Every year, dozens of people seek medical help from doctors because of wasp stings. Vasily Frolov, a general practitioner at Polyclinic No. 8 of the Moscow Health Department, talks about what to do if you are bitten by a wasp and how to provide first aid.
A wasp sting is quite painful, causing acute pain and severe burning. The consequences of a bite and the body’s reaction may be different for everyone: from redness and slight swelling to severe allergic reaction, which occurs in approximately 1% of people.
The most common manifestations of wasp sting allergies are:
- the bite site itches (the itching may spread beyond the bite site);
- severe swelling of the bite site (especially the area of the eyes, mouth, oral cavity, larynx), swelling extends to large plot tissues, and in some cases organs;
- unstable pulse (fast or slow);
- wheezing, increased breathing, difficulty breathing;
- dizziness;
- loss of consciousness;
- nausea, vomiting.
If the body successfully fights the poison, then the swelling subsides within 2-3 hours. But if the swelling only gets stronger over time, this is a sign of an allergy to a wasp sting. In this case, you must definitely seek medical help.
You cannot do without doctors if a person has received multiple bites. Bites on the neck, lip and tongue are especially dangerous. This often leads to suffocation, in which case you should immediately call an ambulance.
What to do if bitten by a wasp?
- Examine the wound. If there is a sting left, carefully remove it, preferably using tweezers. Hands and tweezers must be clean.
- If the sting cannot be removed, it should not be squeezed out of the wound. This can speed up the process of toxins entering.
- Treat the bite site with an antiseptic, which will prevent infection and development.
- Apply a sterile dressing. Apply ice or a wet compress - this will help localize and reduce pain.
- Drink a lot. This promotes abundant urination and removal of toxins from the body.
Summer is coming very soon - the season of relaxation, walks and picnics. But it is in nature that vacationers can be in danger - ticks. They can not only ruin your vacation, but also infect you with infections, including viral encephalitis. NTV talks about what to do if you are bitten by a tick.
Read below
How dangerous is a tick?
The tick poses the greatest danger due to the fact that it can carry dangerous infections. The most common of them are encephalitis and borreliosis. The infection is transmitted during a bite through saliva, which is injected into the human body.
In nature there are also so-called pure ticks that do not carry any infections. However, without the participation of specialists and a laboratory, it is impossible to determine which tick bit you.
What to do if you are bitten by a tick?
It is necessary to remove the tick from the surface of the skin as soon as possible. It is best to do this in an emergency room, and immediately send the tick to a special laboratory in order to find out whether it is a carrier of dangerous diseases or not. However, if you cannot quickly go to a medical facility, you will have to remove the tick yourself.
Remember that the tick does not burrow immediately: it can remain on the skin from 30 minutes to 1.5 hours. It is during this time that it can be detected and carefully removed without crushing it with your fingers. If you are bitten by a tick, under no circumstances should you pull it out, only carefully twist it out.
How can I remove a tick?
You can remove a tick by different means. For example:
using special tweezers. It is similar to a two-pronged fork: the tick must be squeezed between two teeth, and then carefully twisted. Using such a device, the tick’s body is not damaged, which means the risk of contracting infections is reduced. You can also use regular tweezers or a surgical clamp.
fingers. This method is considered less secure, but if not special means, then you can quickly remove the tick with your hands;
thread. Choose a strong thread that will not break when removing the tick.
Photo: TASS / Boris Kavashkin
How to properly remove a tick?
1. It is necessary to grab the tick with tweezers or fingers wrapped in clean gauze as close as possible to its mouthparts (that is, the bite site). Holding it strictly perpendicular to the surface of the bite, turn the body of the tick around its axis and remove it from the skin.
If you remove it with a thread, then tie a knot (loop) close to the tick's proboscis, and remove it by slowly swinging and pulling up.
2. The bite site must be disinfected. For this, 5% iodine, alcohol (a solution of at least 70%), brilliant green, and a solution of hydrogen peroxide are suitable.
