Cases reported "Bites and Stings"

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1/18. Unusual injury pattern in a case of postmortem animal depredation by a domestic German shepherd.

    A case is presented of a 38-year-old woman with skeletization of the head, neck, and collar region and a circumscribed 26-cm x 19-cm defect on the left chest with sole removal of the heart through the opened pericardium but undamaged mediastinum and lungs. The injuries showed V-shaped puncture wounds and superficial claw-induced scratches adjacent to the wound margins that have been described as typical for postmortem animal depredation of carnivore origin and derived from postmortem animal damage by the woman's domestic German shepherd. The circumscribed destruction of the left chest with unusual opening of the pericardium is explained by the physiognomy of the muzzle of the German shepherd and differs from previous reports. Any case presented as postmortem animal mutilation should be viewed with skepticism and undergo a full autopsy.
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2/18. Catfish spine envenomation: a case report and literature review.

    Catfish spine envenomations are common injuries, reported in both freshwater and saltwater. Such injuries are complex puncture wounds, often complicated by severe infection. signs and symptoms range from simple local pain and bleeding to systemic manifestations with hemodynamic compromise. Care and treatment involve aggressive pain management, judicious wound cleansing, prophylactic antibiotics, and close follow-up. A case of catfish spine envenomation from a freshwater catfish is presented here.
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3/18. Sea urchin puncture resulting in PIP joint synovial arthritis: case report and MRI study.

    Of the 600 species of sea urchins, approximately 80 may be venomous to humans. The long spined or black sea urchin, Diadema setosum may cause damage by the breaking off of its brittle spines after they penetrate the skin. Synovitis followed by arthritis may be an unusual but apparently not a rare sequel to such injury, when implantation occurs near a joint. In this case report, osseous changes were not seen by plain x-rays. magnetic resonance imaging (MRI) was used to expose the more salient features of both soft tissue and bone changes of black sea urchin puncture injury 30 months after penetration. In all likelihood, this type of injury may be more common than the existing literature at present suggests. It is believed to be the first reported case in this part of the world as well as the first MRI study describing this type of joint pathology. Local and systemic reactions to puncture injuries from sea urchin spines have been described previously. These may range from mild, local irritation lasting a few days to granuloma formation, infection and on occasions systemic illness. The sea urchin spines are composed of calcium carbonate with proteinaceous covering. The covering tends to cause immune reactions of variable presentation. There are only a handful of reported cases with sea urchin stings on record, none of them from the Red Sea. However, this condition is probably more common than is thought and can present difficulty in diagnosis. In this case report, the inflammation responded well to heat treatment, mobilization and manipulation of the joint in its post acute and chronic stages. As some subtle changes in soft tissues and the changes in bone were not seen either on plain x-rays or ultrasound scan, gadolinium-enhanced MRI was used to unveil the marked changes in the joint.
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4/18. Occult craniocerebral injuries from dog bites in young children.

    Although dog bite injuries to the head and scalp of children occur frequently, penetrating dog bite wounds to the cranial vault occur only occasionally and may go unnoticed on initial examination. Substantial morbidity and mortality can ensue if these penetrating injuries are not detected and treated. The authors detail the evaluation of dog bites of the scalp in young children. They highlight the ease with which puncture wounds of the calvarium may be missed during physical examination as a result of scalp displacement at the time of puncture. The cranial puncture may not be large and may later be covered by scalp that returns to its native position. Well-scrutinized skull films and a careful, methodical physical examination are advocated. Recognized craniocerebral injuries should be explored. Depressed cranial fractures should be irrigated, debrided, and elevated. Dural tears should be repaired. Expedient management is necessary to prevent meningitis and its associated sequelae.
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5/18. Centipede (Scolopendra gigantea Linneaus 1758) envenomation in a newborn.

