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Rabies is a fatal aggressive disease of the nervous system which predominantly causes motor and autonomic dysfunction. Limbic system involvement has been reported rarely, with limited data on its prevalence. The diagnosis becomes challenging when a patient presents with limbic system involvement in the absence of a clear history of an animal bite. We herein illustrate a case of a young man who presented with recurrent episodes of inappropriate ejaculation. He eventually developed hydrophobia and aerophobia, leading to a diagnosis of rabies. This case emphasises the importance of considering the possibility of rabies encephalitis when a patient presents with symptoms of limbic system involvement since early diagnosis helps in instituting appropriate public health measures and reducing exposure to infection. Furthermore, high-quality intensive care with supportive management is the mainstay of therapy in such patients until we have novel and effective antiviral drugs for rabies treatment.

We present a case of a 51-year-old immunosuppressed man with underlying chronic lymphoproliferative leukaemia (CLL), who presented to us in emergency with breathlessness, hydrophobia, anxiety and restlessness. He had a history of category 3 dog bite 2 months ago and had received a full course of rabies immunoglobulin and antirabies vaccine (ARV) as per the national schedule. As there were frank clinical reports of rabies, the patient was managed according to Milwaukee regimen. The patients died within a week of the appearance of symptoms. The brain autopsy revealed Negri bodies conforming the mortality due to rabies.Immunosuppressed patients, like our patient who had CLL have low antibody formation after rabies prophylaxis. Antibody titres in immunosuppressed patients need to be measured after the 2–4 weeks of the last injection of ARV to decide whether a booster of ARV needs to be administered or not.

Peripheral nerve injury due to animal bite is a rare phenomenon. Most animal bites are from dogs. Monkey bites constitute a common risk, second only to dog bites, among travelers. Peripheral nerve injuries may occur due to a combination of monkey's strong jaws and sharp long teeth penetrating deep into the soft tissues. Such injuries are associated with increased perineural fibrosis. Human amniotic membrane (HAM) wrap around the nerve repair site reduces fibrotic response, prevents adhesions and scar formation thereby improving outcome. We report a case of "High Radial nerve palsy due to monkey bite, treated by neurorrhaphy with HAM wrap".A 3-year old boy presented with wrist drop, and inability to extend the fingers and thumb of his right dominant hand, following a monkey bite over the distal arm. The diagnosis of high radial nerve injury was corroborated by high frequency ultrasound and electrodiagnostic studies. On exploration the radial nerve was found to be transected. An end to end repair was performed, with HAM wrap around the neurorrhaphy.Wrist dorsiflexion recovered at 2.5 months followed by active finger and thumb extension at 4 months with no infection or immune rejection.Nerve regeneration in our patient occurred at a faster rate as compared to the conventional 1 mm/day. This could be attributed to decreased perineural fibrosis, improved neurotropism due to the HAM wrap and neuronal plasticity in young brain in addition, the patient being a small child having better regenerative ability in comparison to an adult.

Background While the majority of reported cases of jellyfish envenomation are self-limited with few lasting complications, a few can cause life-threatening and debilitating illnesses. We present the case of a 15-year-old male who had an unusual presentation of a jellyfish sting that led to acute compartment syndrome. Case presentation A 15-year-old Lebanese (Arab) boy was stung by a jellyfish, which led to acute compartment syndrome in the left arm. Decompression fasciotomy and local application of diluted nitroglycerin helped to relieve the ulnar and radial artery spasms. The patient was left with shoulder and elbow pain and elbow flexion weakness, which improved after physiotherapy over a period of 6 weeks. Conclusions Current therapy recommendations for acute compartment syndrome following jellyfish stings are mainly based on case reports. Urgent fasciotomy and local application of nitroglycerin have been demonstrated to be helpful in severe jellyfish stings associated with acute compartment syndrome.

We present a case of renal abscess caused by

We report two confirmed human bite cases by Lactrodectus geometricus , also known as the brown widow spider. These are the first reported bite envenomation incidents by L. geometricus in Malaysia. The incidents occurred in Tawau, Sabah and Paka, Terengganu. Both men were bitten on their ear while putting on motorcycle helmets. The spiders appeared to have nested in the helmets. The dead specimens were collected and sent to the Invertebrate and Vertebrate Neurobiology Laboratory, Department of Parasitology, Universiti Malaya for identification. The species identity was confirmed by DNA barcoding.

Catfish have the ability to inflict stings on their victims through spines located on their dorsal and pectoral fins. The stings of catfish can release toxins that have dermonecrotic, edemogenic, and vasospastic factors. In this case, a 56-year-old man suffered a catfish sting to his right thumb, which resulted in acute hand compartment syndrome and resultant hand fasciotomies. His hospital course was complicated by multiple irrigation and debridements, finger amputations, hand fluid cultures positive for Vibrio damsela, and eventual wrist disarticulation. The combination of envenomation, infection, and delayed presentation for treatment ultimately led to a hand amputation.