Photo: TASS / Smityuk Yuri
3. After removing the tick, you should wash your hands with soap.
4. If, after removal, a black dot of any size remains under the skin, this means that the head or proboscis of the tick came off during the extraction process. The bite site should be treated again with 5% iodine. The remains of the tick should come out on their own.
If this does not happen, you need to treat the affected area of skin with alcohol. Then heat the needle over a fire, also wipe it with alcohol and carefully remove the remains of the tick in the same way as removing a splinter.
Be careful - not the slightest particle of a tick should remain under the skin.
5. After being bitten, you should consult a doctor. According to statistics, out of 10 ticks, 1 is infectious, and according to appearance infected and not infected are no different. The doctor will check to see if you successfully removed the tick and will give you a referral for a blood test, which can be taken 10 days after the bite. It will show the presence or absence in the blood tick-borne encephalitis and borreliosis.
Important to remember!
When removing a tick, you should never use oil; it will not only prevent it from being removed, but will also clog its respiratory openings, and the tick will die while remaining in the skin.
Photo: TASS / Bushukhin Valery
What to do after extraction?
If the tick is dead, then it must be burned or poured with boiling water. If he is alive, then he can be taken to a special laboratory, where he will be examined for the presence of tick-borne encephalitis.
How to protect yourself from a tick bite?
To avoid putting your health at risk, try to cover your entire body when going outdoors. Don't forget about appropriate shoes and hat. In addition, vigilance will help protect against tick bites: examine yourself and your loved ones every hour, spend Special attention open areas body, hair, bends of elbows and knees.
Remember that outdoor recreation is not always fraught with danger. Follow our simple recommendations, be attentive to your health and the health of your loved ones.
What to do if you are bitten by a tick: simple recommendations from NTV
Which bring people not only benefits in the form of tasty and healthy honey, but can also cause serious trouble.
So, bee and wasp stings can trigger the development various diseases and even lead to death. How to act correctly when bitten by these insects and how to protect yourself from their bites will be discussed further.
Stung by a bee or wasp?
Many of us in childhood could not distinguish a bee from a wasp, and this is very important, since first aid for their bites is somewhat different. Well, let's fill this gap and highlight main differences these insects.
· Bees attack only when they sense danger from a person, in other words, they defend themselves. And here wasps are annoying: It doesn’t need any reason to sting.
· A bee stings only once in its entire life., since its jagged sting gets stuck in the skin and comes off, which provokes the death of the bee. A wasp can sting many times, because it has a smooth sting that does not break and easily comes out of human skin.
· Wasps sting more painfully bees
· The round body of a bee is covered with villi and has a muted color, while the body of wasps is smooth, elongated and has a bright color.
· Bees only eat pollen, while the diet of wasps is very diverse.
Bite symptoms
· Sharp pain and burning at the bite site
· The appearance of edema, which may progress
Redness of the affected area
Formation of a white dot at the site of penetration of a bee or wasp sting
· Development of an allergic reaction, manifested by hives, cough, difficulty breathing, nausea, vomiting, chills, swelling of soft tissues, a sharp decrease in blood pressure, fever, dizziness, loss of consciousness.
Bitten by a bee (wasp): first aid
Most often, bee and wasp stings do not pose a serious danger to human life. But if an insect stings a child or a person suffering from allergies, then to exclude serious negative consequences it is necessary to competently provide first aid to the victim.
1. Carefully remove the tip without squeezing it out. It is best to use tweezers for these purposes; in this case, the bite site and the instrument itself should first be disinfected with any alcohol solution, failing which the affected area should be washed clean water. If you are stung by a bee, then in the process of pulling out the sting, it is advisable not to damage the small bag of poison attached to the sting shaft.
2. After removing the sting disinfect the wound using alcohol, iodine, brilliant green, hydrogen peroxide or regular soap.
3. Relieve pain by treating the affected area with saline solution, the preparation of which will require 1 tsp. spoon and glass boiled water. You can also resort to painkillers and antipruritic drugs.
