD) to determine factors associated with misreporting UCD. Methods: We analyzed fatality data from 1999-2016 from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research by UCD and MCD animal-encounter mentions (International Classification of Diseases, 10th Revision codes W53-59, X20-27 and X29, T63.0-63.6, T63.8-63.9, and T78.2-78.4). We examined differences in reporting by age, sex, race, autopsy (yes, no, unknown), allergic reactions, and toxicities. Results: The number of animal-encounter mentions by UCD was 3638 (202 average per year) and by MCD was 4280 (238 average per year), a difference of 18% (n = 642; 36 average per year) by MCD analysis. The number of nonvenomous animal-encounter mentions increased 20% (from 2138 UCD to 2567 MCD), and the number of venomous animal-encounter mentions increased 14% (from 1500 UCD to 1713 MCD). Decedents aged ≥65 had the highest additional number of animal-encounter mentions among all age groups, primarily encounters with other reptiles (n = 113), other mammals (n = 71), and dogs (n = 42). Of 642 MCD additional animal-encounter mentions, heart disease (n = 211, 33%) and infections (n = 146, 23%) represented more than half of the UCD. Of 553 dog-encounter fatalities, 165 (30%) were among children aged ≤4. Conclusions: Animal-encounter fatalities, analyzed by UCD alone, may be underreported. An initiating animal injury, complicated by comorbidities and fatality, may obscure the causal chain, resulting in misreporting UCD. Ongoing training for medical certifiers is recommended, highlighting accurate identification of UCD and contributing causes in the causal chain of death. [ABSTRACT FROM AUTHOR]

Background: Human rabies can be prevented through postexposure prophylaxis (PEP). Although the case fatality rate is high, there are only one to three human cases per year in the United States. Despite the low incidence, the cost of rabies diagnostics, prevention, and control is significant. Recommendations exist regarding which patients should receive PEP, though several studies demonstrate a high frequency of unnecessary prescribing of PEP.Objective: The purpose of this study is to determine if an animal bite protocol improves compliance with state and national recommendations regarding treatment of patients presenting to the emergency department (ED). Potential cost savings will also be evaluated.Methods: An institutional review board-approved, single-center, retrospective chart review was conducted from January 1, 2017 to March 18, 2018 to evaluate patients presenting to the ED with an animal bite prior to and after implementation of a protocol. The primary outcome was defined as the percentage of PEP offered as indicated by the protocol. Secondary outcomes included the appropriateness of not offering PEP and estimated cost savings after protocol implementation.Results: PEP was indicated four times out of 29 offers pre-protocol and three times out of five offers post-protocol (p = 0.0476). There was no difference in the appropriateness of not offering PEP (pre-protocol 105/107 times vs. 29/29 times; p = 0.9998). Cost savings was associated with protocol implementation.Conclusion: A pharmacist-driven protocol can beneficially influence prescribing habits after potential rabies exposure and is associated with cost savings. [ABSTRACT FROM AUTHOR]

Objective: No studies using national data have evaluated changes in nonfatal dog bite injuries among children, adolescents, and young adults during the past 2 decades. We examined estimates of annual nonfatal dog bite injuries among persons aged 0-19 treated in US emergency departments (EDs) from 2001 through 2017. Methods: We examined data from the Web-based Injury Statistics Query and Reporting System to compare estimates of the annual rates of nonfatal dog bite injuries in EDs among all persons aged 0-19, by age group (0-4, 5-9, 10-14, and 15-19), and by sex. We determined significance by comparing 95% confidence intervals (CIs), and we standardized rate calculations to the year 2000 population. Results: During 2001-2017, an estimated 2 406 109 (95% CI, 2 102 643-2 709 573) persons aged 0-19 were treated in EDs for nonfatal dog bite injuries (age-adjusted rate of 173.1 per 100 000 persons aged 0-19). The estimated number of nonfatal dog bite injuries declined significantly, from 181 090 (95% CI, 158 315-203 864) in 2001 to 118 800 (95% CI, 97 933-139 667) in 2017. The highest rate was among children aged 5-9. Male children, adolescents, and young adults were significantly more likely than female children, adolescents, and young adults to be treated in the ED for nonfatal dog bite injuries, driven by male–female differences in children and adolescents aged 5-14. Conclusions: Although the estimated number of nonfatal dog bite injuries among persons aged 0-19 declined significantly in the past 2 decades, additional regulatory and educational efforts specific to age and sex may lead to further reductions in nonfatal dog bite injuries. [ABSTRACT FROM AUTHOR]

