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Introduction: Capnocytophaga ochracea is found in the human oral microbiome and is a rare cause of antibiotic-resistant, opportunistic septicemia in immunocompromised hosts. The zoonotic transmission of C ochracea from canines to humans has not yet been reported in the literature. Cohabitation with people is associated with oral colonization in dogs and may be a reservoir for Capnocytophaga infections, which have a decreased susceptibility to first-line antibiotics commonly used to treat animal exposures.Case Report: This is the case of a 70-year-old male with a remote history of lymphoma status post splenectomy, in remission, who presented with stigmata of Capnocytophaga septicemia after a dog bite, which included purpura fulminans on physical examination. Initial broad-spectrum coverage with cefepime failed to slow the progression into multiorgan failure. A Capnocytophaga strain with extended resistance was suspected. Antibiotics were transitioned to meropenem, and the patient eventually made a good recovery. Blood cultures isolated C ochracea.Conclusion: Capnocytophaga infections should be suspected in patients with severe sepsis and purpura fulminans after a canine exposure. Canine pets may be a reservoir for Capnocytophaga species with increased antibiotic resistances, such as C ochracea, which trace their origins to the human oral microbiome. A thorough medical history is essential to identify risk factors such as asplenia and active immune compromise that are associated with infections from antibiotic-resistant strains and worse outcomes. For Capnocytophaga infections that fail initial therapies, cephalosporins should be avoided because of high resistance rates, and the use of carbapenems may be favored over combination beta-lactam/beta-lactamase inhibitors in select clinical scenarios.

Dog bites are common within the United Kingdom, with their incidence increasing over recent years. Bites to the head and neck region can have substantial and multifactorial implications for victims, and can provide a challenge to maxillofacial departments. This study is a 10-year retrospective review of head and neck dog bites that required input from the maxillofacial team within the Cwm Taf Morgannwg University Health Board. Data collected included demographics of the patients involved, relationship with and breed of dog, nature of the injury, treatment received, and nature of any complications. In total, 168 records matched our inclusion criteria. The median age of our cohort was 12 years, with 57.1% of patients being younger than 15. Of the patients, 52.4% were female. Eighty-three per cent of cases involved a known dog, with Jack Russells being the breed most commonly involved. The upper lip was the most commonly affected area (30.3%), followed by the cheek (24.5%). Twenty-eight per cent of patients were admitted for management in theatre, with 8% of the total patients experiencing a complication. In conclusion, head and neck dog bites most commonly affect children and the upper lip. [ABSTRACT FROM AUTHOR]

Background: In India, over 35% of global human Rabies deaths occur, primarily from dog bites which are responsible for over 95% of cases. Objective of this study was to assess the epidemiological profile and practices regarding animal bite, among animal bite victims attending the OPD of Rural Health and Training Centre affiliated to a Tertiary Care Centre in Rewa. Methods: This was a facility based cross-sectional study. Sample size was 150. New animal bite victims were interviewed using a semi-structured questionnaire after obtaining informed verbal consent. The questionnaire consisted of demographic profile and questions regarding victims’ awareness about rabies, anti-rabies vaccine and their practices following the animal bite. Conclusion: Younger age group (persons of 0-30 years age group) are more commonly affected. Awareness among participants may be raised by utilising school health programs Major biting animals were dogs. Very few people are aware of the need for observing animals post bite. Wound care practices need to be improved. Pet dog rabies vaccination rate is very low, which needs to be focused upon for achieving rabies control. [ABSTRACT FROM AUTHOR]

Capnocytophaga canimorsus is a gram-negative bacterium commonly found in the saliva of dogs and cats. Despite the frequency of animal bites, infection with Capnocytophaga species is rare, and severe infections are usually associated with underlying risk factors, such as alcohol use disorder, asplenia, or immunosuppression. We describe a case of a man who presented with a purpuric rash, lower extremity edema, and acute renal failure and was found to have tricuspid valve endocarditis and infection-associated glomerulonephritis due to C. canimorsus. Despite treatment with cefepime, the vegetation increased in size and valvular function worsened. He was readmitted with an inferior wall myocardial infarction, heart failure, and pulmonary embolism. He underwent an urgent tricuspid valve replacement with a bioprosthetic valve. A 16S ribosomal RNA amplicon sequencing performed on the resected valve tissue verified involvement of C. canimorsus. Post-operatively, he had several episodes of gastrointestinal hemorrhage requiring multiple endoscopic interventions and arterial embolization. The recurrent gastrointestinal hemorrhage combined with his severe functional decline ultimately led to his death. This patient had an uncommon presentation with leukocytoclastic vasculitis and infection-associated glomerulonephritis, which revealed an underlying diagnosis of infective endocarditis due to C. canimorsus, a rare gram-negative bacterial etiology of infective endocarditis. [ABSTRACT FROM AUTHOR]

Background: Rabies is a fatal disease with no cure but 100% preventable and effective vaccines are available. Time trends in epidemiological factors related to exposure to biting animal, management & adherence to vaccination have poorly studied. Hence, we have undertaken this study to analyze the time trends in epidemiological factors associated with animal bite cases over the period of eight years. Methods: Present study was cross sectional in nature conducted in patients presenting to ARV clinic. Results: Of the various age group classes, majority (47.46%) of the cases were from 15-44 years followed by 19.06% from 6-14 years age group. Majority (61.29%) of the cases were males. maximum (81.43%) cases were from category 2 of WHO classification of animal bite exposure. 89.42% cases type of animal bite exposure was dog. Male gender, age group of 15-44 years, category 3 exposures & cases presenting within 24 hours had shown significantly increasing trend with time (p

BACKGROUND: Bite injuries, particularly those involving the hands, present a significant medico-legal challenge, often leading to complications and frequent emergency department visits. Dog and cat bites, especially among children, are major contributors to infections due to the complex anatomy of the hand, which predisposes it to severe infections even from minor bites. Capnocytophaga canimorsus, found in the oral cavity of dogs and cats, is particularly concerning due to its potential to cause severe infections. Prompt and appropriate treatment is essential to mitigate these risks. Managing such injuries poses significant challenges, necessitating clear guidelines for reporting and safety measures. This article highlights the urgent need for additional research, support, and education, particularly focusing on children, along with the development of international guidelines to improve outcomes for patients. CASE REPORT: A case study of a sixteen-year-old girl who had her left forearm amputated due to a rottweiler bite is presented. Despite initial attempts at replantation, complications led to the decision for amputation. CONCLUSIONS: This case underscores the challenges in managing severe dog bite injuries, emphasizing the importance of prompt assessment, thorough debridement, and proper wound management to minimize complications. Additionally, psychological evaluation and treatment are crucial for patients and parents following such traumatic events. From a medical standpoint, this case highlights the importance of monitoring inflammatory markers, appropriate surgical priorities, and the need for psychological support. Prevention of dog bites is crucial, requiring increased awareness among public authorities and dog owners. Clear guidelines for reporting dog bites are essential, but further research is needed to improve their comprehensiveness and effectiveness. [ABSTRACT FROM AUTHOR]