Elimination of dog-transmitted human rabies worldwide will require large-scale dog vaccination campaigns. However, this places participating vaccinators at increased risk. Data from the 2016–2017 Haitian mass rabies vaccination campaign was analyzed to determine dog bite incidence among vaccinators. A survey was then developed for completion by all identifiable bitten vaccinators covering demographics; experience and training; bite episode details; attitudes toward dogs and rabies; and medical care. A parallel group of unbitten vaccinators was also surveyed. Dog bite incidence was 0.03% (43/127,000) of all dogs vaccinated. The capture, vaccinate, and release method of vaccination carried a significantly higher risk of dog bite (0.35%, 6/1,739 vaccinations) than other methods (P < 0.001). Twenty-seven bitten vaccinators, and 54 control vaccinators were included in the survey analysis. No differences were found between groups in demographics, experience, or training. However, bitten vaccinators were significantly more likely than the control group to have experienced a dog bite before the study period (P < 0.001). This may be associated with a lesser appreciation of dogs, and/or a poorer ability to interpret dog behavioral signals within this group. Although 98% of the control group indicated they would seek medical care for a dog bite, only 35% of bitten vaccinators sought such care. On a yearly basis, for the Haitian campaign, a full series of postexposure rabies vaccinations for all bite victims would prove more cost-effective than preexposure vaccination of all vaccinators. These findings may prove useful for the planning and safety of future mass dog vaccination campaigns.

Dog bite injuries are common within the pediatric population. Currently, there are inconclusive data on best sedation practice, antibiotic regimen, and need for plastic surgery referrals for treatment of dog bite injuries in the emergency department (ED) versus operating room (OR). This study set out to determine sedation practice, infection management, and necessity for plastic surgery referral at a level I pediatric trauma center.A retrospective review of all pediatric (0-18 years old) dog bites documented in electronic medical records from January 1, 2010, to December 31, 2019, was performed. Bitten by dog encounters were identified by International Classification of Diseases, Ninth Revision and Tenth Revision codes E906.0 and W54.0, W54.0XXA, and W54, respectively. Data gathered included age, gender, month of injury, circumstance of injury, injury characteristics, location of repair, person performing repair, sedation (if used, then length of sedation), inpatient admission, antibiotics prescribed, dog characteristics (breed, size, sex, age, relationship to patient), and complications. Summary statistics were calculated as mean ± SD. Comparisons for nominal variables were performed using the χ2 test. All analyses were performed using Stata v.16. 1.A total of 1438 pediatric patients were included in this study over a 10-year period. Of injuries requiring repair (n = 846), most repairs were performed in the ED (97.1% [822/846]), whereas 24 (2.8%) required repair in the OR. Of the bites that required repair (n = 846), 81.1% (686/846) were performed by an emergency medicine physician and 147 (17.4%) by plastic surgeons. Procedural sedation in the ED was performed in 146 repairs (17.3%). Documented sedation time ranged from 10 to 96 minutes. Most patients received a prescription for antibiotics (80.5%), usually amoxicillin/clavulanate (90.8%). Infection was the most common sequela (9.5%). There was no significant difference in infection rates between repairs performed in the ED versus those in the OR.Our study indicates that pediatric patient dog bite injuries can be successfully managed in an ED. Procedural sedation has demonstrated no increased safety risks compared with the OR. Rates of infection are also not demonstrated to be significantly higher in repairs done in the ED versus those taken to operating theater.

Inflammation and partial loss of the tail occur with high frequency in pigs and must be combated if animal welfare is to be improved. In this context, consideration of tail biting as sole explanation fails to go far enough. Inflammation and necrosis of the tail occur regularly even without the intervention of other pigs. The evidence of such alterations already at the time of birth, the clustered synchronous occurrence on different parts of the body such as the tail, ears, teats, claws, amongst others as well as the pathohistological evidence of blood vessel-associated changes advocate a primarily endogenous cause bearing a syndromic character even if the symptomatology interacts with environmental factors. Alterations may be observed in suckling and weaning piglets as well as in fatteners. Environmental improvement may lead to a significantly reduced symptomatology. At the same time, genetic effects of boar and sow have been demonstrated. This review article highlights all facets of the syndrome known to date and provides an insight into the key points of the pathogenesis. The awareness of a new clinical syndrome that must be distinguished from tail biting will afford a contribution to combating this entity and thus increasing animal welfare in swine.Entzündungen und Teilverluste des Schwanzes treten in hoher Frequenz auf und müssen bekämpft werden, wenn das Tierwohl beim Schwein verbessert werden soll. Dabei greift die alleinige Berücksichtigung des Schwanzbeißens zu kurz. Entzündungen und Nekrosen des Schwanzes treten regelmäßig auch ohne Zutun anderer Schweine auf. Der Nachweis entsprechender Veränderungen bereits zum Zeitpunkt der Geburt, das gehäuft synchrone Auftreten an so verschiedenen Körperlokalisationen wie Schwanz, Ohren, Zitzen, Klauen und anderen Partien, sowie der pathohistologische Nachweis Blutgefäß-assoziierter Veränderungen sprechen für eine primär endogene Ursache und ein Syndrom, auch wenn die Symptomatik mit Umweltfaktoren interagiert. Die Veränderungen können bei Saug- und Absatzferkeln sowie in der Mast beobachtet werden. Die Verbesserung der Umwelt kann zu erheblicher Reduktion von Entzündungen und Nekrosen führen. Gleichzeitig zeigen sich erhebliche genetische Effekte der Eber und Sauen. Der vorliegende Übersichtsartikel beleuchtet alle bislang bekannten Facetten von SINS (Swine Inflammation and Necrosis Syndrome) und gibt einen Einblick in die Eckpunkte der Pathogenese. Das Bewusstsein für ein neues und vom Schwanzbeißen abzugrenzendes Krankheitsbild soll einen Beitrag zu dessen Bekämpfung und somit zur Steigerung des Tierwohls beim Schwein leisten.