Dog bites are a frequent source of injury requiring emergency department (ED) management. We sought to evaluate the longitudinal burden of dog bites presenting to US EDs. Cross-sectional study of a complex survey. We evaluated the National Hospital Ambulatory Medical Care Survey, a complex survey of non-federal US ED encounters between 2002 and 2017. Dog bites were identified via ICD-9-CM and ICD-10-CM codes. We report trends in dog bites (adjusted to US Census population data) overall and among patients younger than 18 years using the Spearman rank correlation test. Of 2.0 billion ED encounters, 6.6 million (0.3%, 95% confidence interval [CI] 0.3–0.4%) were for dog bites. There were 13.5 encounters per 10,000 population (all ages) and 20.8 per 10,000 among those younger than 18 years. Rates of bites increased over time for encounters younger than 18 years (rho = 0.54, 95% CI 0.08, 0.82), but not for those aged 18 years or older (rho = 0.44, 95% CI −0.08, 0.77). Among patients younger than 18 years, the rate of presentations increased from 17.7 to 22.3 per 10,000 encounters during the 16-year period. The highest rate of encounters was among patients aged 6–11 years, where 24.3 per 10,000 presented with dog bites and for which 59.3% (95% CI 49.1–69.6%) were boys. Overall, 75.3% (95% CI 72.3–89.3%) were provided with antibiotics and 4.1% (95% CI 2.5–5.7%) were diagnosed with skin/soft tissue infection. Dog bite presentations demonstrated a small but significant increase in rates of presentation over time among children and youth. Continued efforts are needed to curb this common injury. [ABSTRACT FROM AUTHOR]

Introduction: Each year, rabies causes approximately 59,000 deaths worldwide, including approximately two deaths in the United States. Before 1960, dogs were a common reservoir of rabies in the United States; however, increasingly, species of wildlife (e.g., bats, raccoons) are the main reservoirs. This report characterizes human rabies deaths, summarizes trends in rabies mortality, and highlights current rabies risks in the United States.Methods: Rabies trends in the United States during 1938-2018 were analyzed using national rabies surveillance data. Data from the Healthcare Cost and Utilization Project for 2006-2014 were used to estimate the number of postexposure prophylaxis (PEP) visits per 100,000 persons during 2017-2018. The Centers for Medicare & Medicaid Services' average sales price data were used to estimate PEP costs.Results: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. In 2018, approximately 55,000 persons sought PEP after contact with a potentially rabid animal.Conclusions and Comments: In the United States, wildlife rabies, especially in bats, continues to pose a risk to humans. Travelers also might be exposed to canine rabies in countries where the disease is still present; increased awareness of rabies while traveling abroad is needed. Vaccinating pets, avoiding contact with wildlife, and seeking medical care if one is bitten or scratched by an animal are the most effective ways to prevent rabies. Understanding the need for timely administration of PEP to prevent death is critical. [ABSTRACT FROM AUTHOR]

Objective: Ants, bees, hornets, wasps, and yellow jackets (insects in Order Hymenoptera) are potentially a serious concern to outdoor workers, as the venom from their stings can cause life-threatening allergic reactions. This study assessed the impacts of Hymenoptera stings and related worker training regimes of forestry workers across the United States (US). Methods: A survey was distributed to nearly 2,000 outdoor workers in the forestry industry from four US regions (South, West, Northeast, and Midwest). Results: Ants are a primary concern in the South, with >75% of participants reporting ant stings within the last 5 years. Bees, hornets, wasps, and yellow jackets are a concern for surveyed foresters in all US regions, with 60–70% and 75–93% of participants, respectively, having been stung by bees or hornets/wasps/yellow jackets within the last 5 years. Despite such a large number of participants experiencing stings, nearly 75% of participants were not concerned about being stung or their reaction to stings. Approximately, 70% of participants reported not having received any safety training related to Hymenoptera from their employers. Conclusion: No significant difference was shown in the number of foresters stung at work between safety trained and non-safety trained participants. However, it was significantly more likely for participants to carry a first aid kit if they had received Hymenoptera safety training. Consequently, more comprehensive and frequent training should be considered to help reduce risk of exposure to Hymenoptera. [ABSTRACT FROM AUTHOR]

