Kinkajou Bite


Article Author:
Yamama Hafeez


Article Editor:
Zia Asif


Editors In Chief:
Venkat Minnaganti
John Brusch
Janak Koirala


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
Kristina Soman-Faulkner
Benjamin Eovaldi
Radia Jamil
Sobhan Daneshfar
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes


Updated:
6/22/2019 7:55:34 PM

Introduction

Kinkajou (Potos flavus) is an omnivorous rainforest mammal that lives in the tropical forests of Central and South America. It is considered related to raccoons despite its resemblance to primates. The current medical literature lacks specific guidelines for medical management of Kinkajou bites and any subsequent soft tissue infections. The goal of this article is to outline basic guidelines for primary healthcare providers in their approach toward managing patients with kinkajou bites that have either a high risk of soft tissue infection or present with soft tissue infections at the bite site.[1]

Animal bites, in general, account for 1% of the total emergency department (ED) visits which are approximately 2 to 5 million ED patients annually. Ten percent of those patients presenting in the ED require suturing, and only 1% to 2% need hospitalization for treatment with intravenous (IV) antibiotics or observation. Any animal bite, including kinkajou bites, warrants proper inspection to evaluate their capacity to become infectious.[2]

Etiology

Animal bites account for significant morbidity and mortality worldwide. Most patients presenting to the ED with animal bites usually have been bitten by dogs and cats. Kinkajou bites, although rare, must undergo evaluation with similar urgency. Medical literature on kinkajou bites is scarce, and the only reported bacterial isolates from kinkajou bites are that of alpha-hemolytic streptococci, mixed anaerobic bacteria, and Kingella potus which forms the bulk of the strains.[3][4]

Reported isolates were from a female zookeeper who had to undergo exploratory surgery of her hand due to suspected infection of her flexor tendons after a kinkajou bite. She was treated successfully with clarithromycin, ciprofloxacin, and metronidazole for 14 days.[1]

The only other case of a kinkajou bite in literature reports zoonotic transmission of Blastomyces dermatitidis to a man from his pet kinkajou after a bite. This reported patient had a recalcitrant infection after being on antibiotics. Physical exam findings suggested chronic ascending lymphadenitis, and he fully recovered after being treated with itraconazole for 6 months.[5]

Epidemiology

Most animal bites presenting to the emergency department are due to dogs and cats; kinkajou bites are rare. There are no reported incidence rates of kinkajou bites in the United States. Based on case reports in the literature, caretakers of these kinkajous have the most bite wounds.[6]

Pathophysiology

Kinkajou bite wounds both in literature and including the author's one reported case had been small puncture wounds with minimal tissue tear. There is no reported blunt force trauma to the bones. Following the bite injury, there are reports of soft tissue infections treated successfully with antibiotics. The wound discussed in this case was narrow and deep with the mechanism of the bite described by the patient as biting and holding down.[7]

History and Physical

Clinicians should take a detailed history and physical exam of every patient with a kinkajou bite. These should include information about the circumstances surrounding the bite incident, for example, the bite location and how long it took the patient to seek medical care after the bite. The patient might need local anesthesia during exploration of the bite site. [7]

Evaluation

A patient's bite site should be thoroughly evaluated to assess for underlying neurovascular compromise or foreign body presence. The patient must be provided with appropriate pain management for associated swelling at the bite site. An active and passive range of motion testing should be performed to assess for underlying tendon involvement. The patient further is evaluated for the need for any imaging at the bite site such as x-ray, ultrasound, MRI or CT. If need be, a patient should be taken to the operating room for irrigation and exploration under local anesthesia.

Treatment / Management

Given lack of literature and guidelines on how to manage Kinkajou bites and subsequent development of cellulitis, the following is a proposed protocol based on the reported case and current animal bite treatment and management guidelines.

  • Wound management as per current wound-care guidelines for animal bites including irrigation, exploration, and debridement of the wounds
  • Proper imaging (x-ray, ultrasound, CT, or MRI) should be done to access for deeper structure involvement.
  • Assess for any need for surgical exploration at the wound site.
  • Based on the type of wound if the risk of infection is high at the kinkajou bite site patient should be admitted to the hospital.
  • Obtain wound and blood cultures before the start of any antibiotics.
  • Broad-spectrum antibiotics should be started to cover both gram-positive and gram-negative infections.
  • Administer tetanus toxoid, DTaP, or Td as indicated.
  • Kinkajou bite patients should get rabies vaccine series which consists of a regimen of 1 dose of immune globulin at patient presentation and 4 doses of rabies vaccine over a 14-day period.