Dog bite injuries often present to Emergency Departments (ED), and between 2001 and 2003, approximately 4.5 million adults and children were injured. Injuries may range from puncture wounds to deep tissue lacerations or avulsions. Deaths have been described. Our objective was to describe dog bite injuries, the overall location of injuries, and need for vaccination among children who presented to a Pediatric ED designated as a level III trauma center with a robust facial surgical infrastructure. This was a 6-year retrospective study. Charts were identified by International Classification of Diseases, Tenth Revision (ICD-10) codes for lacerations or injuries secondary to animal bites and accessing the hospital's trauma database. Variables abstracted were age, sex, type of injury, location, need for antibiotics, immunization states and requirement of tetanus or rabies vaccine, disposition from ED to the operating room, home, or any in-patient unit. We excluded children older than 17 years of age and children who had a post-bite injury infection or injury not initially managed in our facility or medical system. The final cohort consisted of 152 children. The median age was 52 months and age ranged from 2 to 215 months. Children with a single bite injury were older when compared with those with numerous injuries, 81 and 62 months of age, respectively. Among young children, 75% of injuries occurred above the neck and 15.1% were managed in the operating room. Twenty-four percent of children required either a tetanus or rabies vaccination. Most dog bite injuries occurred to facial structures. Comprehensive care of dog victims included awareness of both dog and injured child vaccination status. [ABSTRACT FROM AUTHOR]

A 4-year-old boy was referred to our tertiary hospital after a penetrating adnexal injury by a large-breed dog to the left orbital area. There was an increase in lacrimation, which was thought to be due to an inflammatory reaction. However, it was discovered that the lacrimation increased in the reverse-Trendelenburg position and with the Valsalva maneuver. Halo sign and beta transferrin test were positive, which led to the diagnosis of cerebrospinal fluid (CSF) fistula, and the patient was operated using a supraorbital craniotomy. A dural tear was visualized and sutured appropriately, then fibrin glue and an autologous galeal graft were applied to the tear. The CSF oculorrhea stopped postoperatively, and the patient was discharged after 10 days of follow-up. The patient had no recurrent CSF leakage at 4-year follow-up. Although CSF oculorrhea is rare and may be difficult to discern from lacrimation, the presence of pneumocephalus and halo sign should suggest fistula repair.

Introduction: India has the highest burden of animal bite cases globally, with a large proportion of the population affected by dog bites. India is endemic for rabies and accounts for 36% of the world’s rabies deaths. Mortality can be prevented by Post-Exposure Prophylaxis (PEP) with effective vaccines that are available. Vaccines are provided free of charge in Government hospitals. Aim: To estimate the compliance rate of Anti-Rabies Vaccine (ARV) regimen managed by the intradermal route. Materials and Methods: This was a cross-sectional record-based study from the ARV Register of Government Hospital, Gummidipoondi, Tamil Nadu, India. The victims of animal bite cases attending the hospital for the ARV regimen for a month were selected from the register to assess adherence to the full course updated Thai Red Cross regimen and identify any constraint factors hindering them from completing the course. Results: Out of 108 patients, 79 completed the full course ARV regimen, resulting in a compliance rate of 73.1%. Factors such as the distance of the hospital, timings, and forgotten dates were identified as major constraints. Conclusion: The compliance rate was found to be moderate, with constraint factors like forgotten dates and the distance of the hospital being significant hindrances to compliance. This highlights the importance of strengthening awareness through sensitisation programs and health education in both urban and rural areas to achieve a rabies-free India.

Background: Rabies is a viral zoonotic disease that is 100% fatal, yet 100% preventable. It is estimated that 17.4 million exposures with 20,000 deaths due to animal bites occur every year in India, with higher cases in particular seasons. Hence, this study aimed to find out the seasonal trend among animal bite victims for the past 3 years. Subjects and Methods: It was a record-based retrospective study conducted in a tertiary care hospital, Jabalpur, for a period of 2 months (September 2022 to October 2022) for the years 2018, 2019, and 2020 among 1518 victims. Data were entered into MS Excel, and descriptive statistical analysis was done using IBM-SPSS version 23.0. Results: It was observed that, majority were dog-bite victims with maximum unprovoked bite showing decrease in trend from 2018 to 2019, and then increase in 2020. In this study, maximum bites were seen in winter (23.99% in 2018, 52.61% in 2019, and 50% in 2020), followed by monsoon (12.64%) in 2018 and summer in both 2019 and 2020. Conclusion: In the study, maximum bites were noted during winter, followed by the monsoon in 2018 and summer in 2019 and 2020, showing an increase in trend and then a downfall in 2020, maybe due to the COVID-19 period lockdown. This study will help policymakers formulate appropriate plans, activities, and logistic support for the management of animal bite victims.

Dog-mediated rabies is endemic in India. The country records the highest mortality due to dog-bite-related rabies despite the availability of interventions to prevent deaths. We present a case study of the death of a 59-year-old man in a suburban town of Northeast India after a dog bite from an owned pup. Through this case study, we investigate various omissions and commissions in communities and health professionals that make rabies rampant in India. The circumstances surrounding the death were investigated by interviewing the wife, relatives, neighbour, the hospital/nursing home where the bite case was reported, the district Rapid Response Team (RRT), and the Veterinary and Animal Health Department Officer and through the information recorded in the disease outbreak report. While the biting animal was not vaccinated and had no restriction over its movement imposed by the owners, the response of the hospital staff and public authorities was delayed and inadequate. A poignant reminder of the complexities surrounding dog-mediated rabies in India, this case study calls for a holistic protocol to address dog bites through ensuring the One Health approach encompassing education, provision of post-exposure prophylaxis (PEP) and canine rabies vaccines for dogs, promotion of responsible dog ownership, and intersectoral collaboration. Moreover, strengthening communication channels through effective data exchange and encouraging synergy among healthcare, veterinary, and public health sectors is indispensable to maximize the impact of rabies prevention and control interventions.