Introduction: To review recent (2008-2015) United States mortality data from deaths caused by nonvenomous and venomous animals and compare with historical data.Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was queried to return all animal-related fatalities between 2008 and 2015. Mortality frequencies for animal-related fatalities were calculated using the estimated 2011 United States population. Inclusion criteria included all mortalities that were a consequence of bite, contact, attack, or envenomation (International Classification of Diseases 10th revision codes W53-W59 and X20-X29).Results: There were 1610 animal-related fatalities, with the majority from nonvenomous animals (4.8 deaths per 10 million persons annually). The largest proportion of animal-related fatalities was due to "other mammals," largely composed of horses and cattle. Deaths attributable to Hymenoptera (hornets, wasps, and bees) account for 29.7% of the overall animal-related fatalities and have been steady over the last 20 years. Dog-related fatality frequencies are stable, although the fatality frequency of 4.6 deaths per 10 million persons among children 4 years of age or younger was nearly 4-fold greater than in the other age groups.Conclusions: Appropriate education and prevention measures aimed at decreasing injury from animals should be directed at the high-risk groups of agricultural workers and young children with dogs. Public policy and treatment pricing should align to ensure adequate available medication for those at risk of anaphylaxis from stings from Hymenoptera. [ABSTRACT FROM AUTHOR]

Objectives. To determine the geographic distribution of scorpion envenomations in the United States by zip code, with particular attention to the neurotoxic Centruroides sculpturatus (Arizona bark scorpion), for which an antivenom is available. Methods. We obtained scorpion exposure cases for 2010 to 2015 from the National Poison Data System. Using geographic information systems software, we mapped total exposures and incidence rates for 9 states that reported more than 100 annual calls. We also mapped cases that reported fasciculations and nystagmus (unique to C. sculpturatus among native scorpions). Results. The highest exposure incidences occurred in Phoenix (up to 677 per 100 000 population) and Tucson (584), both in Arizona. Elsewhere, high incidences were found in El Paso, Texas (213); Oklahoma City (209) and Tulsa (178), Oklahoma; and Las Vegas, Nevada (170). Fasciculations and nystagmus were reported in Arizona and southeastern Nevada, with small numbers in surrounding states, including Utah. Conclusions. Scorpion exposures occurred at baseline rates throughout many of the southern states, whereas several states reported effects indicative of Arizona bark scorpion envenomation. [ABSTRACT FROM AUTHOR]

Objective: This study documents previously unreported cases of laboratory animal bite anaphylaxis in animal laboratory facilities in the United States. Methods: An online survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National institutes of Health Office of Laboratory Animal Welfare. Results: One hundred ninety eight organizations responded and 15 organizations indicated that workers had experienced anaphylaxis following an animal bite. case report forms were completed by nine of these institutions for 14 cases, 13 for rodent bites, and one involving a needlestick from a horse. in half of the cases involving rodents, there was no prior history of animal allergy. All workers had uncomplicated recoveries. Treatment, testing, and work restrictions varied across cases. Conclusions: While uncommon, anaphylaxis from laboratory animal bites occurs more frequently than suggested by the literature. [ABSTRACT FROM AUTHOR]

BACKGROUND: Each year, the average number of nonfatal occupational injuries among landscaping and groundskeeping workers are consistently above the total number of injuries for all other occupational injuries among worker in the U.S. From 2004 to 2007, fatalities among groundskeepers averaged 13.3 per 100,000 workers compared to an overall rate of 4.0 fatalities per 100,000 for all U.S. workers with the majority reported as either Hispanic or Latino. OBJECTIVE: The aims of this project were to describe the use of personal protective equipment and work safety climate among a sample of landscaping and groundskeeping workers employed by public universities in North Carolina (N = 67). METHODS: Data from a cross-sectional study was collected among workers using group-administered surveys. Statistical associations with work safety climate were tested between personal, work and safety behavior characteristics with work safety climate scores using one-way ANOVA. RESULTS: Nearly half of workers (49.3%) reported experiencing one or more work-related injuries or illnesses within the past 12 months. While work safety practices were perceived as being very important to management, only 56.7% reported having regular safety meetings. In bivariate analysis, work safety climate scores were significantly lower among those reporting race "other than white" (P = 0.01). CONCLUSIONS: This is the first study of its kind to evaluate work safety climate among landscaping and groundskeeping workers. Although self-reported safety practices were moderate, minority workers described their work safety climate as being poor. As a pilot study, these results suggest that employers of landscaping and groundskeeping workers could do more to improve safety climate within the organization with an emphasis on safety training for minority and underrepresented workers. [ABSTRACT FROM AUTHOR]