Children under the age of 14 account for over 40% of the almost 900,000 annual hospital visits associated with dog bites. Care for dog bites ranges from simple wound irrigation to complex surgical reconstruction. Due to a number of factors, children frequently sustain dog bites to highly vulnerable regions, often necessitating intervention by plastic surgeons.This retrospective study analyzed data from the 1422 pediatric patients who sustained dog bites and presented to the Le Bonheur Children's Hospital Emergency Room from January 2011 to May 2017.The typical pediatric dog bite case was male (63.5%), African-American (57.4%), and less than 10 years old (69.4%). The head and neck were the most commonly affected areas (64.7%). Of the head and neck regions, the cheeks and lips were the most frequently injured structures (34.5%). Hospital admission was required for 188 patients (13.2%) and operative repair was deemed necessary in 16.9% of all cases. Of the patients requiring inpatient operative repair, most (78.3%) were discharged in less than 24 hours. Operative complications occurred in 5.8% of all cases, with infections accounting for the majority (92.9%). No fatal dog bites occurred in this study.Age, bite location, and number of bites sustained are several factors of significance, which may aid the novice plastic surgeon in identifying, which pediatric dog bite cases will require surgical intervention.

Vietnam is a rabies-endemic country where eating dog meat is customary. However, the risks of rabies transmission to dog slaughtering and processing workers have not been identified. This study aimed to determine the rabies neutralizing antibody (NTA) and risk factors in dog slaughterers to propose appropriate intervention methods for this occupational group. In 2016, a cross-sectional study on NTA against rabies virus and related factors was conducted among 406 professional dog slaughterers in Vietnam. The participants were interviewed using a structured questionnaire, and their sera were tested for rabies NTA by a rapid focus fluorescence inhibition test. Statistical algorithms were used to analyze the data. The results showed that most of the professional dog butchers (344/406 subjects, 84.7%) had no rabies NTA. Interestingly, 7.8% (29/373) had NTA without a rabies vaccination history. Over 5 years of experience as a dog butcher was positively associated with the presence of NTA in unvaccinated individuals (OR = 6.16, P = 0.001). The NTA in vaccinated butchers was present in higher titer and for longer persistence to those of other previously reported professionals, which is possibly as a result of multiple exposures to low levels of rabies virus antigens during dog slaughtering. Our study demonstrated that professional dog butchers in Vietnam are at a high risk of rabies virus infection, apart from those with common bite experiences. In countries where dog meat consumption is customary, rabies control and prevention activities should focus on safety during dog trading and slaughtering.

BackgroundGlobally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5–24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited.MethodsA new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations.ResultsThe total number of children ConclusionInjuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.

In the animal kingdom, intraspecific variation occurs, for example, between populations, different life stages, and sexes. For venomous animals, this can involve differences in their venom composition. In cases where venom is utilized in the context of mating, the differences in composition might be driven by sexual selection. In this regard, the genus

Rabies remains a public health problem in the Philippines despite the widespread provision of rabies vaccines and rabies immunoglobulin (RIG) as post-exposure prophylaxis (PEP). Detailed descriptions of recent human rabies cases in the Philippines are scarce. This study aimed to describe the clinical, epidemiological, and spatial features of human rabies cases between January 1, 2006, and December 31, 2015. We conducted a retrospective hospital-based case record review of all patients admitted to one referral hospital in Manila who received a clinical diagnosis of rabies. During the 10-year study period there were 575 patients (average 57.5 cases per year, range 57 to 119) with a final diagnosis of rabies. Most patients were male (n = 404, 70.3%) and aged ≥ 20 years (n = 433, 75.3%). Patients mostly came from the National Capital Region (n = 160, 28.0%) and the adjacent Regions III (n = 197, 34.4%) and IV-A (n = 168, 29.4%). Case mapping and heatmaps showed that human rabies cases were continuously observed in similar areas throughout the study period. Most patients had hydrophobia (n = 444, 95.5%) and/or aerophobia (n = 432, 93.3%). The leading causative animals were dogs (n = 421, 96.3%) and cats (n = 16, 3.7%). Among 437 patients with animal exposure history, only 42 (9.6%) had been administered at least one rabies vaccine. Two patients (0.5%), young children bitten on their face, had received and a full course of rabies vaccine. Human rabies patients were continuously admitted to the hospital, with no notable decline over the study period. The geographical area in which human rabies cases commonly occurred also did not change. Few patients received PEP and there were two suspected cases of PEP failure. The retrospective design of this study was a limitation; thus, prospective studies are required.