Introduction: India has the highest burden of animal bite cases globally, with a large proportion of the population affected by dog bites. India is endemic for rabies and accounts for 36% of the world's rabies deaths. Mortality can be prevented by Post-Exposure Prophylaxis (PEP) with effective vaccines that are available. Vaccines are provided free of charge in Government hospitals. Aim: To estimate the compliance rate of Anti-Rabies Vaccine (ARV) regimen managed by the intradermal route. Materials and Methods: This was a cross-sectional recordbased study from the ARV Register of Government Hospital, Gummidipoondi, Tamil Nadu, India. The victims of animal bite cases attending the hospital for the ARV regimen for a month were selected from the register to assess adherence to the full course updated Thai Red Cross regimen and identify any constraint factors hindering them from completing the course. Results: Out of 108 patients, 79 completed the full course ARV regimen, resulting in a compliance rate of 73.1%. Factors such as the distance of the hospital, timings, and forgotten dates were identified as major constraints. Conclusion: The compliance rate was found to be moderate, with constraint factors like forgotten dates and the distance of the hospital being significant hindrances to compliance. This highlights the importance of strengthening awareness through sensitisation programs and health education in both urban and rural areas to achieve a rabies-free India. [ABSTRACT FROM AUTHOR]

• Season and photoperiod influence severe dog attack cases. • The relative risk to be injured by dogs is modulated by age, season and photoperiod. • The relative risk for DBIH in adults is higher in winter. • A positive trend for severe dog attacks was found in adults in winter and in autumn. Dog bites in humans are a serious public health problem widely documented. Although some studies report a seasonal effect on dog bite incidence, the rationale for these findings is poor. This study aimed to describe the influence of season and photoperiod on the incidence of dog bite injury hospitalizations (DBIH) in Sicily, a Mediterranean climate region, over 10 years (2012-2021). Four hundred and forty-nine cases of severe dog bites that required hospitalization were analyzed. Patients were divided into two age groups: group 1 (0-19 years) and group 2 (≥20 years). A Poisson regression general linear model analysis was used to model incidence data across seasons and photoperiods (short photoperiod [SP] and long photoperiod [LP]). The results revealed that the relative risk for group 1 is higher during summer (2.03; 95%CI 1.30-2.17) and, in general, during LP (1.788; 95%CI 1.274-2.55) when compared with autumn and SP, respectively. Comparing group 2 with group 1, a lower relative risk is observed in both summer (0.42; 95%CI 0.28-0.63) and spring (0.32; 95%CI 0.22-0.45), and in LP (0.41; 95%CI 0.31-0.53). In group 2, results showed a significant increase of DBIH during winter and autumn (P < 0.05) and in both photoperiods with a positive trend over 10 years (P < 0.05). Results from this study suggest an influence of season on DBIH modulated by the age of patients. This aspect should be considered in developing preventive approaches for dog bite injuries. [ABSTRACT FROM AUTHOR]

Copyright of Epidemiological Review / Przegląd Epidemiologiczny is the property of National Institute of Public Health - National Institute of Hygiene and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective Pediatric dog bite injuries are a major public health concern and antibiotic prophylaxis is often prescribed due to concern about the development of infection. The Infectious Diseases Society of America recommends 3‒5 days of antibiotic prophylaxis for high‐risk dog bites. The purpose of our study was to compare infection rates among patients receiving antibiotic prophylaxis and those who did not receive antibiotic prophylaxis. Methods We conducted a retrospective cohort study of children aged 3 months to 17 years enrolled in the healthcare systems’ affiliated accountable care organization (ACO). Eligible children with a dog bite injury presented at an urgent care center or emergency department between 2016 and 2019. We excluded children who were immunosuppressed or had bites that required closure by a surgeon. An electronic health record review was completed and ACO claims data were used to determine if a prescription was filled. Patients with an International Classification of Diseases (ICD)‐10 code concerning for infection within 7 days of injury were recorded as having a bite infection. Results A total of 2653 non‐immunosuppressed children presented for care of dog bite injuries and 672 children met eligibility criteria. Thirty‐five children developed an infection of their injury. Of the 539 children who received antibiotic prophylaxis, 5.8% developed an infection and 3.0% of the 133 children who did not receive antibiotic prophylaxis developed an infection (p = 0.28). Conclusion The overall infection rate for pediatric dog bite injuries was 5.2%. In our single‐center study, no difference in infection rates was found between those receiving and not receiving antibiotic prophylaxis.

The COVID-19 pandemic and subsequent lockdown measures have changed various aspects of society, including patterns of human-animal interactions. This audit investigates the incidence and severity of dog bites admitted under the plastic surgery department at a major trauma centre before and after COVID-19 lockdowns. We assessed trends in dog bite cases over the course of one year (2018) prior to the COVID-19 lockdown and one year after (2022). A time period during COVID-19 lockdown itself was not included to avoid confounding factors due to changes in healthcare provision during the pandemic. Our analysis reveals a 47 % increase in dog bites after lockdowns ended compared to before. We also demonstrate statistically significant increases in the need for operative management (90 % of patients compared to 78 %) and length of inpatient hospital stay (average 63 h compared to 51). Moreover we show that dog bites have increased in severity, with a clear increase in patients presenting with deeper tissue injuries, tissue loss and muscle, nerve, vascular or bone involvement. This represents a significant functional, cosmetic and psychological impact for patients as well as financial impact on the NHS and increased workload for plastic surgery departments. This is the first paper to examine the severity of dog bite injuries and to demonstrate a sustained effect even after the easing of lockdown measures. Our findings shed light on the potential impact of lockdown measures on human-dog interactions and highlight the importance of public awareness and prevention strategies in mitigating dog bites. Our study demonstrates that dog bite injuries increased in frequency by 47 % following COVID-19 lockdowns. Patients with dog bites are also being admitted for longer than before, requiring more operations and have more severe injuries, with some requiring skin grafting, nerve repair or more complex plastic surgery reconstruction. [ABSTRACT FROM AUTHOR]