In the United States and Canada, the most recent documented cases of rabies have been attributed to bat rabies viruses (RABV). We undertook this systematic review in an effort to summarize and enhance understanding of the risk of infection for individuals who have been potentially exposed to a suspect or confirmed rabid bat. United States rabies surveillance summaries documented a total of 41 human bat-rabies virus variant verified non-transplant cases between 1990 and 2015. All cases were fatal. Seven (17.1%) of 41 cases reported a bite from a bat. Ten (24.3%) cases had unprotected physical contact (UPC); these included seven cases that had a bat land or crawl on them (contact with claws) and one case that touched a bat’s teeth. Seven (17.1%) cases had probable UPC. Insectivorous bat teeth are extremely sharp and highly efficient for predation upon arthropod prey. Bats also have sharp claws on the end of their thumbs and feet. One of the most common bat RABV variants has an ability to replicate in non-neural cells. Questioning individuals about unprotected contact with bat teeth and claws (including a bat landing or crawling on a person) may help identify additional exposures. [ABSTRACT FROM AUTHOR]

Wild and exotic animal attacks are not common in the United States. Animal-related injuries in the United States are usually caused by dog bites, followed by cattle and horse injuries. Exotic animal attacks can occur when the animals are provoked, depressed, or housed improperly by owners. We report the case of a 51-year-old woman who sustained multiple systemic traumatic injuries after she was pinned to a fence by an elephant’s trunk. Upon arrival in the emergency department, she was hypothermic with a temperature of 35.1ºC (95.1ºF), hypotensive to 94/60 mm Hg after 5 L crystalloid, tachycardic at 108 beats/min, and intubated with oxygen saturation of 100%. Tranexamic acid was administered in addition to starting a massive transfusion protocol. Injuries included bilateral multiple rib fractures, left abdominal wall degloving injury, right pneumothorax, right hemothorax, left chest wall puncture wound, grade IV splenic laceration, 3 grade III liver lacerations, retroperitoneal hematoma, and degloving injuries to bilateral posterior thighs requiring more than 30 operations. Why should an emergency physician be aware of this? Several factors need to be considered when evaluating animal-related injuries, including type, age, and sex of the animal. Multisystem traumatic injuries should be assumed when a large animal is involved. Prehospital care and transport time are vital to a patient’s survival in both urban and rural settings. During the initial resuscitation, administering antibiotics tailored to the specific animal can greatly decrease risk of infection and morbidity. Additionally, tetanus immunoglobulin, tetanus toxoid, and rabies immunoglobulin and vaccine may be needed, unless the victim has been previously vaccinated. [ABSTRACT FROM AUTHOR]

Objective: This study documents current treatment protocols for laboratory animal bite anaphylaxis in the United States. Methods: An online survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National institutes of Health Office of Laboratory Animal Welfare. Results: One hundred eighty-nine organizations responded to the question of whether they had a treatment protocol with 32% indicating that they had a protocol. Having a case of anaphylaxis increased the likelihood of having a protocol (61%). Of those with a protocol, 58% included treatment with injectable epinephrine, if clinically indicated. Among all respondents, only 14% reported keeping injectable epinephrine at the location where animal work is performed. Conclusions: A minority of responding organizations had protocols in place to address laboratory animal bite anaphylaxis. Organizations with workers at risk should consider implementing a protocol for assessment and treatment. [ABSTRACT FROM AUTHOR]

Objective: Injuries resulting from contact with animals and insects are a significant public health concern. This study quantifies nonfatal bite and sting injuries by noncanine sources using data from the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP). Methods: The NEISS-AIP is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal and insect sources of bite and sting injuries being treated. Data were weighted to produce national annualized estimates, percentages, and rates based on the US population. Results: From 2001 to 2010 an estimated 10.1 million people visited EDs for noncanine bite and sting injuries, based on an unweighted case count of 169,010. This translates to a rate of 340.1 per 100,000 people (95% CI, 232.9–447.3). Insects accounted for 67.5% (95% CI, 45.8–89.2) of bite and sting injuries, followed by arachnids 20.8% (95% CI, 13.8–27.9). The estimated number of ED visits for bedbug bite injuries increased more than 7-fold—from 2156 visits in 2007 to 15,945 visits in 2010. Conclusions: This study provides an update of national estimates of noncanine bite and sting injuries and describes the diversity of animal exposures based on a national sample of EDs. Treatment of nonfatal bite and sting injuries are costly to society. Direct medical and work time lost translates to an estimated $7.5 billion annually. [ABSTRACT FROM AUTHOR]