4. To exclude or alleviate allergy symptoms, it is recommended take any antihistamine.
5. Drink a lot of liquid, and it is desirable that it contains glucose.
6. If allergy symptoms develop rapidly, you can use an auto-injector with adrenaline.
7. To prevent low blood pressure, you need to drink 25 drops of cordiamine.
8. In case of cardiac arrest or when breathing stops, the victim is given artificial respiration , and closed heart massage.
Important! If the condition of a victim of a bee or wasp sting worsens, you should immediately seek qualified medical help!
How to relieve swelling if bitten by a bee
To cope with swelling caused by a bee or wasp sting, the usual cold compress, after all low temperature Not only reduces nerve endings, but also dulls pain receptors, bringing minor, but still relief.
You can overcome swelling with special ointments and creams, which are available in pharmacies. If there is no opportunity to purchase such a product, then you can use traditional medicine recipes.
Yes, you can cook soda slurry: Apply soda, diluted with water to a pasty consistency, to the affected area of the skin.
Significantly reduces swelling taking activated carbon at the rate of 1 tablet per 10 kg of body weight.
Can be applied to the bite site alcohol compress(the main thing is that the alcohol content does not exceed 70%). Will also relieve swelling mint or onion juice compress. From traditional methods You can note the application of pounded plantain, celandine or parsley to the sore spot.
Important! Often, swelling after a bee or wasp sting goes away quickly. If this does not happen within two days, then you should immediately consult a doctor!
How to remove swelling if bitten by a bee
Redness and swelling appear immediately at the site of a bee or wasp sting. This is especially dangerous if the bee was swallowed, and the bite itself was in the throat area. In this case, the resulting tumor will block the airways, which will cause respiratory arrest.
Will help relieve swelling rafinated sugar, applied to the bite site and neutralizing the effect of the poison.
No less effective ice packs, ammonia and potassium permanganate solution.
You can also reduce swelling by rubbing the sore area. lemon juice or ordinary table vinegar (you can use sliced fresh cucumber as a cooling agent).
What not to do when bitten by bees and wasps
1. Kill or injure a stung bee, which in such a situation releases substances that cause aggression of the entire swarm. And this threatens a massive bee attack.
2. Rub or comb bite site, otherwise the poison may enter neighboring tissues, which significantly increases the risk of infection.
3. Press on the bite site, trying to remove the sting (this will help prevent the spread of infection).
4. Drink alcohol, dilates blood vessels and opens the way for the spread of poison.
5. Take sleeping pills, enhancing the effects of the poison.
Bee sting to the head
Bee or wasp sting to the face may cause pain and may lead to severe swelling, allergic reactions and suffocation. Moreover, if you are stung by more than three individuals, you may develop toxic reaction. The fact is that bee venom in such quantities is very toxic and can lead to a noticeable deterioration in health.
Most dangerous bites on the lip, tongue or larynx: in these cases, the resulting swelling can spread to the entire larynx, which can cause suffocation. Therefore, in such cases, you should immediately call an ambulance.
Bee sting on the lip
If a bee or wasp bites your lip, then you need to urgently seek help from a doctor.
In order to alleviate the condition of the victim, you should first of all treat the damaged area. soap solution. You can also use an alcohol-free facial toner because alcohol increases tissue swelling.
A stung lip will quickly swell, which is not something to be afraid of. The swelling will go down in a day or two. But still chamomile compresses, green tea or aloe vera will not interfere as a sedative, analgesic and decongestant.
Bee sting in the eye
The eye is a very sensitive organ that reacts to any external influence with a pronounced reaction. And a bee or wasp sting is no exception.
Danger of being bitten in the eye It also lies in the fact that it is located close to the main mucous membranes, as a result of which the swelling of the eyelid can affect other areas of the face and neck, thereby causing not only blurred vision, but also suffocation.
Signs of a bite to the eye:
sharp pain
redness of the eyelid
· burning sensation
· profuse tearing
inflammation of the mucous membrane of the eye and eyelid (up to the development of panophthalmitis)
Closure of the palpebral fissure.
Peak swelling of the eyelid is observed the day after the bite. In addition, there appear swelling, itching and pain in the eyes, lacrimation becomes difficult, vision deteriorates. The listed symptoms can be observed for 2 to 10 days.