A 4-year-old boy was referred to our tertiary hospital after a penetrating adnexal injury by a large-breed dog to the left orbital area. There was an increase in lacrimation, which was thought to be due to an inflammatory reaction. However, it was discovered that the lacrimation increased in the reverse-Trendelenburg position and with the Valsalva maneuver. Halo sign and beta transferrin test were positive, which led to the diagnosis of cerebrospinal fluid (CSF) fistula, and the patient was operated using a supraorbital craniotomy. A dural tear was visualized and sutured appropriately, then fibrin glue and an autologous galeal graft were applied to the tear. The CSF oculorrhea stopped postoperatively, and the patient was discharged after 10 days of follow-up. The patient had no recurrent CSF leakage at 4-year follow-up. Although CSF oculorrhea is rare and may be difficult to discern from lacrimation, the presence of pneumocephalus and halo sign should suggest fistula repair. : [ABSTRACT FROM AUTHOR]

Traumatic injuries are common in grey langur (Semnopithecus entellus) and are mostly associated with a fight among themselves. Tooth avulsion and luxation are some of the commonly reported dental emergencies. A 2-year-old male grey langur was presented with a history of dog bite injury on the oral cavity. On general clinical examination, the langur was dull and depressed, with physiological parameters within the normal range. A detailed examination of the oral cavity revealed a lacerated wound on the gum with avulsion of the left central and lateral maxillary incisors. The lateral skull radiograph confirmed teeth avulsion and ruled out the involvement of jaws. The langur was stabilized with fluids (normal saline and DNS @ 5 ml/kg), cefotaxime @ 20 mg/kg, and meloxicam @ 0.2 mg/kg. General anesthesia was induced with ketamine hydrochloride @ 15 mg/kg intramuscular along with lignocaine infiltration. The oral cavity was cleaned using chlorhexidine gluconate rinse (0.12%). The injured left lower central and lateral incisor teeth were removed. Excess bleeding in the gum was controlled by applying direct pressure using adrenaline-soaked gauze. The torn gum tissue was sutured using polyglactin 910 (3-0) in a simple interrupted pattern to re-approximate the wound edges. Post-bite anti-rabies vaccine and tetanus toxoid were administered subsequently. The animal recovered uneventfully.

Capnocytophaga canimorsus is a gram-negative bacterium commonly found in the saliva of dogs and cats. Despite the frequency of animal bites, infection with Capnocytophaga species is rare, and severe infections are usually associated with underlying risk factors, such as alcohol use disorder, asplenia, or immunosuppression. We describe a case of a man who presented with a purpuric rash, lower extremity edema, and acute renal failure and was found to have tricuspid valve endocarditis and infection-associated glomerulonephritis due to C. canimorsus. Despite treatment with cefepime, the vegetation increased in size and valvular function worsened. He was readmitted with an inferior wall myocardial infarction, heart failure, and pulmonary embolism. He underwent an urgent tricuspid valve replacement with a bioprosthetic valve. A 16S ribosomal RNA amplicon sequencing performed on the resected valve tissue verified involvement of C. canimorsus. Post-operatively, he had several episodes of gastrointestinal hemorrhage requiring multiple endoscopic interventions and arterial embolization. The recurrent gastrointestinal hemorrhage combined with his severe functional decline ultimately led to his death. This patient had an uncommon presentation with leukocytoclastic vasculitis and infection-associated glomerulonephritis, which revealed an underlying diagnosis of infective endocarditis due to C. canimorsus, a rare gram-negative bacterial etiology of infective endocarditis.

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Rabies, a fatal neurological disease of warm-blooded animals, is endemic and occurs throughout the year in all parts of Nigeria. A cross-sectional study was carried out to assess dog owners' knowledge, attitudes, and practices following dog bites. Umuahia North and Umuahia South Local Government Areas (LGAs) were purposively selected being active urban areas. A validated well-structured questionnaire was administered to 200 dog owners by face-to-face interviews who were consenting respondents conveniently selected from the study site. Data generated were analysed with statistical significance at p = 0.05. Out of the 200 dog owners, 172 (86%) were not aware of rabies, 48 (24%) were of the notion that rabies does not kill only animals and 52 (26%) did not know that the virus that causes rabies is found in the nerves. One hundred and fifty (75%) respondents knew that rabies could be spread through the saliva of a rabid animal, 9 (4.5%) did not know that dogs are possible common sources of rabies in Nigeria and only 125 (62.5%) knew the age at which dogs should receive the first dose of rabies vaccine. Also, a good number of them 162 (80%) knew that keeping dogs that are not vaccinated against rabies is dangerous and should be avoided. One hundred and forty five (72.5%) respondents agreed that dog handlers should always wear protective clothing, and 117 (58.5%) accepted that it is good to wash dog bi te wounds with soap and water. Age, Marital status, Occupation and Qualification were the socio-demographic variables associated with the knowledge, attitude and practice level of the respondents that were statistically significant (P=0.05). Inadequate knowledge of some aspects of rabies, negative attitudes, and practices of dog owners following dog bites are indicative of a high risk of exposure of dog owners to rabies. It is suggested that public health education targeting dog owners be implemented to increase their level of awareness of rabies. [ABSTRACT FROM AUTHOR]

Traumatic injuries are common in grey langur (Semnopithecus entellus) and are mostly associated with a fight among themselves. Tooth avulsion and luxation are some of the commonly reported dental emergencies. A 2-year-old male grey langur was presented with a history of dog bite injury on the oral cavity. On general clinical examination, the langur was dull and depressed, with physiological parameters within the normal range. A detailed examination of the oral cavity revealed a lacerated wound on the gum with avulsion of the left central and lateral maxillary incisors. The lateral skull radiograph confirmed teeth avulsion and ruled out the involvement of jaws. The langur was stabilized with fluids (normal saline and DNS @ 5 ml/kg), cefotaxime @ 20 mg/kg, and meloxicam @ 0.2 mg/kg. General anesthesia was induced with ketamine hydrochloride @ 15 mg/kg intramuscular along with lignocaine infiltration. The oral cavity was cleaned using chlorhexidine gluconate rinse (0.12%). The injured left lower central and lateral incisor teeth were removed. Excess bleeding in the gum was controlled by applying direct pressure using adrenaline-soaked gauze. The torn gum tissue was sutured using polyglactin 910 (3-0) in a simple interrupted pattern to re-approximate the wound edges. Post-bite anti-rabies vaccine and tetanus toxoid were administered subsequently. The animal recovered uneventfully. [ABSTRACT FROM AUTHOR]

An 11-year-old girl presented at the emergency service with a nasal defect caused by a dog bite in the midface. Autologous nose reconstruction in the pediatric population is challenging due to donor site morbidity and remaining facial growth. Temporary prosthetic treatment is difficult to accept due to problems with retention. We present an innovative solution using a 3D printed patient specific titanium implant for support of a nasal prosthesis. With preoperative 3-dimensional planning, the implant can be designed to find fixation in the areas with the best bone quality, avoid potential damage to tooth buds and dental roots and avoid interference to soft tissues such as the nasal septum. Clear communication between the anaplastologist, surgeon and medical engineer is crucial for treatment success. The impact of facial growth is still unclear and will have to be assessed.