Animal bites are a frequent reason for visits to the emergency department. Bite injuries are particularly important in pediatrics as more than half of victims are children. Although most bite wounds heal uneventfully, infectious complications are common. Emergency physicians should be familiar with the approach to the assessment and management of bite wounds and the treatment of infections that may occur. This article will review the epidemiology, management, and prevention of animal bite infections, including those from humans, dogs, cats, and other vertebrates. [ABSTRACT FROM AUTHOR]

The article discusses Lyme disease (LD), a bacterial infection that's transmitted to humans through the bite of an infected tick and the most common vector-borne disease in the US. It mentions that erythema migrans (EM) rash is the early sign of LD; late LD is characterized by intermittent or persistent arthritis in some joints. Diagnosis of LD can be confirmed by blood testing for Borrelia burgdorferi; antibiotic treatment with doxycycline is recommended. INSET: Treatment recommendations.

The article presents practice recommendations related to rabies postexposure prophylaxis and their combined pharmacological characteristics in the emergency department (ED). It states that human rabies immune globulin (HRIG) products are preservative-free immunoglobulin preparations. It mentions that combine vaccination and animal control programs have reduced the cases of domestic animal rabies cases. It was concluded that naturally acquired human rabies cases is from bats.

The article presents the basic information on the life cycle and feeding habits of bedbugs. It provides various bite consequences, infestation and treatment. It mentions several prevention methods through awareness methods. It suggests that well informed public can take steps to limit exposures and prevent spread of these parasites.

The article focuses on the threat of bed bug on public health and prevention and treatment guidance for health educators in educating public regarding bed bug. It states that the survey of National Pest Management Association (NPMA) and the University of Kentucky reveals that 85% of respondents had experienced bed bug infestations. It mentions that education and communication play a significant role in bed bug control program.

Babesiosis is caused by a protozoan parasite of the genus Babesia. In the United States, the usual infective organism Babesia microti, is most commonly transmitted through the bite of an infected Ixodes tick. While the majority of patients exhibit sub-clinical signs and symptoms, significant illness can result. Spontaneous splenic rupture is a life-threatening complication of some viral and protozoan infections. We present a case of Babesiosis with spontaneous splenic rupture in which conservative management with blood transfusions and hospital-based care were successful, and the patient was spared splenectomy. To our knowledge, this is the first reported case treated without splenectomy. Our successful experience suggests conservative management may be appropriate for some patients. [ABSTRACT FROM AUTHOR]

The article discusses the resurgence of bed bugs. An overview of Cimex lectularias, the species of bed bug most adapted to living in human conditions in Central Asia, Europe and North America, is given. Data from the National Pest Management Association showed that bed bug-related extermination calls rose by 80 percent. Some reasons for the resurgence of bed bugs are discussed, including immigration, over-crowding in residential properties and changes in pest control practice.

About 4,000 to 6,000 venomous snakebites occur each year in the United States. Although these envenomations (also known as envenomings) are rarely fatal, about 70 percent require antivenom therapy. Few evidence-based guidelines are available for the management of envenomation. Antivenom therapy is the cornerstone of management for hemorrhagic or coagulopathic envenomation from pit vipers (with or without paralytic features), and for paralytic envenomation from coral snakes. Early intubation and ventilation may be required after bites from pit vipers whose venoms contain presynaptic neurotoxins. Although relatively controversial, antivenom therapy seems to be effective for the management of severe envenomation from widow spiders. Conversely, little evidence supports any specific management strategy for necrotic envenomation from recluse spiders. Cytotoxic fish stings, cnidarian stings, and traumatic penetrative envenomation by stingrays are typically managed symptomatically. Private collection of nonnative venomous animals in the United States is another source of medical risk. [ABSTRACT FROM AUTHOR]