Background Shark-related injuries (SRIs) are a dreaded, but rare, source of injury that have not been well described. The present study aims to examine the incidence, injuries, and outcomes of SRIs presenting to US trauma centers. Study Design The National Trauma Data Bank was queried from 2015 to 2018 to identify SRIs using ICD-10 e-codes W56.41XA, W56.42XA, and W56.49XA. Descriptive analyses were conducted on patient demographics, injuries, hospital course, procedures, and outcomes. Results Fifty-three patients were identified with a mechanism of injury that was shark-related. The median age was 29 years (range: 3-67) and median injury severity score was 5 (IQR: 3-10). The majority of patients (96%) were admitted to the hospital (median length of stay (LOS): 4.0 days, IQR: 3.0-8.0), 55% went directly to the operating room, and 53% required intensive care unit (ICU) admission (median ICU LOS: 4.5 days, IQR: 1.3-7.0). Extremity injuries were common: 47% suffered lower extremity injuries, 40% had upper extremity injuries, and 13% had both. The majority of patients underwent surgical procedures: 83% had soft tissue injuries requiring debridement, flap coverage, or skin grafting; 28% suffered neurovascular injuries (17% requiring nerve repair and 2% requiring arterial bypass); and 59% required orthopedic intervention. Six patients (11%) required amputation(s). All patients survived to discharge. Conclusion Although an exceedingly rare source of trauma, SRIs are frequently associated with devastating injuries. Given the severity of injuries and associated procedures required, these patients warrant referral to a trauma center capable of providing comprehensive care.

Background Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center. Methods This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries. Demographic information, injury details, management, outcomes, and financial information were analyzed. Results Most pediatric dog bite injuries afflicted male children (55.6%), ages 6 to 12 years (45.7%), by a household dog (36.2%). The most common offending breed was a pit bull or pit bull mix (53.0%). Infants and grade schoolers were more likely to sustain bites to the head/face (P = 0.001). Usual management consisted of primary repair (75.9%), whereas approximately 25% of the patients required advanced reconstructive techniques. Most patients healed uneventfully, but prolonged antibiotics, additional wound care, or procedures were necessary in 8.4% of the patients. Hospital charges per patient averaged US $8830.70 and tended to be higher in the younger age groups. Insurance status was statistically associated with use of conscious sedation, surgical consult placement, and surgical repair. Conclusions Although most pediatric dog bite injuries in this study healed uneventfully from primary management in the emergency department, 25% required additional interventions. Furthermore, patient care for these injuries was associated with significant but potentially avoidable personal and financial burden to families. Our data reflect a need for safety education on animal care, behavior, and interaction.

Introduction Only a small portion of horse injuries are related to horse bites. In the majority of these occurrences, injuries are minor and self-treated. However, in some cases, the injury may be destructive and limb- and life-threatening. In these instances, the patient requires complex surgery and compound perioperative care. Case report We present the case of a 35-year-old Albanian male farm-worker in whom a horse bite caused an extensive lacero-contusive and avulsive wound to the arm. The wound resulted in injury to the brachial artery, brachial and basilic vein, and biceps and brachialis muscles. Nerve structures and underlying humerus remained intact. The initial management of the severe hemorrhagic shock caused by the bleeding at the site of injury included reconstruction of the brachial artery by interposing saphenous graft and that of the brachial vein by termino-terminal anastomosis. Basilic vein was ligated. The wound was extensively debrided, and after a drain was placed in the wound, biceps and brachialis muscles were reconstructed. The patient received several units of red blood cells and fresh frozen plasma before and after surgery, as well as antibiotic, antitetanic, and antirabies prophylaxes. He had several consecutive necrectomies in the following days. However, due to postoperative sepsis and hemorrhagic shock at time of admission, the patient developed acute renal failure, therefore requiring several hemodialysis sessions. After his general and local condition was stabilized, the patient also underwent several reconstructive surgeries. Conclusion Horse bites of large extent require a multidisciplinary approach. The composition of the team of physicians needed for treatment varies depending on the degree of the injury and eventual complications. In the case of our patient, emergency department physicians, vascular and plastic surgeons, intensive care specialists, nephrologists, and infective care specialists were involved. In different instances, the inclusion of other specialists may be necessary to save and functionalize the limbs of the patient, or save his/her life.

Summary Mammalian bites are common injuries, but management has been shown to vary widely. The aim of this study was to assess how the COVID-19 pandemic impacted management of mammalian bite injuries and resulting outcomes. We conducted a retrospective review of prospectively collected data on mammalian bite injuries assessed in our Plastic and Reconstructive Surgery department during April and May 2020. 37 patients presented with mammalian bite injuries during this period. Median age was 27 (range 1-75) with equal gender distribution. The majority presented on the day or day after injury. Bites were from dogs (78%), humans (14%) and cats (8%). Body parts involved were finger/hand (21), face (8), arm/forearm (5) and thigh/leg (3). 6 wounds were superficial (i.e. not penetrating the full-thickness of the skin) and 4 were associated with a fracture or significant soft tissue damage. 30 out of 31 non-superficial injuries were washed out under local anaesthesia, patients received a tetanus booster (if required) and were discharged with oral antibiotics and safety net advice. One wound associated with extensor tendon injury and metacarpal fracture was admitted and treated in the operating theatre. No complications were registered and only one patient represented with an infected wound, which was washed out under local anaesthesia and the patient discharged. Our experience during the COVID-19 pandemic suggests that the majority of mammalian bite injuries can safely be managed with washout under local anaesthesia, oral antibiotics and discharge on the same day with safety net advice. Going forward, healthcare resources can be optimised by taking these results into account.