Introduction: Rabies causes 100% case fatality in animal bite victims if left untreated, and it ranks as the 10th leading cause of death due to infectious diseases worldwide. India alone reports 20,000 human rabies deaths annually, accounting for one-third of global mortalities related to the disease. However, rabies is 100% preventable. The nationwide lockdown imposed from March 25, 2020, to curb the spread of the Coronavirus Disease-2019 (COVID-19) disrupted various essential health services, including Post-Exposure Prophylaxis (PEP) for rabies. Aim: to describe the socio-demographic profile of animal bite cases and assess the burden of animal bites during the pre and post COVID-19 Pandemic, specifically in patients reporting to the dedicated Anti-Rabies Clinic (ARC) of a tertiary care hospital in Hassan, Karnataka, India. Materials and Methods: A retrospective record-based study was conducted from January 2019 to November 2021 among animal bite cases reporting to the ARC at Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Data on age, gender, locality, and socio-economic status were collected from the records maintained at the ARC. All subjects with complete data in the records were included in the study. All animal bite cases were managed according to the World Health Organisation (WHO) guidelines, with necessary COVID-19 precautions taken. A total of 3,706, 3,303, and 2,144 subjects were considered for the years 2019, 2020, and 2021, respectively. Results: There was a decreasing trend in the reported cases during the pandemic. The proportion of animal bite cases among those less than 19 years old was 1,146 (30.9%), 1,124 (34.1%), and 711 (33.1%) in the years 2019, 2020, and 2021, respectively. The majority of animal bite victims were males: 2,489 (67.2%), 2,240 (67.8%), and 1,173 (54.7%) in the years 2019, 2020, and 2021, respectively. The majority belonged to the rural population, with 2,668 (72.0%), 1,057 (32%), and 1,586 (74%) in the years 2019, 2020, and 2021, respectively. However, there was an increase in the number of victims from the urban population in the year 2020, with nearly 2,246 (68%). Most of them, 2,299 (62%), 2,114 (64%), and 1,441 (67.2%) in the years 2019, 2020, and 2021, respectively, belonged to a lower socio-economic status. Category-III bites made up the majority representation in all the years 2019, 2020, and 2021. Conclusion: The number of animal bite cases reported during the pandemic was lower compared to the pre-pandemic phase. This highlights either missed reporting of cases or a reduction in exposure to animals, which decreased the risk of animal bites.

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Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of

Objective To investigate the efficacy of collagen thread and silk thread in debridement and suture of facial dog bite. Methods A total of 46 facial trauma patients who visited this department from January 2020 to June 2022 were randomly divided into the collagen thread group (n=24) and the silk thread group (n=22), and each group was treated with 5-0 absorbable surgical sutures after adequate hemostasis by electrocautery to reconstruct important muscles and morphology layer by layer. The patients in the collagen thread group were sutured with 6-0 modified absorbable collagen thread, while the patients in the silk group were sutured with No.1 silk thread. Postoperative wound infection rate, Visual Analogue Scale (VAS) score and Vancouver Scar Scale (VSS) score at 1,3 and 6 months after surgery were compared between the two groups. Results There was no significant difference in postoperative wound infection rate between two groups (P＞0.05). The VAS score of postoperative suture removal in the collagen thread group and the VSS score at 1,3 and 6 months after surgery were lower than those in the silk thread group, with statistically significant differences (P＜0.05). Conclusion The effect of collagen thread applied in debridement suture of facial dog bite is better than that of ordinary silk thread [ABSTRACT FROM AUTHOR]

Background: Rabies is a vaccine-preventable, zoonotic, viral disease affecting the central nervous system that kills approximately 59,000 people every year throughout the world. In India, an estimated 17.4 million animal bites occur annually which accounts for an incidence of 1.7%, and an estimated 20,000 human rabies death occurs per annum. The majority of rabies cases are caused by rabid dog bites. The present study was conducted to assess the awareness of MBBS interns regarding epidemiology, prevention, and management of rabies in a medical college in South India. Materials and methods: A cross-sectional study was conducted in the Department of Community Medicine of a medical college over a period of two months among 107 MBBS Interns. A predesigned semi-structured study questionnaire was used to collect the relevant data on awareness of rabies. The information regarding epidemiology, prevention, and management of rabies among the study population was noted. Collected data were entered in a Microsoft Excel sheet and analyzed by using the software IBM SPSS version 26. The results were represented in the form of percentages and proportions. Results: The majority of the study participants were females 59 (55.1%) and the males were 48 (44.9%). The mean age of study participants was 23.2 years. Awareness of the causes of rabies transmission was 75.7% in this study. Only 60.7% of the study participants were having correct knowledge of recommended time for washing of wound after a dog bite. Awareness of the type of rabies vaccine regimen given by intradermal route was present in only 41.1% of the study participants. Conclusion: The present study findings concluded that there exists a certain gap in the awareness or knowledge regarding rabies vaccination and animal bite management among medical interns. Undergraduate-level teaching curriculum in wound care, pre-exposure prophylaxis, and PEP must be practically oriented. [ABSTRACT FROM AUTHOR]

