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Animal bites





Animal bites

Causes of bites

Animal and human bites occur for a number of reasons, depending on the animal or person involved and the circumstances.

An animal bite that becomes infected should be seen by a healthcare professional. Humans bites should always be assessed by a healthcare professional. 

Dog bites

Many dog bites are unprovoked. A family dog or a dog that belongs to a friend or neighbour is usually responsible.

Dogs are territorial creatures and sometimes perceive innocent actions as an invasion of their territory. They may interpret certain actions as hostile acts, prompting them to bite.

Actions that may cause a dog to bite include:

  • disturbing it when it’s sleeping/eating/caring for its puppies
  • running, screaming or shouting in its presence
  • being petted by someone they don’t know (always let a dog smell your hand before stroking it)

Some dogs, particularly young ones, can get over-excited when playing, and may accidentally give a friendly nip. Dogs that are sick or in pain can also react unpredictably.

The dogs that are most likely to cause more severe bites are the larger and stronger breeds. These include:

  • German shepherds (alsatians)
  • pit bulls (breeding, selling or exchanging pit bulls is banned in England under the Dangerous Dogs Act 1991)
  • rottweilers
  • dobermans
  • chows

However, any breed of dog should be regarded as being potentially dangerous, and smaller dogs - such as Jack Russells, dachshunds and chihuahuas - are often more aggressive than larger dogs.

Cat bites

It’s estimated that the majority of cat bites come from stray, female cats. All cats are predators and they can react unpredictably. This is particularly true of undomesticated cats (those that aren’t used to living in a house with people).

Around one in five cat bites are from a person’s own cat. A pet cat may bite if they:

  • mistake a sudden action as an aggressive act
  • get excited when playing - they may jump at and bite a moving object, such as your hand
  • can’t attack their intended target, such as another cat - they may lash out at the nearest target

Sometimes, for reasons that are unclear, an apparently contented cat can suddenly bite their owner after being petted for a few minutes.

Human bites

Most human bites occur when one person punches another person in the teeth (these are know as fight-bites). Young men who have been drinking heavily are usually those involved.

Intentional bites are common in very young children and in people with severe learning difficulties, as these groups are often unaware that such behaviour is socially unacceptable.

Accidental bites can happen during contact sports, such as rugby and football, when a person accidentally knocks another person’s teeth.

Accidental bites can also occur during vigorous sexual activity, particularly oral sex. Although you may feel embarrassed, always seek medical treatment for this type of accidental bite, because there’s a high risk of it becoming infected.

Other causes of human bites include:

  • domestic violence or sexual assault 
  • accidentally biting your tongue during a seizure (fit)
  • self-inflicted biting, which can sometimes occur in people who are emotionally disturbed or mentally disabled

Other types of animal bites

Bites from pets such as hamsters, rabbits and guinea pigs tend to be less common and less serious than bites from dogs and cats. However, they can sometimes occur when children stick their fingers through the bars of the pet’s cage.

Bites from animals other than pets are less common in England, but they are more of a concern for certain occupations. For example, people who work with pigs are sometimes bitten, and monkeys and apes can be a problem for zoo and laboratory workers.

Read more about how to avoid bites.  

Published Date
2014-04-02 10:00:21Z
Last Review Date
2014-03-28 00:00:00Z
Next Review Date
2016-03-27 00:00:00Z
Classification






Animal bites

Complications of bites

The main complication that can occur from animal or human bites is infection.

Infected bites rarely cause serious problems, as long as they’re treated promptly with antibiotics.

However, they can lead to more serious secondary infections, including: 

Signs of a serious secondary infection include having a high temperature (fever) of or above 38°C (100.4°F) or feeling unwell.

Contact your GP immediately if you think you may be developing a more serious secondary infection. If this isn’t possible, you can telephone NHS 111 or your local out-of-hours service for advice.

Post-traumatic stress disorder (PTSD)

It’s estimated that around 1 in 4 children who require hospital treatment for a severe dog bite (and 1 in 10 who require treatment for a moderate dog bite) will develop post-traumatic stress disorder (PTSD).

This is an anxiety disorder caused by very stressful, frightening or distressing events. In children, this usually takes the form of repeated nightmares and becoming very nervous and frightened around dogs.