Exotic (foreign or non-native) snakes, including venomous species, are becoming increasingly popular pets in Western countries. Some of them are kept illegally (as defined by the UK Dangerous Wild Animals Act of 1976). There is a large international market for such animals, with contraventions of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). In the UK, several other European countries and the USA the reported numbers of bites by venomous exotic snakes, although small, are increasing but still underestimate the occurrence of these occasionally fatal events because of the victims’ reluctance to seek medical care. Victims are predominantly young men who have been drinking alcohol. Bites may be intentionally provoked. In Europe, the species most often involved are cobras, green mambas, American pit vipers particularly rattlesnakes, African adders, vipers and Asian green pit vipers. To illustrate the special problems involved, case histories are presented of bites by exotic species in the UK and of bites abroad, where patients were repatriated for treatment. In view of the relative rarity and diversity of these cases, expert advice must usually be sought. These requests should include information about the species thought to have been responsible and the history and timing of the evolution of envenoming. Sources of advice and antivenom are discussed together with recommendations for appropriate first aid and emergency treatment while this is being awaited. Respiratory and cardiovascular resuscitation may be required and when systemic or severe local envenoming develops, specific (equine or ovine) antivenom is indicated. [ABSTRACT FROM PUBLISHER]

Introduction. Bites from reptiles cause thousands of injuries but fortunately few deaths in the U.S. each year. This article reviews deaths from reptile bites over the last 25 years. Methods. Mortality data was obtained using CDC WONDER to evaluate deaths that occurred from 1979 to 2004 due to reptile bites. Information on race, gender, ages, and state where death occurred is reported. Results. There were 134 deaths reported over this 25-year time period. Whites were 93.3% of the victims, and males were 79.1% of the victims. The age group reporting the most deaths was the 25 to 34 year old category. There were 17 (12.7%) victims less than 15 years of age, and 25 (18.7%) victims older than 65 years of age. Seventy-five of the fatalities (55.9%) occurred in five states. Conclusions. An average of five deaths occurs from reptile bites each year in the U.S. White males living in the Southern part of the United States are more likely to be the victim of a fatal reptile envenomation. [ABSTRACT FROM AUTHOR]

The article provides information on community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly in the U.S. Patients with CA-MRSA skin infection often report a spider bite as lesions appear suddenly and unexpectedly in areas without a history of any disease. It states that individuals who are at high risk for CA-MRSA are users of health clubs or participants in contact sports, men who have sex with men and prisoners. It outlines a rational approach to manage patients who have lesions likely to have been caused by CA-MRSA including the importance of consulting a physician.

Background. Since the 1980s, rare cases of rabies in humans in Canada and the United States have been almost exclusively caused by the bat-variant virus. Methods. We reviewed indigenously acquired cases of bat-variant rabies in humans in Canada and the United States from 1950 through 2007. Results. Of 61 cases identified, 5 occurred after organ transplantation and were excluded from further analysis. A bite was reported by 22 (39%) of the case patients, 9 (16%) had a direct contact (i.e., were touched by a bat) but no history of a bite, 6 (11%) found bats in their home (2 [4%] in the room where they slept) but reported no direct contact, and 19 (34%) reported no history of bat exposure whatsoever. With the exception of California (8 cases) and Texas (7 cases), no state or province had >3 cases. Of the case patients, 76% were men, and 40% were 10-29 years of age. The median incubation period was 7 weeks (<10 weeks in 72% of cases). The incidence of bat-variant rabies cases increased from 2.2 per billion person-years in 1950-1989 to 6.7 per billion person-years in 1990-2007. Of 36 case patients with bat rabies described since 1990, 16 had no history of direct bat contact; 2 (13%) of the 16 would have qualified for rabies postexposure prophylaxis on the basis of exposure criteria expanded in 1995 to include bats that were in the same room as a sleeping person. The incidence of rabies for this type of exposure was 0.6 cases per billion person-years. Conclusion. The true preventable proportion of cases and the number needed to treat with rabies postexposure prophylaxis to prevent 1 case would be useful information to inform the current guidelines. [ABSTRACT FROM AUTHOR]