In severe cases, mucopurulent discharge and even destruction of the sclera may be observed, not to mention the development of such serious illnesses How cataract and glaucoma.
First aid for a bite in the eye is no different from the measures taken if a wasp or bee stings anywhere else on the body.
But! If you are bitten in the eye, you need to act with extreme caution, and after removing the sting, you must definitely consult a doctor, which will help prevent the development of complications.
Bee sting on the neck
A bite to the neck area is characterized by severe swelling and inflammation of nearby lymph nodes, as well as the appearance of nagging pain not only at the site of the bite, but also directly in the lymph nodes.
Swelling, like redness, lasts on the skin from one to ten days.
The main danger of a bite to the neck– the possibility of swelling of the larynx, which can lead to respiratory arrest and death. Therefore, it is extremely important to competently provide first aid and take the victim to the hospital.
At home, traditional medicine recipes will help relieve swelling.
Onion: the bulb is cut in half and applied with the cut to the site of swelling.
Collection of herbs plantain, dandelion and parsley, which are taken in equal proportions and passed through a juicer, after which cotton swabs are soaked in the resulting juice, which are frozen and then applied to the swollen areas of the skin.
Raw potatoes , which should be grated, and the resulting pulp should be applied to the bite site for 10 minutes.
Bee sting on the leg or arm
Bee sting in the upper or lower limb does not pose a serious danger to people who do not suffer from allergies. Therefore, it is enough for them to remove the sting and treat the bite site. Swelling, redness and itching usually disappear within 24 hours.
Human bites At first glance, this is a strange topic of conversation for adults and children, but in practice, human bites are not uncommon. People bite each other kindergarten, at school, in fights, love games with sadomasochistic tendencies.
You need to know what to do if one person is bitten by another, how to provide first aid in such situations at home. The fact is that human bites are much more dangerous than dog bites due to the nature of the bite itself and possible infection - transmission of various viruses and infections: hepatitis B and C, HIV infection and more.
Human teeth do not so much bite as they grind, crushing skin and tissue. In addition, in the mouth of any person there are much more microorganisms than, for example, in the mouth of a dog or cat. For most people: untreated teeth, chronic tonsillitis and other sources of persistent infection. With a human bite, healing is much slower and the risk of infection with tetanus increases. That's why Every person should be vaccinated against tetanus. This is especially true for children.
A child cannot always tell about the fact that someone bit him. Therefore, when talking with him, parents must be persistent and find out the cause of the wound or bite.
First aid for a bite
First aid for a human bite is the same as for a bite from various animals (see page “ “).
Immediate health care for bites it is necessary in the following cases:
- if the bite is made by a person and the skin is damaged;
- if the bite was caused by a wild animal;
- when bitten on the face or neck;
- if the bitten citizen suffers from allergic reactions;
- if a child is bitten.
Wounds after a human bite can occur as a result of physical violence (for example, when the skin is damaged by teeth when a blow to the jaw) and during sexual contact (so-called love bites).
Bites are localized mainly on the fingers or arms, less often in the neck, chest, and genitals.
About 30% of abrasions on the hand caused by a blow to the teeth are accompanied by deep damage and the development of infections of the ligaments and bones, especially when seeking medical help late (more than 24 hours).
Bacteria such as streptococcus, staphylococcus, and anaerobes most often enter the wound. Infection with viruses such as hepatitis B virus, hepatitis C virus and HIV is much less common.
During the initial visit, anamnesis is collected (time of bite and type of animal), smears are taken for bacteriological examination and primary surgical treatment of the wound. If there are systemic signs of infection, blood is also drawn to identify aerobic and anaerobic pathogens. If bitten by a person, it is also necessary to conduct an examination for infection with the hepatitis B virus and HIV. Other clinical and instrumental studies are performed as indicated (for example, radiography or ultrasound if bones, joints are suspected of being involved in the process, or the presence of a foreign body in the wound).
Procedure for a bite
- Treat the wound and the skin around it with 3% hydrogen peroxide or povidan-iodine;
- treat the bite site with tincture of iodine;
- sprinkle the wound with a layer of Streptocide, Norsulfazole, Penicillin or boric acid;
- apply a dry aseptic bandage.
