Animal bites and scratches

Question 1

Cat bite tx? to cover?

also for what other types of bites?

Answer 1

ampicillin-sulbactam / piperacillin-tazobactam / imipenem to cover Pasteurella multocida + anaerobes
also for human and dog bites

Question 2

h/o splenectomy plays with a pet dog, sustains a scratch/laceration. Next morning, hypotensive.

Answer 2

septic shock 2/2 Capnocytophaga carnimorsus

Question 3

after punching someone in the mouth

Answer 3

Eikenella corrodens (punched “Ike” in the mouth)

Question 4

toothache + submandibular lymphadenopathy, PCN allergy

Answer 4

clindamycin

Question 5

Pt with a cat, pustular lesion on hand and tender lymph node in the axilla OR
HIV patient with multiple nodule lesions on extremities. AST and ALT elevated. Biopsy –> silver stain +/Warthin starry organisms +. Liver –> peliosis hepatis (cystic spaces with blood)

Answer 5

Cat scratch disease

etio: Bartonella henselae
tx: doxycycline/erythromycin

HIV pt Dx: Bacillary angiomatosis. Treatment is the same.