Animal Bite-associated Infections

Microbiology and Treatment

Nicole Thomas; Itzhak Brook

Expert Rev Anti Infect Ther. 2011;9(2):215-226.

Nonhuman Primate Bites

Monkey bites are not common in the USA. They can, however, present in returned travelers and zoo or lab workers. The bites inflicted by the nonhuman primates can be severe, and infection is common. The bacteriology of simian bite wounds is diverse and includes α-hemolytic and other Streptococci, Enterococcus spp., Staphylococcus epidermidis, Enterobacteriaceae, Bacteroides, Fusobacterium spp. and Eikenella corrodens have also been isolated.^[44] In addition to the risk of a polymicrobial bacterial infection, similar to that seen after human bites, the transmission of viral infections is also possible.

Monkeys may transmit rabies, and prophylaxis should be given if the bite occurred in a rabies-endemic area. Simian herpes virus B (also called Cercopithecine herpes virus 1, herpes B, monkey B virus or herpes virus B) may also be transmitted via the bites of macaque monkeys.^[45] Infections with this virus can lead to rapidly fatal encephalomyelitis. It is not known whether postexposure prophylaxis is beneficial, however 14 days of oral valacyclovir is recommended if an individual is scratched or bitten by a macaque.^[46]

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Table 1. Microbiology and antimicrobial therapy of bite infections.
Animal	Organism	Empiric antibiotic therapy
Human	Eikenella corrodens Viridans Streptococci Staphylococus aureus Coagulase-negative Staphylococus Corynebacterium Bacteroides Peptostreptococcus Hepatitis B/C HIV	Oral Amoxicillin/clavulanate (Augmentin®, GlaxoSmithKline, Brentford, UK) OR Moxifloxacin (only suitable for patients >18 years of age) Intravenous Ampicillin/sulbactam OR Piperacillin/tazobactam OR Cefoxitan OR Ertapenem PCN allergic Moxifloxacin (only suitable for patients >18 years of age); Doxycycline (only suitable for patients >8 years of age) OR Metronidazole or clindamycin PLUS Trimethoprim/sulphamethoxazole OR Another fluoroquinolone (ciprofloxacin/levofloxacin)
Dog	S. aureus/intermedius Pasteurella canis/multocida Capnocytophaga canimorsus Streptococcus spp. Moraxella spp. Clostridium spp. Bacteroides Fusarium	Same as human
Cat	Pasteurella multocida Streptococcus spp. (especially S. pyogenes) S. aureus Moraxella spp. Fusobacterium Bacteroides Porphyromonas	Same as human
Nonhuman primates	Mixed flora (aerobic/anaerobic) Streptococcus spp. Neisseriae spp. Haemophilus influenzae Enterobacteriaceae Simian Herpes B	Same as human + Valacyclovir
Rodents	Streptobacillus moniliformis Spirillum minus Salmonella spp. Staphylococcus Leptospira Pasteurella Corynebacterium Fusobacterium	Same as human
Ungulates	Polymicrobial Actinobacillus spp. Pasteurella spp. Staphylococcus spp. Viridans Streptococci (Streptococcus equi)	Same as human
Reptiles (i.e., crocodiles/alligators)	Aeromonas hydrophila Pseudomonas Proteus vulgaris Enterobacter Citrobacter Burkholderia Serratia spp. Mixed anaerobes	Ceftazadime + PCN + metronidazole OR Ceftriaxone + doxycycline + metronidazole
Marine organisms fish	Vibrio spp. Mycobacterium marinum Erysipilothrix rhusiopathiae Aeromonas hydrophila	Doxycycline OR Ciprofloxaxin OR Third-generation cephalosporin OR Extended-spectrum penicillin

PCN: Penicillin.
Data taken from [28].

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