Craniofacial fractures from canine bites are rare, but can be devastating events that lead to complex surgical management, long-term functional deficits, and psychological sequelae. The objective of this case-control study was to identify risks associated with craniofacial fractures in pediatric dog bite victims. From 2008 to 2019 at our quaternary center, all children with craniofacial fractures from dog bites were included in this study. Controls were obtained in a 2:1 ratio via a random sample of all dog bite encounters. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Of 3602 dog bite encounters, 114 children were included in the study with an average age of 4.8 years (interquartile range = 2.4-9.1 years) and 51 patients (45%) were female. Seventy-four children (65%) were bitten by a family-owned dog. Thirty-eight patients with 60 craniofacial fractures were identified. The following factors were significantly associated with increased risk for craniofacial fractures: Caucasian race (OR 7.3, CI 1.6-16.7), age under five (OR 4.1, CI 1.6-10.7), rural location (OR 3.9, CI 1.3-12.3), child location on the floor (OR 6.2, CI 2.4-16.2), and dogs weighing over 30 pounds (OR 19.6, CI 5.8-82.3). Nine patients (12%) required multiple reconstructive operations, and four patients (5%) developed post-traumatic stress disorder. In conclusion, toddlers in rural households with large dogs are at high risk for sustaining craniofacial fractures from bite injuries. Craniofacial surgeons, pediatricians, and emergency department physicians should use these data to lead prevention efforts in the community.

Animal and human bite injuries are a public health burden. Dog bites outnumber cat bites, but cat bites pose the greatest risk for infection. Skin and soft tissue infections are the most frequent infectious manifestations resulting from bite injury, although invasive infection may occur through direct inoculation or dissemination through the bloodstream. Although contemporary, well-designed trials are needed to inform clinical practice, preemptive antibiotic therapy after a bite injury is warranted for injuries posing high risk for infection and for patients at risk of developing severe infection; antibiotics should target aerobic and anaerobic microbes that comprise the oral and skin flora.

Background Rabies is found in many countries of the eastern Mediterranean and is one of the most important zoonotic diseases in the world. The study aims to describe rabies suspected exposures (RSE) and rabies prophylaxis practices in Antalya-Turkey between 2010 and 2013. Methods All 2513 RSE cases presenting to a rabies vaccination center in Antalya, southwestern Turkey, were retrospectively investigated. Results The mean age of the RSE cases was 30.04 ± 19.63 years with male predominance (63.6%). The vast majority was from urban areas (91.7%), and a postexposure rabies vaccination program was applied to 79.7% of participants. Dogs were the primary source of RSE cases (61.2%). The 39.2% of animals were under observation, and 9.53% of them died. Forty-two animals (1.7%) were laboratory confirmed rabid; 61.9% of them were cows. The rabid animal rate in the rural area was significantly higher than the urban area (18.2% versus 0.2%; p = 0.001). Conclusions This study includes a large number of RSE cases and prophylaxis practices in southwestern Turkey. Most RSE cases had dog or cat contact. As most RSE cases were in urban areas; more focused efforts should be made for elimination and vaccination of feral dog and cat population in Turkey.

Objectives To describe the clinical features and outcomes of a case series of adult tetanus and illustrate inadequacies in confronting this preventable disease. Design and Methods This study retrospectively evaluated 24 relatively severe, confirmed cases of tetanus, diagnosed between March 2017 and December 2018, in Kabul Antani Hospital, Afghanistan. Results Regarding the source of the infection: 18 patients (75%) had a history of injuries, 1 had a history of a dog bite and 1 was an intravenous drug user; 4 patients had no external injuries or wounds. Dysphagia was the main clinical manifestation for which patients sought medical treatment (50%). Of the 12 patients who died, 7 presented with confusion and seizure, 1 with acute kidney injury, and 2 with pneumonia. Conclusions Mortality due to tetanus is high in Afghanistan (Case Fatality Rate (CFR) 50%)), suggesting an urgent need for vaccination policy and programs, post-exposure protocols, and facilities equipped for the treatment of adult tetanus. The Ministry of Public Health of Afghanistan should seek to improve the accessibility, distribution and recording of tetanus immunization through vaccination.

The Swat district, a conflict-hit territory due to Taliban militancy, had a damaged local health infrastructure. Animal-bite injuries leading to rabies is one of the major health concerns in developing countries, especially within conflict zones. The current prospective epidemiological study was conducted to estimate the cumulative incidence of animal-bite injuries, to summarize characteristics of bite victims and biting animals, and to collect information about post-exposure prophylaxis (PEP) practices in Swat district, Pakistan, during 2014. A questionnaire was designed to collect data about the sociodemography of the patients, bite incident situation (provoked or unprovoked), injury pattern, animal type, PEP, and vaccination. Descriptive analyses were conducted using bar graphs, frequency tables, and chi-square tests were used to determine associations. The cumulative incidence of animal-bite injuries was 39 per 100,000 people during the study period (May–August 2014). The majority of incidents were reported from rural regions (77.7%) and were males (76.6%) younger than 10 years (37.3%). Dogs were the most frequent biting animal (86.8%) followed by rats (4.7%). About 77.7% patients washed their wound before arrival at hospital. After an eclipse phase of 10 days, 44 (10.1%) animals developed sign of rabies. The current study has highlighted a topic of interest for health, education, veterinary, and local government policy makers regarding prevention of animal bites, benefits of PEP, vaccination of human and domestic animals, control of stray dogs, and eradication of rabies in developing countries with damaged healthcare structures.