Other symptoms of PTSD in children may include:

  • refusing to go outside on their own 
  • becoming unusually shy or aggressive with friends and family 
  • a lack of interest in games or school activities
  • fear of the dark
  • fear of being left alone

PTSD may get better by itself within a couple of months. However, if the symptoms persist or get worse, your child may require treatment.

Treatment options for PTSD in children include cognitive behavioural therapy (CBT), which is a type of talking therapy that aims to change patterns of negative thinking or behaviours.

CBT for PTSD often focuses on helping the child realise that while fear and distress are very real and upsetting emotions, it’s possible to control them.

You should never force your child to be in close contact with a dog in an attempt to overcome their fears, if they are obviously distressed. This could make the problem worse.

Read more about treating post-traumatic stress disorder.

Tetanus

Tetanus is a rare but serious bacterial infection that usually occurs when a flesh wound becomes contaminated.

It’s possible to catch tetanus from an animal or human bite. The bite itself doesn’t cause tetanus, but the break in the skin can allow tetanus bacteria (Clostridium tetani) to enter your body.

The most common symptom of tetanus is stiffness in your jaw muscles (sometimes known as lockjaw), which can make it difficult to open your mouth. Muscle stiffness and spasms can also spread to other parts of your body.

The symptoms of tetanus can develop between 4 and 21 days after the infection has taken place (known as the incubation period).

You may be given tetanus immunoglobulin (TIG) if you have a bite that’s at risk of being infected by tetanus. TIG is medication that contains antibodies (infection-fighting proteins). The antibodies neutralise the toxins produced by the bacteria that cause Clostridium tetani.

TIG is injected into a muscle and provides immediate, short-term protection against tetanus.

Read more about how to treat tetanus.

Immunisation is the best way to prevent the condition. The complete course of the tetanus vaccination is five doses. In the UK, all children are routinely offered the tetanus vaccination as part of the NHS childhood vaccination programme.

As an adult, if you’re unsure about whether or not you’ve been fully immunised against tetanus, speak to your GP or practice nurse. They’ll be able to advise you about having a booster injection.

Rabies

Rabies is a potentially fatal infection of the nervous system. You can catch it if you’re bitten by an infected animal. In rare cases, rabies can also be caught if an infected animal licks an open wound, such as a scratch or abrasion.

Most cases of rabies occur in Africa, Asia (particularly India) and central and southern America. Some cases have been reported in Europe - mostly in Eastern Europe.

If you’re bitten by any animal while in these areas, you should seek medical advice as soon as possible because you  may need urgent treatment, including vaccination.

You may need immunisation for rabies if you’re visiting these areas or if your job involves coming into contact with animals that have been imported from abroad.

Read more about the rabies vaccination and who should have it.

It was thought that rabies had been wiped out in all animals in the UK. However, some bats have been found to carry the disease. If you’re bitten by a bat in the UK, your bite should be immediately assessed and, as a matter of urgency, you should be given the rabies treatment to prevent rabies developing. The same advice applies if you’ve been bitten by an animal while abroad in a country where rabies is widespread.

Treatment to prevent rabies developing after a bite is known as post-exposure prophylaxis. You’ll be given one dose of rabies immunoglobulin (a blood product that contains antibodies against the disease) and five doses of the rabies vaccine. If exposure to rabies is uncertain, the vaccination on its own may be considered.

Read more about how to prevent bites.

Published Date
2014-04-02 09:59:17Z
Last Review Date
2014-03-28 00:00:00Z
Next Review Date
2016-03-27 00:00:00Z
Classification
Cognitive behavioural therapy,PTSD,Rabies,Tetanus






Animal bites

Introduction

Animal and human bites can become infected if they’re not assessed and treated promptly.

Animals have bacteria in their mouths that can infect you if you’re bitten. Therefore, you should always seek medical advice unless the wound is very minor (see below).

Human bites should always be assessed by a healthcare professional, as there is a high risk of infection.

Cleaning the wound

If the wound from an animal bite is small, you can clean it yourself using tap water before seeking medical advice (see below).

If the wound is bleeding heavily, put a clean pad or sterile dressing over it and apply pressure.

Large, deep or dirty wounds should be assessed and treated by a healthcare professional.

Seeking medical advice

Always seek medical advice if you’ve been bitten by an animal or human, unless the wound is very minor and you’re confident it doesn’t need medical attention.