In case of extensive bites, primary surgical treatment of the wound is especially necessary.
Further medical care
Suturing wounds recommended for fresh (less than 6 hours), presumably uninfected processes, as well as in for cosmetic purposes(on the face). Delayed wound suturing (after 3–5 days) is used for bites more than 6–8 hours old, localized in the extremities and accompanied by tissue crushing.
Indications for hospitalization are fever, sepsis, progressive cellulitis, severe swelling or tissue damage, loss of limb function, immunocompromised state of the patient, as well as infection with dangerous infections for which patients must be kept in quarantine.
Purpose preventive antibiotic therapy indicated for bites by humans, cats or complicated dog bites, as well as when the process is localized in the area of the extremities, genitals and face, severe damage, involvement of bones and joints in the pathological process or localization of the bite near a prosthetic joint and in patients with immunodeficiency conditions of various origins.
The choice of antibacterial drug is based on bacteriological examination data. Until the results are obtained, the drug of choice is Amoxicillin-clavulanate (625 mg 3 times a day for adults). If you are allergic to penicillins, Metronidazole can be prescribed in combination with Doxycycline for cat and dog bites. For human bites, Metronidazole in combination with Erythromycin can also be used, but Ciprofloxacin in combination with Clindamycin is preferred. If the infection is severe, antibiotics are administered intravenously; the duration of therapy depends on the clinical dynamics.
Preventive antiviral therapy(hepatitis B virus, HIV, rabies and Herpesvirus simiae) is carried out if the possibility of infection is suspected. Prevention of tetanus (tetanus vaccine and tetanus immunoglobulin) is carried out in the absence of a confirmed immunological history in the patient (i.e., data on the timing of planned tetanus immunoprophylaxis). If there is a risk of contracting hepatitis or HIV, patient monitoring should continue for at least 3 months.
Folk remedies at home
Traditional medicine advises ( The recommendations given here for treating human bites at home are given for informational purposes only - approx. author of the site):
Tincture calendula. Dilute the tincture with water in a ratio of 1:5 and wash the wound and the area of the body around it.
Tincture echinacea. Dilute it in a ratio of 1:5 and wash the wound and the area around it. Echinacea tincture can be given to the victim orally (15 drops 1 time per hour, three to four times).
Hydrogen peroxide. Used to wash wounds, hydrogen peroxide is especially effective for lacerated and crushed wounds, as it washes away dirt and germs from the very depths of the wound.
Oil lavender or oil tea tree have good disinfectant properties. Add 3-5 drops of one of the oils per 100 ml of water and use to wash the wound. After bandaging the wound, you can drop 1-2 drops onto the bandage over the wound.
Regular web, placed on any wound, greatly speeds up the healing process (the web contains antibiotic-like substances).
Gruel and juice from leaves plantain.
You can use a whole plantain leaf by placing it on the wound.
In case of a serious wound, in addition to the above remedies, you can take it orally acidophilus 1 teaspoon of powder or liquid).
Chinese ethnoscience uses decoctions and infusions to treat wounds goldenseal.
Powder from dried porcini mushrooms, if sprinkled on a wound, it speeds up healing.
If all these means are not available, you can use your own to treat the wound. urine.
Prophylaxis of tetanus is carried out by general principles. Assess the hepatitis B status of the person who committed the bite and immunize the patient if necessary. The person who bit the patient may be infected with HIV, and therefore the patient requires urgent emergency prevention of HIV infection. When a person is bitten, the hepatitis C virus can be transmitted, which requires special measures (but emergency prevention measures for hepatitis C have not been developed).
When a person is bitten, the patient often requires hospitalization and antibiotic therapy: a person’s oral cavity contains a large number of aerobic and anaerobic pathogens that can cause a severe necrotizing infectious process, especially when bitten in the area of the foot or palm.