Capnocytophaga canimorsus is a bacteria commonly found in the normal oral cavity of dogs that can cause bacteremia in immunocompromised patients following a dog bite. This case describes sepsis and disseminated intravascular coagulation associated with C. canimorsus in a patient with a history of alcohol abuse. Clinicians must be alert to the risk factors for this infection and provide appropriate prophylaxis following dog bites.

Risk factors for infective endocarditis (IE) include congenital heart defects, poor dentition, immunosuppression, or recent instrumentation. The occupational hazard of a dog bite, combined with bicuspid aortic valve (BAV) led to IE. 16S ribosomal DNA was able to pinpoint the causative organism. A healthy 33-year-old postman presented in profound heart failure and sepsis due to aortic regurgitation and an aortic root abscess. He underwent emergency aortic valve replacement and was found to have a BAV and anomalous right coronary artery. Blood cultures remained negative. 16S ribosomal DNA polymerase chain reaction (PCR) revealed the causative organism was Capnocytophaga canimorsus. On review, he recalled receiving a dog bite followed by a febrile illness a few days later. Congenital BAVs may become infected by seemingly innocuous injuries. 16S rDNA PCR is a more sensitive and specific diagnostic test than culture. This case demonstrates its utility in providing appropriate antimicrobial management for IE.

Soft tissue injuries from animal bites are encountered occasionally in rural areas, resulting from attacks by, for example, dogs, wolves, horses, donkeys, and cats. The commonly affected body parts include the face, head and neck, nose, ears, hands, arms, and legs. The traumatic exposure of the external genital organs following an animal bite is a highly rare condition. Dog bite injuries in this area are a clinical condition that requires careful management due to the bacterial density of the oral flora of dogs, and also the potential bac-terial flora in the genital area, resulting in a high risk of infection. Tissue defects following dog bites to the genital area are at high risk of morbidity, and may even result in life-threatening conditions in the event of a major infection. The classical treatment approaches to soft tissue defects resulting from animal bites include wound irrigation, debridement, rabies and tetanus immunoprophylaxis, antibiotic therapy, and reconstruction after the elimination of the infection. Recently, however, the early acute approach seems to have replaced the conventional late period treatment, with studies recommending surgical repair in the early stage where possible. In this article, an unusual etiology of scrotal defect was determined under the light of detailed literature data. The present study reports on a case in which an early repair was made after wound cleaning and care, debridement, and then prophylactic antibiotic therapy, soon after the referring of the case to the hospital. No signs of local or systemic infection were noticed at the wound site during follow-up. Post-op-erative recovery was uneventful and the repair performed on the case had a satisfactory outcome. Based on our clinical experience, we believe that reconstruction accompanied by an early prophylactic antibiotherapy can produce satisfactory outcomes in genital defects caused by animal bites.

Vinegaroons (Mastigoproctus giganteus), also known as whip scorpions, are arachnids commonly found in the southwestern United States, parts of Mexico, and southern Florida. They do not bite, but have special teeth on the inside of the trochanters of the front appendages, used to crush prey. They are best known for having pygidial gland secretions containing 83% acetic acid, which are sprayed upon potential predators. There are no published descriptions of injury to human related to vinegaroon exposures. Our primary aim was to characterize types of exposures and clinical effects reported to a poison center that serves an area indigenous to this animal.The database from a regional poison center was searched for all cases from 1998 to 2022 regarding human exposures to the vinegaroon. Data captured included age, sex, exposure route, type and duration of symptoms, and part of the body affected.There were 50 exposures reported, with age range from 5 months to 54 years. Females represented 32 cases, males 17, and one unknown. Bites were more commonly described (36 cases), with 13 cases reported skin exposure to secretions, 3 ocular exposures, and 2 ingestions. Location of injury was upper extremities in 16 cases, lower in 11 cases, and torso in 3 cases. Symptoms were present in 88% and included pain, skin erythema, numbness or tingling, itching, and swelling. Ocular exposure were associated with pain in all 3 cases, with blurred vision in one case; effects lasted 1 h, 17 h, and more than 5 days. Four non-ocular exposures were followed to outcome, with duration of effects ranging from less than 1 h to more than 2 days.In a large series of vinegaroon exposures, females predominated, with most exposures occurring from skin contact with secretions. The most common symptoms were pain, erythema, numbness, itching, and swelling, which resolved in less than two days. Ocular exposures were associated with more symptoms and longer duration of effects.

From 2011 to 2020, there were 111 213 cases of rabies exposed people recruited from the rabies immunization clinic of a hospital in Beijing. The monthly distribution of patients in each year was not statistically significant (2011—2020年北京市某医院狂犬病免疫门诊累计接诊狂犬病暴露人群111 213例，各年度暴露人群的月份分布基本一致，差异无统计学意义（