Objectives. This study was conducted to estimate the burden of non-canine-related bite and sting injuries in the U.S.; describe the affected population, injury severity, and bite or sting source; and provide considerations for prevention strategies. Methods. Data were from the 2001 through 2004 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) (a stratified probability sample of U.S. hospitals). Records included information about age, body part affected, cause, diagnosis, disposition, and gender. Narrative descriptions were coded for the source of the bite or sting. Results. Between 2001 and 2004, an estimated 3.6 million people were treated in emergency departments for injuries related to non-canine bites and stings. Results detail the reported sources of the bite or sting, and examine sources by gender and age group. Common sources included bees (162,000 cases annually), spiders (123,000 cases annually), and cats (66,000 cases annually). Female adults were more likely than male adults to be treated for cat bites. Although rare, of the known venomous snakebites, more than half (58.4%) of the patients were hospitalized. Conclusions. Our results demonstrate the public health burden of non-canine-related bite and sting injuries. More than 900,000 people were treated in emergency departments annually for non-canine bite or sting injuries, or roughly 1.7 injuries per minute. Treatment consumes substantial health-care resources. While preventing these injuries should be the first line of defense, resources could be conserved by educating the public about immediate first aid and when warning signs and symptoms indicate the need for professional or emergency care. [ABSTRACT FROM AUTHOR]

Much has been written about injury, diarrhea, and respiratory cases but less is known about other threats, specifically snake, scorpion, and spider encounters. To examine the risk from local fauna, a cross-sectional study using an anonymous survey was conducted among U.S. troops in Southwest Asia between January 2005 and May 2006. Among 3,265 troops, 9 cases (0.3%) of snakebites and 85 cases (2.6%) of spider stings and scorpion bites were reported, equating to an incidence of 46.1 per 10,000 person-months for scorpion/spider encounters and 4.9 per 10,000 person-months for snakebites. There was a significant association with service branch and toileting facilities for snakebites. Season, deployment location, rank, and toileting facilities were associated with differential risk of scorpion/spider encounters. Troops are at risk for local fauna encounters while deployed in the current operational environment. The potential morbidity, mortality, and operational impact of these health hazards need to be considered. [ABSTRACT FROM AUTHOR]

This article presents news from the U.S. Centers for Disease Control and Prevention. Results of a study on human cases of rabies in Indiana and California in 2006 are presented. The study looked at two cases where the patients received treatment similar to the care given to the first human to survive rabies. The case of a 10-year-old girl is presented where she was not diagnosed through the first symptoms of the disease and she died. In the second case the death of an 11-year-old boy is recounted. The report finds that if the treatment is to be successful, it must be administered in the early stages of the disease.

Venom immunotherapy (VIT) is a life-saving medical treatment for individuals allergic to Hymenoptera species. Delivery of VIT is a complex process that requires proper extract preparation, shipping, storage, refrigeration, and administration by qualified medical personnel in a facility that can manage a life-threatening allergic emergency (anaphylaxis). Successful VIT requires 3 to 5 years of uninterrupted maintenance injections, which may be difficult to maintain during deployments, particularly in combat operations. The complexity of VIT has resulted in service members being deemed nondeployable and has led to interruption or discontinuation of VIT for deployed service members in the past. We report the case of a 34-year-old Army National Guard soldier who successfully received maintenance VIT while deployed to Operation Iraqi Freedom. This case demonstrates that, with proper coordination and appropriate risk assessment, continuation of complex medical care, such as VIT, can be supported in a combat zone. [ABSTRACT FROM AUTHOR]

The article discusses the first known bite of a human host in the U.S. by Haemaphysalis longicornis, the invasive Asian longhorned tick. Topics include several case reports of human parasitism, infestations resulting in severe blood loss and decreased growth, and widespread distribution of H. longicornis in the U.S.

Abstract: Bites by the woodlouse spider, Dysdera crocata, are virtually innocuous. The main symptom is minor pain, typically lasting less than 1h, probably due mostly to mechanical puncture of the skin. However, because the spider has a strong proclivity to bite, has large fangs which it bares when threatened and is commonly mistaken for the medically important brown recluse spider in the United States, documentation of the mild effects of its bites may prevent excessive, unwarranted and possibly harmful treatment. We present information on eight verified bites reported to us as well as eight additional bites recorded in the literature. [Copyright &y& Elsevier]

Reports on the distribution of the surveys for bite mark cases created by Diplomates of the American Board of Forensic Odontology in the U.S. Importance of bite marks on developments in investigations of violent crimes; Participation of various forensic odontologists worldwide in the survey; Evaluation of the bite mark patterns from respondents of the study.

