GPAtlas🧭 When to suspect
The presentation is usually obvious: a wound following a bite from an animal or another person. The clinical skill is not diagnosis but structured risk assessment – deciding which bites need antibiotics, which need tetanus or rabies cover, which need referral, and which carry a safeguarding concern.
Every bite is several questions at once. First, infection risk, which varies sharply with the animal: a small cat bite is far more dangerous than its appearance suggests. Second, tetanus – bites are classed as tetanus-prone wounds. Third, rabies, driven by geography and species (and any bat). Fourth, for human bites, exposure to blood-borne viruses and the possibility of interpersonal violence.
Suspect established infection where there is increasing pain, swelling, spreading redness, purulent discharge, an unpleasant smell, or fever. Treat any wound over a joint, tendon, or in a high-risk site (hand, foot, face, genitals) as potentially deep until proven otherwise.
| Bite type | Infection risk & typical organisms |
|---|---|
| Cat bite | Highest infection risk (up to ~50%). Needle-like teeth drive deep puncture inoculation into joints and tendon sheaths. Dominant organism Pasteurella multocida. |
| Dog bite | Most common bite; lower infection risk (~5–15%), but crush and tearing cause tissue damage. Pasteurella plus Capnocytophaga canimorsus (fulminant sepsis in asplenic or immunocompromised patients). |
| Human bite | High infection risk; polymicrobial – Eikenella corrodens, streptococci, staphylococci and anaerobes. Also consider blood-borne virus exposure (hepatitis B, hepatitis C, HIV). |
Source: NICE NG184 · UK Health Security Agency
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