Tail biting and lesions are common problems in modern pig production. In 2008 tail docking to prevent tail biting was banned in Switzerland. Since then pigs have been raised with intact tails. This study aimed to assess the current prevalence of tail lesions at Swiss abattoirs and comparing abattoir data with farm-specific data regarding potential risk factors for tail lesions. Data collection was performed in repetitive cycles of two weeks at four abattoirs during all consecutive seasons of one year. Gender, tail length and the tail tip condition were evaluated among other parameters. During 32 weeks in total, 195 704 pigs from 6112 batches from 2510 herds were evaluated. Overall, 63,2 % of the animals included in the analysis were slaughtered with a complete tail (lowest tail length score [TLS]), whereas 36,8 % showed a partial or total loss of the tail. The condition of the tail tip (tail tip condition score [TTCS]) was judged as being intact in 63,0 %, as a healed lesion in 23,7 %, an acute lesion in 1,3 % and a chronic lesion in 12,0 % of all cases. Male animals had significantly higher values for TLS and TTCS than female animals (P ≤ 0,05). TLS values were significantly higher in winter than in spring and summer (P0,001). TTCS values were significantly higher in fall than in spring and summer. TLS and TTCS values differed significantly (P0,001) between the four abattoirs. Only few significant correlations were found between values of TLS and TTCS and farm-specific data. Recording tail lesions at abattoirs is an accurate method to investigate the prevalence of tail lesions in fattening pigs. However, to monitor animal welfare on herd level, this method is very labor intensive. Moreover, data on tail lesions collected at the abattoir cannot replace veterinary on-farm examination for risk factor identification.Schwanzbeissen und Schwanzläsionen sind ein bekanntes Problem in der modernen Schweinehaltung. 2008 wurde das Kupieren des Schwanzes zur Verhinderung von Schwanzbeissen bei Schweinen in der Schweiz verboten. Seitdem werden Schweine mit intakten Schwänzen gemästet. Ziel dieser Studie war es, die aktuelle Prävalenz von Schwanzläsionen bei Mastschweinen in Schweizer Schlachthöfen zu untersuchen und die Schlachthofdaten mit bestandsspezifischen Daten bezüglich potenzieller Risikofaktoren zu vergleichen. Die Datenerhebung wurde in sich wiederholenden Zyklen von je zwei Wochen in vier Schlachthöfen in allen vier Jahreszeiten durchgeführt. Unter anderem wurden Geschlecht, Schwanzlänge und Zustand der Schwanzspitze bei geschlachteten Schweinen bewertet. Während insgesamt 32 Wochen wurden 195 704 Schweine aus 6112 Posten aus 2510 Herden untersucht. Bezüglich der Schwanzlänge wurden 63,2 %der in die statistische Analyse einbezogenen Tiere mit einem intakten Schwanz geschlachtet (niedrigster Tail Length Score [TLS]), wohingegen 36,8 %einen teilweisen oder vollständigen Verlust des Schwanzes aufwiesen. Der Zustand der Schwanzspitze (Tail Tip Condition Score [TTCS]) wurde in 63,0 %als intakt, in 23,7 %als abgeheilte Läsion, in 1,3 %als akute Läsion und in 12,0 %aller Fälle als chronische Läsion beurteilt. Männliche Tiere zeigten signifikant höhere Werte für TLS und TTCS als weibliche (P ≤ 0,05). Die TLS-Werte waren im Winter signifikant höher als im Frühjahr und Sommer (P0,001). Die TTCS-Werte waren im Herbst deutlich höher als im Frühjahr und Sommer. Die TLS- und TTCS-Werte unterschieden sich signifikant (P0,001) zwischen den vier Schlachthöfen. Zwischen den Werten von TLS und TTCS und betriebsspezifischen Daten wurden nur wenige signifikante Korrelationen nachgewiesen. Zusammenfassend lässt sich sagen, dass die Erfassung von Schwanzläsionen in Schlachthöfen eine genaue, aber arbeitsintensive Methode darstellt, um die Prävalenz von Schwanzläsionen in einer grossen Population von Mastschweinen exakt zu untersuchen. Darüber hinaus können die im Schlachthof erhobenen Daten zu Schwanzläsionen die Bestandsbesuche zur Erfassung herdenspezifischer Risikofaktoren durch Tierärzte nicht ersetzen.Les morsures et les lésions de la queue sont des problèmes courants dans la production porcine moderne. En 2008, la Suisse a interdit la caudectomie pour prévenir les morsures de la queue. Depuis lors, les porcs sont engraissés avec des queues intactes. Cette étude visait à évaluer la prévalence actuelle des lésions de la queue dans les abattoirs suisses et à comparer les données de l’abattoir avec les données spécifiques à l’exploitation concernant les facteurs de risque potentiels pour des lésions de la queue. La collecte des données a été effectuée par cycles répétitifs de deux semaines dans quatre abattoirs pendant toutes les saisons d’une année. Le sexe, la longueur de la queue et l’état de l’extrémité de la queue ont été évalués parmi d’autres paramètres. Pendant 32 semaines au total, 195 704 porcs provenant de 6 112 lots de 2 510 troupeaux ont été évalués. Dans l’ensemble, 63,2 % des animaux inclus dans l’analyse ont été abattus avec une queue complète (Tail Length Score [TLS] la plus basse), tandis que 36,8 %présentaient une perte partielle ou totale de la queue. L’état de l’extrémité de la queue (Tail Tip Condition Score [TTCS]) a été jugé intact dans 63,0 %des cas, avec une lésion cicatrisée dans 23,7 %des cas, avec une lésion aiguë dans 1,3 %des cas et avec une lésion chronique dans 12,0 %des cas. Les animaux mâles présentaient des valeurs de TLS et de TTCS significativement plus élevées que les animaux femelles (P ≤ 0,05). Les valeurs de TLS étaient significativement plus élevées en hiver qu’au printemps et en été (P0,001). Les valeurs de TTCS étaient significativement plus élevées en automne qu’au printemps et en été. Les valeurs TLS et TTCS différaient significativement (P0,001) entre les quatre abattoirs. Seules quelques corrélations significatives ont été trouvées entre les valeurs de TLS et TTCS et les données spécifiques à l’exploitation. L’enregistrement des lésions de la queue dans les abattoirs est une méthode précise pour étudier la prévalence de ces lésions chez les porcs d’engraissement. Cependant, pour contrôler le bien-être animal au niveau du troupeau, cette méthode demande beaucoup de travail. En outre, les données sur les lésions de la queue collectées à l’abattoir ne peuvent pas remplacer les examens vétérinaires sur l’exploitation pour l’identification des facteurs de risque.La morsicatura della coda e le lesioni sono problemi comuni nella moderna produzione suina. Nel 2008 il taglio della coda per prevenire il morso della coda nei maiali è stato vietato in Svizzera. Da allora i suini vengono allevati con la coda intatta. L’obiettivo di questo studio era di valutare l’attuale prevalenza delle lesioni alla coda nei macelli svizzeri e di confrontare i dati ottenuti con quelli specifici degli allevamenti per quanto riguarda i potenziali fattori di rischio delle lesioni alla coda. La raccolta dei dati è stata eseguita in cicli ripetitivi di due settimane in quattro macelli durante tutte le stagioni consecutive di un anno. Gli altri parametri presi in considerazione sono il sesso, la lunghezza della coda e lo stato della punta della coda. Durante un totale di 32 settimane, sono stati valutati 195 704 maiali di 6 112 lotti di 2510 branchi. Il 63,2 % degli animali inclusi nell’analisi statistica sono stati macellati con una coda intatta (punteggio più basso di lunghezza della coda (Tail Length Score [TLS]), mentre il 36,8 % aveva una perdita parziale o completa della coda. Lo stato della punta della coda (Tail Tip Condition Score [TTCS]) è stato considerato come intatto nel 63,0 %, con una lesione guarita nel 23,7 %, con una lesione acuta nell’1,3 % e con una lesione cronica nel 12,0 % di tutti i casi. Nei maschi si sono rilevati valori significativamente più alti per TLS e TTCS rispetto alle femmine (P ≤ 0,05). I valori di TLS erano significativamente più alti in inverno che in primavera e in estate (P0,001). I valori TTCS erano significativamente più alti in autunno che in primavera e in estate. I valori TLS e TTCS differivano significativamente (P0,001) tra i quattro macelli. Sono state rilevate poche correlazioni significative tra i valori TLS e TTCS e i dati specifici dell’azienda. La registrazione delle lesioni alla coda nei macelli risulta quindi essere un metodo accurato per valutare con precisione la prevalenza delle lesioni alla coda nei suini da ingrasso ma al contempo molto laborioso per monitorare il benessere degli animali in una grande popolazione. Inoltre, i dati sulle lesioni alla coda raccolti al macello non possono sostituire le visite alla mandria da parte dei veterinari per valutare i fattori di rischio specifici.