Minor bites can be treated by your GP or staff at your local walk-in centre or minor injuries unit. For more severe bite wounds involving bones, joints or tendons, visit your nearest accident and emergency (A&E) department.

The hospital doctor or nurse will assess, clean and dress the wound. If you have an open wound that is bleeding excessively, it may be stitched up straight away to prevent blood loss, despite the risk of infection. An infected wound can lead to serious complications (see below).

A short course of antibiotics may be prescribed for large or deep wounds, to prevent infection. Antibiotics are also used when a person has a weakened immune system - for example, as a result of a health condition such as HIV and AIDS, or from receiving certain treatments such as chemotherapy.

Read more about the symptoms of animal bites and treating animal and human bites.

Common types of bites

Most animals are capable of biting, but dog bites tend to be the most common animal bite, followed by cat bites.

Dog bites

Young children are often bitten by dogs, particularly boys aged five to nine years old.

Male dogs are usually responsible and are either family pets or dogs that belong to friends or neighbours.

Bites from stray dogs are rarer because strays are often wary of humans and usually keep their distance.

Cat bites

Most cat bites (about 70%) are caused by pet cats. Elderly women are often bitten on the hand while feeding or stroking a cat.

As cats are predators, they can sometimes react unpredictably, particularly if they’re undomesticated (not used to living with people).

Human bites

Most human bites occur during fights when a person punches someone in the teeth.

These types of bites are known as closed-fist bites or “fight bites”. Men aged 16-25 are most likely to experience them as they’re most likely to get into fights.

Read about the causes of animal and human bites.

Complications of animal bites

A bacterial infection is the most common complication of an animal or human bite.

The saliva of mammals contains hundreds of millions of bacteria from many different species, many of which can cause an infection.

Signs that a bite has become infected include:

  • redness and swelling around the wound
  • the wound becoming more painful
  • fluid or pus leaking from the wound
  • a high temperature or flu-like symptoms if bacteria enter the bloodstream

Read about the symptoms of an infected animal bite.

Seek immediate medical advice if you think a bite has become infected. Although uncommon, infected animal and human bites can lead to more serious secondary infections, including:

Read more about the complications of animal and human bites.

Avoiding bites

Never leave a child unsupervised with a dog, regardless of what type of dog it is or its previous behaviour.

Many of the more serious dog bites occur when a child is left alone with a dog.

Other things you can do to avoid being bitten by an animal or human include:

  • respecting a dog’s boundaries - like many animals, dogs have a strong sense of personal space
  • not approaching an unfamiliar cat - it could be a stray and react aggressively
  • avoiding binge drinking - most people who end up in fights were drinking heavily

Read more about preventing animal and human bites.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Published Date
2014-07-14 11:09:10Z
Last Review Date
2014-03-28 00:00:00Z
Next Review Date
2016-03-27 00:00:00Z
Classification
Antibiotics,Blood






Animal bites

Preventing bites

Never leave a child unsupervised with a dog, regardless of what type of dog it is or its previous behaviour.

Even if a dog has no previous history of biting, it can still bite. A dog breed’s reputation or appearance is also no guarantee of a dog’s behaviour. Family dogs such as labradors, collies and terriers have all been involved in fatal attacks.

Follow the below advice to help you and your children prevent dog bites:

  • Avoid making your dog too important within the family. Don’t let them sleep on the furniture or beg for food. This can sometimes confuse a dog, making it think it has a higher status within the family group. If someone, such as a young child, challenges that status, the dog may react aggressively.
  • Dogs love to chase things, so you and your children should avoid running or screaming in the presence of a dog.
  • Respect a dog’s boundaries - like many animals, they have a sense of personal space. If you suddenly approach a dog, they can react unpredictably. Don’t greet a dog with an outstretched hand and don’t suddenly interrupt a one when it’s eating, sleeping or playing with a toy. Also, don’t pet a dog without letting it sniff you first.
  • Socialise your dog by allowing it to experience many different types of people, situations and environments. This will help stop your dog becoming frightened or nervous if it finds itself in unfamiliar circumstances or when meeting new people.

Signs that a dog is becoming aggressive and may be about to bite include the:

  • dog’s hairs on its back rising up
  • dog baring its teeth
  • dog’s ears moving forwards or backwards against their head
  • dog staring directly at you
  • the dog’s legs stiffening

If you’re presented with an aggressive dog, you should stand still with your feet together, your arms placed against your chest and your fists folded below your neck. Avoid direct eye contact, as the dog may interpret it as an aggressive act.