Antibiotic therapy. All wounds penetrating the dermis require antibiotic therapy. Cultures to identify aerobic and anaerobic flora should be taken before starting antibiotic treatment. Treatment can be started with amoxiclav at a dose of 500/125 mg three times a day orally (or intravenous cefuroxime and metronidazole). Consult a microbiologist.
Bite on the face. If the bite has caused a serious cosmetic defect, the patient should be referred for a consultation with a plastic surgeon. Puncture wounds should be carefully treated and the patient should be given a prophylactic course of antibiotic therapy. The patient is instructed that during the first few days it is necessary to remove the bandage and remove purulent or bloody discharge 3-4 times a day.
Bites on the arms. Such a patient should be treated by an orthopedist; additional examination is recommended. Carry out thorough treatment of the wound. The first dose of antibiotic is administered intravenously, and then oral administration is continued if there are no signs of systemic spread of infection.
Bites to humans and other mammals are common and sometimes cause serious injury and disability. The hands, limbs and face are most commonly affected, although human bites can occur on the chest and genitals.
Bites from large animals sometimes lead to significant tissue injuries; about 10-20 people, mostly children, die every year from dog bites. However, most bites cause minor wounds
Risk of infection. In addition to tissue injury, the main danger from a bite is infection by the microbial flora of the mouth. Human bites can theoretically transmit viral hepatitis and HIV infection. However, transmission of HIV infection is unlikely because The concentration of the virus in saliva is much lower than in the blood, and inhibitors contained in saliva make the virus ineffective.
Risk of contracting rabies from the bite of certain mammals. In the United States, monkey bites commonly occur in personnel working with laboratory animals, with a small risk of infection by simian herpes virus, which causes vesicular lesions of the skin at infected sites that can lead to encephalitis, often fatal.
Bites to the upper extremity carry an increased risk of infection; This risk is especially characteristic of human bites resulting from a blow from a fist to the mouth (fright bite), as the most common case. When bitten in a fight, the skin wounds move relative to the underlying damaged structures when the hand is open, trapping bacteria, and the patient often does not seek treatment immediately, allowing the bacteria to multiply. Human bites to other sites do not carry a greater risk of infection than bites from other mammals. Cat bites to the hand also carry an increased risk of infection, as the cat's long, sharp teeth often penetrate deep structures such as joints and ligaments, and small punctures are often closed.
Diagnosis of a human bite
- Clarification of the position of the limb in which the bite was inflicted.
- Assess damage to underlying nerves, tendons, bones and blood vessels, as well as the presence of foreign bodies in the wound.
Human bites received during an argument are often explained away for other reasons, in order to avoid contacting the authorities or to portray an insurance case. Domestic violence is often denied.
Wounds are assessed for damage to underlying structures and for the presence of foreign bodies. Evaluation should focus on careful consideration of function and bite size. Wounds over joints should be examined from the position in which they were inflicted (eg, with a clenched fist) and examined under sterile conditions to assess tendon, bone, and joint involvement and detect foreign bodies. Pressure wounds may have small scratches, but they should be examined to rule out deeper damage.
Taking material for culture from a fresh wound is useless for prescribing antimicrobial therapy, but a culture must be taken from an infected wound. For patients with human bites, testing for hepatitis and HIV is recommended only if the attacker is known or suspected to be seropositive.
Mammal bites
The general principles of therapy are the same as for a human bite. The wound is treated, discharge from the wound is taken for culture in order to detect aerobic and anaerobic microflora, if necessary, tetanus is prevented, and a prophylactic course of antibiotics is prescribed, as indicated earlier. Consider the need for rabies prophylaxis (vaccine and rabies immunoglobulin) in cases where the bite occurred outside the UK or when bitten bat or animals in quarantine. For consultation and obtaining a vaccine and immunoglobulin, you should contact the doctor on duty of the virology department.
Rabies is transmitted through infected saliva coming into contact with broken skin or by inhaling the virus (from infected bats). Clinical signs - a prodromal period is characteristic, as with any viral infection, later paresthesia and fasciculations occur. Excitement, confusion, muscle spasms, local paresis with subsequent development of brainstem disorders. Once clinical symptoms of the disease occur, treatment is ineffective. A significant role belongs to the implementation of preventive measures.