To reduce dog aggression against people, breed-specific legislation has been enacted in many countries that prohibit the raising of certain breeds or impose certain rules for dogs of these breeds. The aim of the study was to reveal the opinions of veterinarians on the aggression levels of dogs of various breeds against people and breed-specific legislation. A questionnaire targeting small animal veterinarians was applied via online or printed forms. Multinomial logistic regression analysis was applied to examine the relationship between the opinions of veterinarians about the prohibition/restriction of dog breeds and their opinions on the level of aggression of these breeds. While 29.23% of veterinarians approved the prohibition of dangerous dog breeds, 45.64% of veterinarians stated that dogs of these breeds should be restricted. However, 25.13% of the participants did not approve of breed-specific legislation for whatever reason. The Pitbull Terrier was the dog breed most approved to be banned (approximately 25% of the participants). It was followed by Dogo Argentino (15.17%), Bull Terrier (14.20%), Rottweiler (10.44%), American Staffordshire Terrier (7.74%), Japanese Tosa (7.69%), and Fila Brasileiro (7.63%), respectively. Perceptions of veterinarians about the severe aggression levels of Bull Terrier, Doberman Pinscher, Dogo Argentino, Fila Brasileiro, Japanese Tosa, Pitbull Terriers, and Rottweiler breeds are effective in adopting the "should be banned" opinion for these breeds instead of "should be free" (P < 0.05). As a result, veterinarians were of the opinion that individuals of dog breeds that can frequently exhibit aggression resulting in severe injury or death to the victim should be restricted instead of banning them. Furthermore, alternative methods focused on increasing the legal responsibilities of animal owners and educating society can be considered instead of breed-specific legislation. • Opinions of small animal veterinarians regarding the breed-specific legislation. • The majority of vets were of the opinion that dangerous breeds should be restricted. • Increasing the responsibilities of owners and educating society can be considered. • Views of veterinarians on aggression levels of breeds affect should be banned opinion. [ABSTRACT FROM AUTHOR]

Introduction: Rabies causes 100% case fatality in animal bite victims if left untreated, and it ranks as the 10th leading cause of death due to infectious diseases worldwide. India alone reports 20,000 human rabies deaths annually, accounting for one-third of global mortalities related to the disease. However, rabies is 100% preventable. The nationwide lockdown imposed from March 25, 2020, to curb the spread of the Coronavirus Disease-2019 (COVID-19) disrupted various essential health services, including Post-Exposure Prophylaxis (PEP) for rabies. Aim: to describe the socio-demographic profile of animal bite cases and assess the burden of animal bites during the pre and post COVID-19 Pandemic, specifically in patients reporting to the dedicated Anti-Rabies Clinic (ARC) of a tertiary care hospital in Hassan, Karnataka, India. Materials and Methods: A retrospective record-based study was conducted from January 2019 to November 2021 among animal bite cases reporting to the ARC at Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Data on age, gender, locality, and socio-economic status were collected from the records maintained at the ARC. All subjects with complete data in the records were included in the study. All animal bite cases were managed according to the World Health Organisation (WHO) guidelines, with necessary COVID-19 precautions taken. A total of 3,706, 3,303, and 2,144 subjects were considered for the years 2019, 2020, and 2021, respectively. Results: There was a decreasing trend in the reported cases during the pandemic. The proportion of animal bite cases among those less than 19 years old was 1,146 (30.9%), 1,124 (34.1%), and 711 (33.1%) in the years 2019, 2020, and 2021, respectively. The majority of animal bite victims were males: 2,489 (67.2%), 2,240 (67.8%), and 1,173 (54.7%) in the years 2019, 2020, and 2021, respectively. The majority belonged to the rural population, with 2,668 (72.0%), 1,057 (32%), and 1,586 (74%) in the years 2019, 2020, and 2021, respectively. However, there was an increase in the number of victims from the urban population in the year 2020, with nearly 2,246 (68%). Most of them, 2,299 (62%), 2,114 (64%), and 1,441 (67.2%) in the years 2019, 2020, and 2021, respectively, belonged to a lower socio-economic status. Category-III bites made up the majority representation in all the years 2019, 2020, and 2021. Conclusion: The number of animal bite cases reported during the pandemic was lower compared to the pre-pandemic phase. This highlights either missed reporting of cases or a reduction in exposure to animals, which decreased the risk of animal bites. [ABSTRACT FROM AUTHOR]

Simple Summary: Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. Here, we describe an assessment of dog bite incidence in Islamabad, Pakistan, from December 2019 to July 2020 using a cross-sectional study design and a mobile phone-based application to detect and record dog bites in the community. Our results suggest that future work on dog bite prevention should include a One Health approach incorporating mass canine vaccination, access to rabies vaccines and immunoglobulins, and community engagement. Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of <0.05. A total of 338 dog bite cases were captured in the World Veterinary Service (WVS) application, and most cases (n = 226, 85.6%) were reported in December 2019 with a male-to-female ratio of 2:1. Most cases were reported from the age group of 22 to 31 years (n = 178, 53%). Out of the total number of cases, 263 (78%) presented with a single anatomical location, and 174 (51%) had Category II wounds. All dog bite patients were given only the first dose of the anti-rabies vaccine at the hospital level. Real-time dog bite surveillance via a mobile-based application proved to be effective for the timely recording and management of dog bite cases. Young people were reported to be mostly affected by dog bites, and nearly half of the cases were managed in hospitals. Refresher training was conducted for medics and paramedics for mobile-based applications, dog bite management, and proper referral of cases to tertiary care hospitals. [ABSTRACT FROM AUTHOR]

Objectives: The main aim of the present study was to assess the knowledge, attitude, and practice of Kabul City residents towards Rabies. Methods: A cross-sectional questionnaire survey was carried out from September to December 2022. Eight of the 22 districts of Kabul city were selected, and after oral consent was obtained, 400 questionnaires were filled out. The data were analyzed using MS Excel and SPSS software. Results: The results of the present study showed that 85% of the sample population have heard the name Rabies while, only 46% of them had information about the disease. Three-fourths of the participants knew that Rabies is transmitted by a suspected dog bite. Furthermore, only half of the interviewees knew that Rabies is a vaccinepreventable disease. Likewise, pet animal vaccination practice against Rabies was poor among dog and cat owners. Conclusion: It is concluded that community awareness and animal vaccination practice about the disease was poor especially, in the illiterate population of the city. A comprehensive awareness campaign across the country is needed to enhance community awareness regarding Rabies. [ABSTRACT FROM AUTHOR]

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A dog bite is the most common trauma among animal bites, and it has varying severity, from simple skin lacerations to defects in whole tissue layers. Considering the aesthetic and functional importance of the nose, an appropriate reconstruction should be conducted for large and full-thickness tissue defects. Although this is quite common, literature detailing surgical reconstruction is lacking, especially in domestic journals. A 45-year-old male patient visited an outpatient clinic due to nasal trauma caused by a dog bite. The patient’s nose showed whole-layer tissue defects, with necrotic tissues at the periphery. Nasal reconstruction surgery was conducted using a forehead flap and ear cartilage composite graft. Pedicle division was conducted three weeks after primary surgery. The functional and aesthetic outcomes of the surgery were satisfactory. Our experience demonstrates that the forehead flap is a useful option for reconstructing a nose badly injured by a dog bite.

