Information on popular complementary and alternative medical topics

Human bites are generally more serious, owing to the bacteriology of the human oral flora and mechanisms of injury. The infection rate of human bites is estimated to be about 10%. Most human bites occur during fights, but approximately 15% to 20% are associated with sexual activity (“love nips”).
Human bites consist of occlusional bites and clenched-fist injuries. A bite wound sustained when human teeth sink into skin is defined as occlusional. Clenched-fist injuries are more serious and occur when one person punches another in the mouth with a clenched fist. This can result in simple cellulitis or lead to septic arthritis or osteomyelitis by direct inoculation of bacteria into the third metacarpophalangeal joint space or bone. The force of the blow can sever a nerve or tendon or cause a fracture. Patients often ignore clenched-fist injuries until these become infected.
The majority of human-bite wounds demonstrate approximately five different microorganisms per wound, with three being anaerobes. The most common infectious organisms isolated from human-bite wounds are S. aureus, Eikenella corrodens, Haemophilus species, and beta-lactamase producing oral anaerobes. E. corrodens, a gram-negative rod, is part of the normal human oral flora. It is the most common organism isolated from clenched-fist injuries. E. corrodens may be susceptible to penicillin, amoxicillin-clavulanate, doxycycline, or fluoroquinolones such as ciprofloxacin.
Transmission of herpesvirus types 1 and 2, hepatitis В and C, and even syphilis has been documented with human bites. The likelihood of transmission of human immunodeficiency virus (HIV) is very low but remains a possibility.
*127/348/5*

Rabies
International travelers are often unaware of the risk of rabies during their trip. Canine rabies remains endemic in the Indian subcontinent, China, Southeast Asia, the Philippines, parts of Indonesia, Latin America and Africa. Globally, less than 10% of persons undergoing rabies post-exposure prophylaxis for an animal bite receive appropriate therapy. Pre-exposure rabies vaccination should, therefore, be considered in travelers who
- Plan a prolonged (more than 30 days) stay in a country where rabies is endemic.
- Travel in remote areas.
- Engage in activities that might involve working near animals or that could attract animals (e.g., cycling).
- Cannot report an exposure if bitten (young children).
In the United States, there are intramuscular formulations of the rabies vaccine adsorbed (BioRab, BioPort) and purified chick embryo cell vaccine (RabAvert, Chiron) and both intramuscular and intradermal formulations of the human diploid cell vaccine (Imovax, Aventis Pasteur). All three types of rabies vaccines are considered safe and efficacious. Pre-exposure rabies immunization consists of three 1.0 mL doses of one of the rabies vaccine formulations given on days 0, 7, and 21 or 28. Adverse effects of the vaccine include headaches, myalgias, and localized lymphadenopathy. Travelers should be given basic information about what to do if they are bitten. After a high-risk bite, persons who underwent pre-exposure vaccination still require local wound care and two additional rabies vaccine doses (on the day of the bite and on day 3), but administration of rabies immunoglobulin is not necessary. Those who are bitten and who have not had prior rabies immunization must receive five doses of a rabies vaccine formulation on days 0, 3, 7, 14, and 28 as well as undergo inoculation with rabies immunoglobulin.

Cholera
Cholera is an acute intestinal infection caused by the toxigenic gram-negative bacillus Vibrio cholerae serogrcup O1 or O139. Infection is typically acquired by ingesting contaminated food or water in endemic areas such as the Indian subcontinent, Africa, the Middle East, and Latin America. The risk of cholera to travelers is so low (0.001% to 0.01%) and the protection of presently available vaccines is so poor that vaccination is believed to be of little benefit. Furthermore, the only licensed cholera vaccine in the United States has been discontinued because of its frequent adverse effects and brief and unreliable immunogenicity. Travelers to cholera-affected areas should be advised to avoid high-risk foods, especially poorly cooked or raw seafood.
*188/348/5*

Japanese encephalitis virus is an arboviral infection that is prevalent in the Indian subcontinent, China, Korea, Japan, and other Southeast Asian countries. It is transmitted by day-biting mosquitoes from May to October in endemic temperate areas and year-round in tropical regions. The majority of human cases are asymptomatic, but in rare cases, the virus can cause severe encephalitis with residual neuropsychiatry sequelae. The case-fatality rate is 30%.
Japanese encephalitis vaccine (JE-VAX, Aventis Pasteur) is not recommended for all travelers to Asia. The overall risk of Japanese encephalitis in areas where the virus is endemic is less than 1 case per million travelers. However, this risk increases with travel to rural areas and a longer duration of stay. In general, the vaccination should be offered to individuals who plan to remain for 30 days or longer in endemic areas during the transmission season, especially if travel might include rural areas. Vaccination should also be considered for short-term travelers who may experience heavy exposure to mosquitoes, such as those who engage in extensive outdoor activities or visit areas of epidemic transmission.
Primary immunization in persons 3 years of age or older consists of three doses of 1.0 mL each given by subcutaneous injection on days 0, 7, and 30. An accelerated schedule, in which doses are given on days 0, 7, and 14, can be used when departure is imminent. A single case-control study has measured the vaccine’s efficacy to be 91% after two doses. A booster dose may be given 3 years after the primary series it continued exposure in high-risk areas is expected.
The last dose of vaccine should be administered at least 10 days before trip departure to ensure an adequate immune response and to have ready access to medical care in the event of a delayed adverse reaction. Fevers, headaches, and myalgias are the most common adverse reactions reported by vaccinees. However, generalized urticaria and angioedema of the face, lips, or oropharynx have occurred within minutes to as long as 2 weeks after immunization. Patients with a history of allergic disorders (particularly to bee venoms and medications) appear to have a greater risk for developing adverse reactions to Japanese encephalitis vaccine. The safety of the vaccine in pregnancy has not been determined. Pregnant women who must travel to an area where the risk of Japanese encephalitis is high should be vaccinated when it is felt that the risks of immunization are outweighed by the risk of infection to the mother and fetus.
*185/348/5*