Vaccination against rabies is carried out for preventive purposes (the vaccine is administered into the deltoid muscle of the shoulder) to all persons who are at risk of being bitten by infected animals (veterinarians, people caring for animals, field workers).
Some Old World monkeys, especially rhesus and cynomolgus macaques, are infected with herpes B virus (which causes an infectious disease in monkeys that is similar in course to herpes infection in adults). The virus is transmitted by a bite and when the saliva of an infected animal comes into contact with damaged skin and causes a fatal disseminated infectious process in humans. If the macaque that bites a human comes from a virus-free colony, valacyclovir 1 g three times daily for 14 days should be given while awaiting test results.
Infections in drug addicts using the intravenous route of administration
In the UK, the majority of regular intravenous drug users are infected with the hepatitis C virus, with fewer being infected with HIV and the Australian antigen. Bacteremia and septicemia caused by S. aureus are frequently observed. If a heart murmur is heard, the patient should undergo echocardiography to rule out IE. Multiple round infiltrates in the lungs are characteristic of tricuspid valve endocarditis with septic emboli.
Necrotizing fasciitis
The patient's condition is usually very serious.
Areas of redness with extreme pain and sometimes crepitus on palpation are identified. X-ray examination can detect gas in the subcutaneous tissue. The task of paramount importance is urgent surgical treatment of the wound by an experienced surgeon. Delaying diagnostic measures before surgery is undesirable, as it does not allow obtaining additional information.
The spectrum of pathogens is often polymicrobial.
Cpindamycin is an important component of any antibiotic therapy regimen for necrotizing fasciitis. For example, the following combination of antibiotics may be prescribed: ciprofloxacin 400 mg 3 times a day intravenously, cpindamycin 600 mg 4 times a day intravenously, benzylpenicillin 1.2-1.4 g every 4 hours.
Typically, patients require daily debridement of the wound in the operating room, and subsequently reconstructive surgery.
Severe acute respiratory syndrome
New human coronavirus infection with high degree contagiousness through close respiratory contact, occurring predominantly among healthcare workers. Fecal-oral and household transmission of the pathogen is possible. The disease is manifested by fever, myalgia, and various symptoms of lung damage with rapid deterioration in the second week of the disease. The disease is rarely found in prepubertal children, and in adults over 60 years of age the disease is associated with high mortality.
Strict patient isolation and careful implementation of infection control are required.
When writing the text of this reference book (July 2003), there was a decline in the epidemic activity of the disease, but it may reappear.
The scope of therapy has not been fully determined. In patients with severe disease, some improvement can be achieved after prescribing high doses of glucocorticoids. Ribavirin does not appear to be effective.
Bioterrorism
Currently, society is increasingly aware of the possibility of the deliberate use of biological and chemical warfare agents. Historically, the causative agents of plague, salmonellosis and anthrax have been used for the purpose of biological terrorism due to their ability to have a nerve-paralytic effect and release biological toxins. The most recent events related to bioterrorism occurred in 1995 in Tokyo (dispersal of the nerve gas sarin in the subway) and in 2001 in the United States (distribution of anthrax spores, resembling a white powder, in a written envelope).
Terrorists can use airborne transmission and contaminate food and water.
Deliberate spread of the pathogen may be indicated by facts such as an unusual distribution of the infection (for example, the emergence of anthrax cases in cities), the appearance of a clinical picture of the disease in a person who has not been in contact with a patient with similar symptoms, or the sudden appearance of similar clinical symptoms in a group of people infectious disease. Such incidents continue to cause concern.
Any suspicion of deliberate spread of an infectious agent should be reported promptly to the Consultant Microbiologist and CCDC (Communicable Disease Control Consultant).
The group of diseases whose pathogens can be used as agents of bioterrorism includes smallpox, plague, tularemia, melioidosis, botulism, glanders ( infectious disease, caused by the bacterium Burkholderia mallei) and viral hemorrhagic fevers.
Treatment of bites of humans and mammals
- Careful treatment of the wound.
- Planned wound closure.