Introduction: Dog bites are a significant health concern in the pediatric population. Few studies published to date have stratified the injuries caused by dog bites based on surgical severity to elucidate the contributing risk factors.   Methods: We used an electronic hospital database to identify all patients ≤17 years of age treated for dog bites from 2013–2018. Data related to patient demographics, injury type, intervention, dog breed, and payer source were collected. We extracted socioeconomic data from the American Community Survey. Data related to dog breed was obtained from public records on dog licenses. We calculated descriptive statistics as well as relative risk of dog bite by breed. Results: Of 1,252 injuries identified in 967 pediatric patients, 17.1% required consultation with a surgical specialist for repair. Bites affecting the head/neck region were most common (61.7%) and most likely to require operating room intervention (P = 0.002). The relative risk of a patient being bitten in a low-income area was 2.24, compared with 0.46 in a high-income area. Among cases where the breed of dog responsible for the bite was known, the dog breed most commonly associated with severe bites was the pit bull (relative risk vs German shepherd 8.53, relative risk vs unknown, 3.28).  Conclusion: The majority of injuries did not require repair and were sufficiently handled by an emergency physician. Repair by a surgical specialist was required

Crepitus following an animal bite is a rare case. We report a case of a 20‐year‐old man who presented to the surgical emergency department 1 h after being bitten by a medium‐sized pet dog. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to identify which patient-level factors, if any, influence the risk of infection following dog bite wounds to the face. Materials and methods: This retrospective cohort study was conducted using the Kids' Inpatient Database (KID). The primary predictor variable was the type of facial injury. The primary outcome variable was the presence of facial infection. SPSS was used to perform statistical analyses and statistical significance was set at a P-value of < 0.05. Results: Our final sample comprised a total of 4,420 patients who suffered dog bites to the face, of which 1,237 (28.0%) resulted in infection. Open wound (n = 4,176, 94.5%) was the most common facial injury, followed by bone fractures (n = 105, 2.4%). Relative to children 16–20 years old, children who were 0–5 years old were three times more likely to develop an infection (P < 0.01). Finally, open wounds (P < 0.01) were over seven times more likely to get infected relative to fractures. Conclusions: Young children, particularly those below the age of five, are vulnerable to dog bite wounds to the face. Open wounds posed the greatest risk of getting infected. [ABSTRACT FROM AUTHOR]

Abstract Introduction Rabies post-exposure vaccination (Rabies PEV) remains the most fundamental prevention of human Rabies if administered in a timely and appropriate manner. The study was aimed to determine the proportion and determinants of non-compliance on Rabies PEV among dog bite patients in Perlis, Malaysia from July 2015 to June 2020. Methods A retrospective cohort study was conducted using Perlis Rabid Potential Animal Bite Registry data. Independent variables and compliance status were obtained from the registry. Logistic regression analysis was utilized on 507 dog bite patients. Results Most of dog bite patients were age group of 46–60 years old (23.1%), male (61.3%), Chinese (49.5%), seeking treatment less than 24 h after the exposure (78.3%), category two of exposure (76.3%) and bitten on lower extremities (57.8%) by an owned dog (58.4%). Only 19.5% were non-compliance to Rabies PEV. Siamese had significantly two-timed (AOR: 2.00; 95% CI 1.06, 3.76) odd higher to become non-compliance. Being bitten during 3rd (AOR: 0.27; 95% CI 0.12, 0.59), 4th (AOR: 0.24; 95% CI 0.11, 0.52) and 5th (AOR: 0.20; 95% CI 0.09, 0.44) year of the outbreak had significantly lower odds to non-comply with Rabies PEV. Conclusion 19.5% of dog bite patients still did not comply with the Rabies PEV series. Siamese would likely to non-comply whereas bitten on the 3rd, 4th and 5th years of outbreak less tendency to non-comply. Continuous health promotion to the public in the various languages despite outbreak status are ongoing to improve the perception of risk and benefit toward compliance of Rabies PEV.

Abstract Background Dog bites associated with the head and neck area in children are a common problem. Most of the lacerations are found in the upper lip and the nose region, and tracheal injury is rare [1]. Tracheal injury requires prompt and accurate diagnosis and treatment to rescue the patient. Especially in children, securing the airway is often more difficult than in adults because of their short neck and narrow trachea. In this report, we experienced a pediatric case of multiple dog bites with tracheal injuries in the neck. Case presentation We report the case of a 3-year-old girl who presented with multiple dog bites. There were multiple wounds on the head, face, neck, and anterior chest, and air leakage was observed from the cervical wound at the time of transfer. It was difficult to perform oral endotracheal intubation, therefore, we extended the neck wound, probed the trachea with finger, and inserted a tracheal tube directly from the cervical wound in the emergency room. Tracheoplasty and another wound cleansing were performed in the operating room. The patient was discharged on the 18th day after surgery, without further complications. Conclusion Tracheal injury from a dog bite is rare. It is important to prompt and accurate diagnosis and treatment. Children should be especially careful because of their short necks and narrow tracheas.

Dog bites injuries are a significant cause of morbidity and mortality. Conventionally, it was suggested to leave the wounds open due to probable increased risk of infections and occurrence of rabies with suturing.Recent publications indicate that primary closure does not necessarily affect the chances of infection but definitely helps in improving the quality of scar. We are presenting our experience and protocol for primary closure of all dog bite wounds. From March 2020 to February 2021, 10 consecutive patients of all ages coming to the emergency of our hospital with category 3 dog bite that penetrated the epidermis and dermis and presenting within 48 hours of injury were included. Every patient was administered first dose of anti rabies vaccine (ARV) (zero dose) for active immunisation and was also given injection tetanus intramuscularly. Mean age of patients in our study was 20.9 with range from 2 years to 90 years. Only 2/10 patients developed infections which were managed conservatively with drainage of abscess and antibiotics. Rest all patients recovered without complications. Primary closure of dog bite wounds when associated with debridement, sufficient irrigation, povidine iodine cleansing and antibiotic administration resulted in improved cosmetic appearance without increase in the rate of infection.

Abstract Crepitus following an animal bite is a rare case. We report a case of a 20‐year‐old man who presented to the surgical emergency department 1 h after being bitten by a medium‐sized pet dog.