    The first case of centipede (Scolopendra gigantea Linneaus 1758) envenomation in a newborn is reported. When first examined, approximately 6 hours after the bite, the 28-day-old girl was irritable, with uncontrollable cry and intense local pain, oedema, local hyperthermia, and blood clots at punctures. Uncontrollable crying in neonates should rise the possibility of an insect or arachnid sting.
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6/18. Fatal weeverfish sting.

    We report a case of fatal weeverfish sting. An 18-year-old man was stung on the left leg by a weeverfish, which he was attempting to capture while snorkelling off the coast of Majorca (spain). The man felt intense pain, but managed to swim to his boat where he lost consciousness after boarding rapidly. An hour later, when examined by a doctor, the subject was found to be in cardiorespiratory arrest. Reanimation manoeuvres were unsuccessful. The most import post-mortem findings were in the skin and lungs. A puncture wound, which traversed the greater saphenous vein and was covered by an intense haemorrhagic infiltrate, was observed in the skin. The lungs showed haemorrhagic alveolar oedema.
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7/18. Hyperbaric oxygen therapy in the treatment of soft tissue necrosis resulting from a stingray puncture.

    Necrotizing soft tissue processes of the foot secondary to an acute stingray envenomation can be a challenge to manage. Very little is reported in the orthopaedic literature to aid the practicing surgeon faced with this problem. In this case report, we describe the wound management and team approach employed in this patient's care, including the indications for hyperbaric oxygen therapy, which, in this case, was ultimately successful.
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8/18. Catfish spine envenomation: a case of delayed presentation.

    Catfish spine envenomations can result in debilitating hand problems. Virulent bacteria may be introduced through a puncture wound. An offending organism may be difficult to culture, and a foreign body may be missed unless there is a high index of suspicion. The majority of cases present early and symptoms resolve within 3 months. We report a markedly delayed presentation and treatment of a catfish "finning" injury that resulted in chronic tenosynovitis to the hand. A review of the literature and current treatment recommendations are provided.
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9/18. tenosynovitis caused by mycobacterium kansasii associated with a dog bite.

    A 68-year-old man with adult-onset diabetes mellitus suffered an accidental puncture wound to the palm of his hand while playing with his pet dog. He received cephalosporin prophylaxis for 1 week. No inflammation occurred. Six months later, a mass developed near his elbow. It was removed. Histopathology revealed granulomas containing acid-fast bacilli (AFB). No culture was done. Swelling and decreased motion of the wrist and fingers developed. magnetic resonance imaging revealed inflammation of the flexor compartment of the hand, wrist, and forearm. Surgical incision and drainage yielded purulent material, granulomatous inflammation, with AFB. Cultures yielded mycobacterium kansasii. Several surgical procedures were required; M kansasii was recovered. He received isoniazid and rifampin for 1 year and prolonged rehabilitation. After 4 years, he was relatively asymptomatic, with good function of wrist and fingers. We believe this to be the first report of tenosynovitis caused by M kansasii in association with a dog bite.
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10/18. Catfish-related injury and infection: report of two cases and review of the literature.

    Two cases of serious infection following catfish spine-related injuries are presented, and the literature on this topic is reviewed. The organisms usually involved in such infections are vibrio species, aeromonas hydrophila, enterobacteriaceae, pseudomonas species, and components of the flora of the human skin. Irrigation, exploration, and culture of these wounds as well as immunization of the patient against tetanus are recommended. patients with hepatic disease or chronic illness and immunocompromised individuals are at unusually high risk of fulminant infection due to vibrio and Aeromonas species and should be treated with antibiotics after sustaining a water-associated wound. patients with normal host defense mechanisms but with late wound care, punctures involving a bone or a joint, progressive inflammation hours after envenomation, fever, or signs of sepsis are at high risk for secondary infection and should receive definitive wound care and antibiotics. For moderate to severe infections, one of the following combinations constitutes a reasonable empirical regimen: (1) a tetracycline and a broad-spectrum, beta-lactamase-stable beta-lactam antibiotic, or (2) a tetracycline, a beta-lactamase-stable penicillin, and an aminoglycoside.
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