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.
• Need tetanus or rabies cover.
• Need referral.
• Carry a safeguarding concern.
Every bite is several questions at once:
• Infection risk, which varies sharply with the animal: a small cat bite is far more dangerous than its appearance suggests.
• Tetanus – bites are classed as tetanus-prone wounds.
• Rabies, driven by geography and species (and any bat).
• 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
• 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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