Abstract Background Capnocytophaga canimorsus, a Gram-negative rod, belongs to the Flavobacteriaceae family and colonizes the oropharynx of dogs and cats. Infections with C. canimorsus are rare and can induce a systemic infection with a severe course of the disease. So far, only five case reports of C. canimorsus infections associated with Waterhouse–Friderichsen Syndrome (WFS) have been reported with only two of the patients having a history of splenectomy. Case presentation Here, we report a fatal case of WFS due to C. canimorsus bacteremia and mycetal superinfection in a 61-year-old female asplenic patient. Despite extensive therapy including mechanical ventilation, antibiotic coverage with meropenem, systemic corticosteroids medication, vasopressor therapy, continuous renal replacement therapy, therapeutic plasma exchange, multiple transfusions of blood products and implantation of a veno-arterial extracorporeal membrane oxygenation the patient died 10 days after a dog bite. The autopsy showed bilateral hemorrhagic necrosis of the adrenal cortex and septic embolism to heart, kidneys, and liver. Diagnosis of C. canimorsus was prolonged due to the fastidious growth of the bacteria. Conclusions The occurrence of a severe sepsis after dog bite should always urge the attending physician to consider C. canimorsus as the disease-causing pathogen. A therapeutic regimen covering C. canimorsus such as aminopenicillins or carbapenems should be chosen. However, despite maximum therapy, the prognosis of C. canimorsus-induced septic shock remains very poor. Asplenic or otherwise immunocompromised patients are at higher risk for a severe course of disease and should avoid exposure to dogs and cats and consider antibiotic prophylaxis after animal bite.

Background: Dog bites associated with the head and neck area in children are a common problem. Most of the lacerations are found in the upper lip and the nose region, and tracheal injury is rare [1]. Tracheal injury requires prompt and accurate diagnosis and treatment to rescue the patient. Especially in children, securing the airway is often more difficult than in adults because of their short neck and narrow trachea. In this report, we experienced a pediatric case of multiple dog bites with tracheal injuries in the neck. Case presentation: We report the case of a 3-year-old girl who presented with multiple dog bites. There were multiple wounds on the head, face, neck, and anterior chest, and air leakage was observed from the cervical wound at the time of transfer. It was difficult to perform oral endotracheal intubation, therefore, we extended the neck wound, probed the trachea with finger, and inserted a tracheal tube directly from the cervical wound in the emergency room. Tracheoplasty and another wound cleansing were performed in the operating room. The patient was discharged on the 18th day after surgery, without further complications. Conclusion: Tracheal injury from a dog bite is rare. It is important to prompt and accurate diagnosis and treatment. Children should be especially careful because of their short necks and narrow tracheas. [ABSTRACT FROM AUTHOR]

We present a case that illustrates the complex contexts in which forensic veterinary pathology examinations may be carried out. A wild muskrat (Ondatra zibethicus) had died after a putative bite attack from a domestic dog. Bite attacks by privately owned dogs on wild animals in Switzerland violate the Swiss civil (and/or hunting) laws, and dog owners are generally punished with a monetary fine; hence, this case appeared to be straightforward. However, the results of the subsequent post-mortem examination of the muskrat not only confirmed the presence of injuries related to the bite attack, but also detected alveolar echinococcosis (ie, infestation with Echinococcus multilocularis). Therefore, as an intermediate host of the parasite, the muskrat could have contributed to further spread of a severe helminthic zoonosis had it not been killed by the dog. It was probably an easy prey for the dog as it probably had been weakened by the disease. Furthermore, muskrats are considered as pests and invasive species, and are non-indigenous huntable game in Switzerland and other European countries in which programmes for the prevention of their further spread and endangerment of native wildlife are established. The role of the forensic veterinary pathologist in such a complex scenario is to adopt an unbiased approach and establish the facts, which in this case was to determine the cause of death and suspected perpetrator, identify any concomitant and/or underlying diseases and consider potential animal welfare issues. [ABSTRACT FROM AUTHOR]

In the field of forensic medicine, injuries due to biting can be encountered in a wide range from mild to severe - even causing death. Animal bites are common nowadays and especially affect children. Although not common, such injuries draw attention with the findings of negligence and abuse, and even deliberate injury. In this study, a pediatric case who was bitten by a pitbull dog from various parts of his body, thrown by shaking and treated in intensive care was presented. It was aimed to discuss the forensic medical responsibilities of the Forensic Medicine Units in this and similar negligent injuries, especially by evaluating the case for whom opinion was requested in terms of negligence, abuse and deliberate injury due to an incision in the throat.

Abstract Background Capnocytophaga canimorsus infection happens frequently in immunosuppressed patients with reported domestic animal bites. Clinical presentation ranges from simple cellulitis to fulminant septic shock with disseminated intravascular coagulopathy, with an overall mortality of 30%. Conventional blood culture is often negative as this is a slow-growing pathogen. Nevertheless, the increasing use of 16S rRNA gene amplification and Sanger sequencing allows a much more rapid diagnostic confirmation. We present two case reports where 16S rRNA gene sequencing helped to diagnose Capnocytophaga canimorsus infection. Case presentation Case 1: A 53-year-old man with a history of non-cirrhotic chronic alcohol consumption was admitted to the intensive care unit (ICU) for septic shock and disseminated intravascular coagulopathy (DIC) of unknown origin. Blood cultures remained negative and a 16S rRNA PCR was performed leading to the identification of Capnocytophaga Canimorsus on day 4. Targeted antibiotic therapy with ceftriaxone for 14 days lead to overall recovery. Afterwards, the patient recalled a dog bite 2 days before hospitalization with a punctiform necrotic wound localized on a finger, which was not obvious at admission. Case 2: A 38-year-old man arrived to the emergency department for acute alcohol intoxication and history of a dog bite 2 days before. At admission, septic shock with purpura fulminans was diagnosed and required ICU hospitalization, invasive mechanical ventilation, vasopressor support and renal replacement therapy due to the rapid clinical deterioration. In the context of septic shock with purpura fulminans, DIC and recent dog bite, the diagnosis of Capnocytophaga canimorsus septic shock was suspected, and early confirmed by 16S rRNA PCR coupled to Sanger sequencing on day 2. Blood cultures became only positive for Capnocytophaga canimorsus 5 days after admission. Ceftriaxone alone was infused for 10 days in total, and the patient was discharged from the ICU on day 25. Conclusions 16S rRNA gene PCR proves an important diagnostic tool when facing a sepsis of unknown origin. In these two cases of septic shock related to Capnocytophaga canimorsus, initial blood cultures remained negative at 24 h, whereas the diagnosis was achieved by 16S rRNA PCR sequencing performed from blood samples obtained at admission.