Rabies is a uniformly fatal viral encephalitis that causes 30,000 to 70,000 deaths worldwide each year. Prevention is the primary approach to the disease. In the United States, 25,000 to 40,000 people are treated annually for exposure to rabid or potentially rabid animals at a per-patient cost exceeding $1000. Rabies is transmitted usually by saliva from infected animal bites. However, recent findings that rabies can be transmitted from bats to humans by relatively casual contact has resulted in dramatic changes in guidelines from the Centers for Disease Control and Prevention for postexposure prophylaxis. We review the 5 clinical stages of rabies, current methods of diagnosis, and prevention in animal reservoirs and in humans. We also discuss the use of rabies immune globulin and active and passive vaccinations for preexposure prophylaxis and postexposure treatment of rabies. Human exposure to rabies will always be a possibility, but methods to prevent the disease both before and after exposure to the virus are safe and readily available. [ABSTRACT FROM AUTHOR]

Presents a study that assessed the number of insect bites, the extent of the insect biting nuisance and the impact on expedition activities of British youth in Alaska. Methodology; Results and discussion.

Many bite wound patients seek treatment in primary care clinics instead of emergency departments. Without treatment, bite wounds can become infected. Presenting symptoms are usually wound site pain with cellulitis and purulent drainage. The infection originates from the oropharyngeal flora of the biting animal or human and the victim's skin. Primary care clinicians must be able to assess and manage animal and human bites, initiate antibiotic therapy if indicated, and refer patients for surgery or rabies prophylaxis when appropriate. Prompt assessment and treatment can prevent most bite wound complications. [ABSTRACT FROM AUTHOR]

Context: Rabies postexposure prophylaxis (RPEP) treatments and associated costs have increased in the United States. The extent to which RPEP use is consistent with guidelines is not well understood.Objective: To characterize animal contacts and determine the frequency and factors associated with inappropriate RPEP use.Design, Setting, and Patients: Prospective case series study of patients presenting with an animal exposure-related complaint from July 1996 to September 1998 at 11 university-affiliated, urban emergency departments (the Emergency ID Net).Main Outcome Measures: Exposure type, circumstances, and RPEP use (appropriateness defined by local public health departments).Results: Of 2030 exposures, 1635 (81%) were to dogs; 268 (13%) to cats; 88 (4%) to rodents/rabbits; 10 (0. 5%) to raccoons; 5 (0.2%) to bats; and 24 (1.2%) to other animals. Among those exposed, 136 (6.7%) received RPEP after dog (95), cat (21), raccoon (8), bat (4), or other animal (8) exposures. Use of RPEP varied by site (range, 0%-27.7% of exposures), with most frequent use reported at sites in the eastern United States. Management was considered appropriate in 1857 exposures (91.5%). Use of RPEP was considered inappropriate in 54 cases (40% of those in which it was given), owing to factors including animal availability for observation and exposure in a low-endemicity area. Rabies postexposure prophylaxis was considered inappropriately withheld from 119 cases (6.3% of those not receiving RPEP), often because a domestic animal was unavailable for observation or testing.Conclusion: These results suggest that use of RPEP is often inappropriate. Greater compliance with current guidelines would increase RPEP use. Physician education, improved coordination with public health officials, and clarification of RPEP guidelines could optimize use of this expensive resource. JAMA. 2000;284:1001-1007 [ABSTRACT FROM AUTHOR]

The incidence of dog, cat and human bites has been increasing steadily and represents an important cause of morbidity and mortality in the United States. Approximately half of all Americans will suffer a bite wound during their lifetime, and the annual medical costs of managing these injuries has been estimated to be over $100 million. Possible complications may include disfigurement, dismemberment and infection. Effective management requires rapid medical evaluation and may necessitate surgical intervention and prophylactic antibiotic therapy. As bite wounds are microbiologically diverse and most often polymicrobial in nature, selection of an appropriate antibiotic regimen requires knowledge of common pathogens. Close clinical follow-up is recommended to minimize the risk of late complications. [ABSTRACT FROM AUTHOR]

Investigates arthropod and nonarthropod sources of reported bites and itching in a word processing division of a municipal department in Saint Louis, Missouri. Large population of pigeons around the window ledges and sighting of mice in the office; Presence of a combination of surface-borne dust on desk tops and floors; Presence of computers as a source of high levels of static electricity.