Don’t attempt to run away from the dog. By standing still, it should lose interest, giving you the chance to back away slowly.

If a dog jumps on you and knocks you to the ground, try to lie still, face down, with your legs together and your fists behind your neck, and your forearms covering your ears. Once the dog realises that you’re not moving, it should lose interest and move away.

Cat bites

As many cat bites are from strays, avoid disturbing or stroking a cat that you don’t know.

If your cat is attempting to bite or jump at your hands and feet while it’s playing (playful aggression), don’t push them away with your hands, because this can reinforce the pattern of behaviour. Instead, use a water spray to discourage them.

Using a sock or small felt toy on the end of a string that you can drag around the room is a good way of letting your cat play without encouraging bad behaviour.

Human bites

Most human bites are the result of alcohol-related violence and disorder. Therefore, the most effective way to avoid being involved in this type of incident is to moderate your alcohol consumption and avoid binge drinking.

Read more about alcohol misuse, including the risks associated with heavy drinking and how to avoid them.

Published Date
2014-04-02 09:58:30Z
Last Review Date
2014-03-28 00:00:00Z
Next Review Date
2016-03-27 00:00:00Z
Classification
Rabies,Tetanus,Travelling outside the European Economic Area






Animal bites

Symptoms of bites

The symptoms of animal bites vary depending on the type of animal involved.

Dog bites

Dog bites usually cause a deep, narrow hole in the skin (puncture wound). They can also cause a jagged wound or cut (laceration) and scrapes to the skin (abrasions).

This is because dogs use their front teeth to “pin” their victim, and their other teeth to bite and pull at the surrounding skin.

In adults, most animal bites are to the hands, arms, legs or feet. As children are smaller, most bites are to the face - usually their lips, nose or cheek.

Cat bites

A cat’s jaws aren’t as strong as a dog’s, but their teeth are sharper and often cause very deep puncture wounds. A cat bite is capable of penetrating bones and joints.

Lacerations and abrasions are less common than in dog bites, but claw wounds can pass on infections because cats lick their paws.

In adults, most cat bites are to the upper limbs, particularly the fingers and hands. In children, the face and neck can also be bitten, as upper limbs.

Even small bites or scratches can lead to infections. Very occasionally, an unusual infection called “cat scratch disease” can develop, caused by a bacterium known as Bartonella henselae.

Human bites

Most human bites are the result of a closed-fist injury, where one person punches another person in the teeth and cuts their hand. Typical symptoms include small cuts to the hand and red, swollen and painful skin.

Bites that occur to the finger when someone is punched in the mouth, known as occlusional bites, can sometimes lead to bacteria being implanted deep into the tissues. This can result in bone infection.

Very occasionally, viruses can be transmitted by human bites. The chances of infection occurring are about 10 times lower than after a needle stick injury or direct transmission via blood contamination. However, all human bites should be taken seriously and be assessed by a healthcare professional.

You will need to have blood tests, and you may be offered a hepatitis B vaccination and other tests, depending on the actual circumstances of the bite injury.

Signs and symptoms of infection

Signs and symptoms that suggest a bite wound has become infected include:

  • redness and swelling around the wound
  • the wound becoming more painful
  • liquid or pus leaking from the wound
  • swollen lymph glands (nodes)
  • a high temperature (fever) of 38°C (100.4°F) or above
  • shivers

When to seek medical advice

If you or your child is bitten by an animal, seek immediate medical attention (unless the bite is very minor).

Animals have bacteria in their mouth, which can cause infection if you’re bitten. Even small cat bites can sometimes penetrate deeply and become infected.

Human bites have a very high risk of becoming infected, so you should always seek immediate medical attention rather than waiting for any symptoms of infection to appear.

If you have a lowered immune system, it’s also very important that you seek immediate medical attention if you’re bitten by an animal or human.

Lowered immunity (immunosuppression) may be caused by a pre-existing health condition that increases your risk of infection, such as diabetes, liver disease or HIV. It can also occur after having certain types of treatment, such as chemotherapy or a splenectomy (removal of the spleen).