Differential Diagnosis

  • Cellulitis
  • Abscess
  • Sepsis

Prognosis

With prompt evaluation by a qualified health care provider prognosis is good. 

Complications

If the bite wound is not cleaned and adequately inspected, complications such as cellulitis or abscess formation may occur. 

Consultations

Consider consulting infectious disease organizations for antibiotic management. Surgical consultation may be warranted if there is concern about the involvement of underlying structures or foreign body removal.

Pearls and Other Issues

A kinkajou is considered an exotic pet, and pet ownership seems to be a growing trend in the United States. The reported patient was at a gas station where she tried to be friendly with a truck driver's pet kinkajou when it bit her. The truck driver with his pet escaped when the women decided to get help.

Enhancing Healthcare Team Outcomes

Kinkajou bites are very rare in the US and only seen in zookeepers and pet owners. This wild animal from South America has razor-sharp teeth but its bites are not deep. In general, the majority of kinkajou bites are managed by the emergency department physician, nurse practitioner, and the primary care provider. Kinkajou bites require the usual tetanus prophylaxis, rabies vaccine and wound cleaning. In most cases, antibiotics are prescribed to prevent the development of cellulitis or osteomyelitis. The majority of patients have a good outcome after treatment.

 

 

 


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Kinkajou Bite - Questions

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A pet kinkajou bites a 17-year-old female at a friends birthday party. What type of wound injury is most commonly seen with kinkajou bites on physical exam findings?



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A 53-year-old male with past medical history of hypertension, gastric reflux presents 24 hours after he got bitten by one of the kinkajous he takes care off at the zoo. The patient is complaining of pain and swelling at the bite site on his right hand, on physical examination patient has multiple bite wounds on his hands with erythema, swelling, and purulent discharge. What is the next step in the management of this patient?



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A 35-year-old male with past medical history of hypertension and type 2 diabetes mellitus presents 24 hours after being bitten by a Kinkajou. The patient is complaining of pain and swelling at the bite site, on physical examination patient has bite wounds on his left leg with erythema, swelling, and purulent discharge. The patient needs to be admitted to the hospital for surgical exploration and wound debridement. What is the best antibiotic regimen for prophylaxis?



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A 65-year-old female with past medical history of hyperlipidemia, type 2 diabetes mellitus presents 24 hours after she was bitten by a kinkajou. The patient is complaining of pain and swelling at the bite site, on physical examination patient has bite wounds on her left wrist and palmar region with erythema, swelling, and purulent discharge. Range of motion testing reveals the patient is not able to extend or flex her wrist. What is the next best step in management?



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A 17-year-old female with past medical history of asthma presents 24 hours after she was bitten by a truck drivers pet kinkajou. She encountered the kinkajou at a gas station. The truck driver fled with the animal after the incident. The patient is complaining of pain and swelling at the bite site, on physical examination patient has multiple bite wounds on her right thigh with erythema, swelling, and purulent discharge. It is decided to assess the patient for rabies vaccination, together with starting her on broad-spectrum antibiotics. What is the next best step in management?



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Kinkajou Bite - References

References

New horizons in the bacteriology, antimicrobial susceptibility and therapy of animal bite wounds., Goldstein EJ,, Journal of medical microbiology, 1998 Feb     [PubMed]
Description of Kingella potus sp. nov., an organism isolated from a wound caused by an animal bite., Lawson PA,Malnick H,Collins MD,Shah JJ,Chattaway MA,Bendall R,Hartley JW,, Journal of clinical microbiology, 2005 Jul     [PubMed]
Mammalian bites. Review of evaluation and management., Wiley JF 2nd,, Clinical pediatrics, 1990 May     [PubMed]
Management of human and animal bite wounds., Goldstein EJ,, Journal of the American Academy of Dermatology, 1989 Dec     [PubMed]
Human and animal bite infections., Brook I,, The Journal of family practice, 1989 Jun     [PubMed]
The management of bite wounds., Fleisher GR,, The New England journal of medicine, 1999 Jan 14     [PubMed]
Blastomycosis in man after kinkajou bite., Harris JR,Blaney DD,Lindsley MD,Zaki SR,Paddock CD,Drew CP,Johnson AJ,Landau D,Vanderbush J,Baker R,, Emerging infectious diseases, 2011 Feb     [PubMed]

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