PERSPECTIVE 27.1 Infection Caused by a Human "Bite"

A 26-year-old man injured the knuckle of the long finger of his right hand during a tavern brawl when he punched an assailant in the mouth. Due to his inebriated condition, a night spent in jail, and the insignificant early appearance of his knuckle wound, the man did not seek medical help until more than 36 hours later. At that time, his entire hand was massively swollen, red, and tender. Furthermore, the swelling was spreading to his arm.The surgeon cut open the infected tissues, allowing the discharge of pus. He removed the damaged tissue and washed the wound with sterile fluid. Smears and cultures of the infected material showed aerobic and anaerobic bacteria characteristic of mouth flora, including species of Bacteroides and Streptococcus. The patient was given antibiotics to combat infection, but the wound did not heal well and continued to drain pus. Several weeks later, X rays revealed that infection had spread to the bone at the base of the finger. To cure the infection, the finger had to be amputated.

wound thoroughly with sterile fluid, and removing dirt and dead tissue. The choice of antibacterial medication includes one effective against anaerobes.

The main features of human bite wound infections are presented in table 27.10.

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