Minor bites can be treated by your GP or by staff at your local walk-in centre or minor injuries unit. For more severe bite wounds involving bones, joints or tendons, visit your local accident and emergency (A&E) department.

Published Date
2014-04-02 10:00:53Z
Last Review Date
2014-03-28 00:00:00Z
Next Review Date
2016-03-27 00:00:00Z
Classification
Cuts and grazes






Animal bites

Treating bites

If you’ve been bitten by an animal or human, clean the wound immediately.

Remove anything from the bite, such as teeth, and clean the wound thoroughly by running warm tap water over it for a couple of minutes.

Encourage the wound to bleed by gently squeezing it, unless it’s already bleeding freely. If the bite is painful, you can take painkillers, such as paracetamol or ibuprofen.

Children under 16 years of age shouldn’t take aspirin.

If the animal bite is very severe, it’s possible that a body part, such as a finger or ear, may have been bitten off. If this is the case, wash the body part with tap water and place it in a plastic bag or sealed container.

Put the container into a tub of iced water (but not frozen) to keep it cool, so that it can be transported to hospital. It may be possible to re-attach the body part using reconstructive surgery.

Medical treatment

Severe bites that need medical treatment will be cleaned, with any damaged or dead tissue removed (known as debridement).

If there’s a risk of infection, the wound will be left open, as this makes it easier to keep it clean. If the risk of infection is believed to be low, the wound can be stitched up.

Wounds that bleed excessively will be closed to prevent blood loss, despite the risk of infection.

Antibiotics

Antibiotics are given as a precaution when it’s believed there’s an increased risk of infection. They’re usually recommended for:

  • all cases of cat bites
  • all cases of human bites
  • animal bites to the hands, feet or face
  • any bites that have caused puncture wounds
  • wounds that need to be closed due to excessive bleeding
  • wounds that require debridement (removal of damaged tissue)
  • wounds that involve joints, ligaments or tendons
  • people with prosthetic (artificial) joints or valves
  • people with a weakened immune system (immunosuppression) from a health condition such as diabetes or HIV, or as a side effect of treatments such as chemotherapy or a splenectomy (removal of the spleen)

In most cases, a three-day course of an antibiotic called co-amoxiclav is recommended, as it’s a broad-spectrum antibiotic (effective against a wide range of different bacteria).

Co-amoxiclav is available in tablet or liquid form. Possible side effects include nausea, vomiting and diarrhoea.

Co-amoxiclav belongs to the penicillin family of antibiotics, so it won’t be suitable for you if you have a previous history of penicillin allergy (which affects around 1 in 15 people).

If you do, you should tell the doctor in charge of your care. Alternative antibiotics are available, such as doxycycline or ciprofloxacin hydrochloride in combination with metronidazole.

Additional treatment

Additional treatment may be required if you have:

  • a deep puncture wound that may have damaged bones, joints, muscles, tendons or nerves
  • a facial wound
  • a bite where a foreign body, such as a tooth, may be embedded in the wound
  • a wound to an area with a reduced blood supply, such your nose or ears (wounds to these areas could take longer to heal and have a higher risk of infection)
  • an infected wound that doesn’t respond to treatment

Further reconstructive surgery may be required for serious or complex wounds. Serious infections, or infections that don’t respond to oral antibiotics, can be treated with injections of antibiotics (intravenous antibiotics).

Blood tests and X-rays

If you’ve been bitten by a human, you’ll be asked if you or they could have a blood-borne virus, such as hepatitis Bhepatitis C or HIV, which could have been spread by the bite.

If you’re unsure and it’s thought there may be a high risk of infection, you may be referred for blood tests and offered a course of hepatitis B vaccinations.

For example, you may need to have blood tests if you were bitten by a person known to inject illegal drugs, as this increases your risk of contracting a blood-borne virus.

Although cases have been reported, the chance of hepatitis B, hepatitis C or HIV being spread by a bite is believed to be low.

You may be referred for an X-ray if you have a closed-fist bite (a bite to your hand from contact with someone else’s teeth). This is because there’s a small chance a fragment of tooth could be embedded in your fist.

Published Date
2014-04-02 09:59:42Z
Last Review Date
2014-03-28 00:00:00Z
Next Review Date
2016-03-27 00:00:00Z
Classification
Antibiotics,Aspirin,Brain,First aid,Liver