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Mismanagement of cat bite wound: lessons to learn
M Leelavathi1, M A Siti Aishah, Y P Wong
1Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. drleelaraj@gmail.com
Abstract:
Animal inflicted wounds, left untreated may result in chronic bacterial or fungal infection. Clinical features of these infections may overlap leading to a delay in diagnosis and treatment. We report a case of chronic non-healing cat bite wound treated with several antibiotics without improvement. Later patient developed the classical "sporotrichoid spread" and a presumptive diagnosis of sporotrichosis was made. Laboratory investigation for fungal culture and skin biopsy failed to identify the underlying pathogen. A trial of oral antifungal agent resulted in complete recovery of the lesions implicating fungus as the causative pathogen. Physicians should have a high index of suspicion for fungal infections when managing animal inflicted wounds.
Insights
Untreated animal wounds can cause chronic infections. A cat bite case, initially unresponsive to antibiotics, was successfully treated with antifungals, highlighting the importance of considering fungal causes in non-healing wounds.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Dermatology
Background:
- Animal-inflicted wounds pose a risk for secondary bacterial or fungal infections.
- Overlapping clinical presentations of these infections can impede timely diagnosis and treatment.
- Chronic non-healing wounds necessitate a broad differential diagnosis.
Observation:
- A patient presented with a chronic, non-healing cat bite wound refractory to multiple antibiotic treatments.
- The patient subsequently developed a characteristic "sporotrichoid spread" pattern of lesions.
- Initial laboratory investigations, including fungal cultures and skin biopsies, were inconclusive.
Findings:
- A therapeutic trial of an oral antifungal agent led to complete resolution of the lesions.
- This clinical response strongly implicated a fungal pathogen as the causative agent.
- The case underscores the diagnostic challenges in identifying fungal infections in animal bite wounds.
Implications:
- Physicians should maintain a high index of suspicion for fungal etiologies in persistent, non-healing animal-inflicted wounds.
- Diagnostic protocols for animal bites should consider fungal infections, especially with atypical presentations.
- Early identification and treatment of fungal infections are crucial to prevent complications and ensure patient recovery.