- Selective use of antibiotics for prophylactic purposes.
Hospitalization is indicated if complications require close monitoring, especially if the patient is likely to refuse follow-up in an outpatient setting. Hospitalization should be indicated under the following circumstances:
- human bite infected (including clenched fist injuries);
- the bite of an animal, excluding humans, is moderately or severely infected;
- dysfunction is obvious;
- the wound threatens or has already damaged deep tissues and structures;
- it is impossible or difficult to care for the wound at home (serious wounds on both arms or legs, wounds of the arms that require the creation of a prolonged elevated position).
Treatment priorities include cleansing, removal of foreign bodies, wound closure, and prevention of infection.
Treatment of the wound. First, the wound is washed with mild antibacterial soap and water (tap water is sufficient), then irrigated with sodium chloride solution using a syringe and an intravenous catheter. Povidone-iodine solution can be used. If necessary, a local anesthetic is used. Dead and non-viable tissue must be removed.
Wound closure is carried out in some cases. Many wounds must initially be open, including the following:
- puncture wounds;
- wounds of the arms, legs, perineum;
- wounds inflicted several hours ago;
- heavily contaminated wounds;
- wounds with severe swelling;
- wounds with signs of inflammation;
- wounds involving deep structures;
- human bite wounds;
- wounds received in a contaminated environment (sea water, field conditions, wastewater).
In addition, wound healing in immunocompromised patients may be better with delayed closure. Other wounds (fresh, skin cuts) can be closed after appropriate sanitization.
Hand bites should be bandaged with a sterile bandage when placing the limb in a working position. If the wounds are moderate or more severe, the arm should be kept in an elevated position (eg suspended from a tripod) at all times.
Bites on the face in cosmetically significant areas and with the potential for scarring may require reconstructive surgery.
Infected wounds may require surgical treatment, removing sutures, using lotions, splinting, creating an elevated position and intravenous antibiotics, depending on the type of infection and clinical picture.
Antimicrobials. Thorough cleaning of the wound is most effective and in an important way preventing infection, and this is often sufficient. There is no consensus on the indications for prophylactic antibiotics. Studies have not demonstrated a definite benefit, and widespread use of prophylactic antibiotics may lead to the emergence of antibiotic-resistant microorganisms. Medicines do not prevent infection in cases of severe contamination or poorly cleaned wounds. However, many doctors prescribe prophylactic antibiotics for hand bites and certain other bites (eg, cats, monkeys).
The choice of antimicrobial drugs to treat an infection must initially be justified by the type of animal. Culture results, when available, guide treatment decisions.
- For human and dog bites For outpatients, amoxicillin + clavulanic acid is preferable for prevention or treatment. Ampicillin+sulbactam is a reasonable empirical choice for inpatients and covers α-hemolytic streptococci, Staphylococcus aureus and Eikenetla corrodens, the organisms most commonly found in human bite cultures, as well as Pasteurelta species and Capnocytophaga canimorsus, which are found in wound from dog bites. Patients with human bites who are allergic to penicillin can be treated with sulfamethoxazole plus trimethoprim (Cotrimoxazole) plus clindamycin. For patients with infected dog bites who cannot tolerate penicillin, doxycycline is an acceptable alternative, except in children >8 years of age and pregnant women. Erythromycin can be used, but the risk of treatment failure is higher due to the resistance of the microflora. Other acceptable combinations include clidamycin and fluoroquinolones for adults or clidamycin and sulfamethoxazole + trimethoprim for children.
- Cat Bites: Fluoroquinolones are recommended for prevention and treatment due to the prevalence of P. multocida. An alternative for patients who are allergic to penicillin is clarithromycin or clindamycin.
- Squirrel, Gerbil, Rabbit and Guinea Pig Bites These bites rarely become infected, but if they do they can be treated with the same medications as cat bites.
- Monkey bites: Monkey bites should be treated prophylactically with intravenous acyclovir.
Patients bitten by a person should receive prophylaxis for viral hepatitis and HIV infection in accordance with the serostatus of the patient and the attacker. If the status is unknown, prophylaxis is not prescribed.