Ticks pose a serious threat to individuals of all ages owing to numerous physical illnesses including chills, aches, and a rash. Tick-borne illnesses range from a mild fever that may be treated at home to a severe disease necessitating hospitalization. Children are at an increased risk of tick bites owing to to their exposure to tick-infested areas during the summer. We report 2 cases of boys aged 3 and 8 years who sustained tick bites to the hemiscrotum and penis. Overnight hospitalization and a course of antibiotics were mandatory. In the first case, the child experienced significant scrotal cellulitis with erythema and edema extending to the suprapubic area with induration of the right anterior scrotum at the site of the tick bite. A scrotal ultrasound demonstrated swelling of the scrotal wall. In the second case, considerable swelling and induration of the distal penis and glans, pruritis of the left groin and penis, and an erythematous rash over the entire anterior pelvis were observed. A high index of suspicion is warranted because a tick bite may present as penile edema. Pediatric emergency physicians should be aware of the risks associated with tick bites and accurately diagnose and initiate treatment to prevent morbidity and mortality.

Despite indications that sharks have an exceptional capacity to heal from traumatic injuries, no detailed microscopic observations of integumental wounds have been reported for sharks. This study details the histopathological features of such wounds in a free-ranging shark. An adult male Blacktip Shark Carcharhinus limbatus was collected in 2017 during fisheries-independent sampling efforts in the coastal southeastern U.S. Atlantic. The shark had numerous lesions on his head, torso, and left pectoral fin that were compatible with shark bites. Representative samples from two wounds on the head were examined by light microscopy. The epidermal changes included hyperplasia and hypertrophy; intracellular edema; and the absence of goblet cells, denticles, and chromatophores. In the dermis, fibrinocellular exudation, granulation tissue, and marked skeletal muscle necrosis and regeneration were observed. The above features were comparable to wound healing in bony fish, albeit minor differences were found. Although this case documents exceptionally good regeneration of skeletal muscle in the shark, we found no evidence of unique morphological healing patterns. Further studies on wound healing are needed because recent molecular and genetic findings do suggest evolutionary adaptations enhancing healing in sharks.

Objectives Errors and misreporting on death certificates are common, along with potential inaccuracies in cause-of-death coding. We characterized and compared fatalities by animal-encounter mentions reported as underlying cause of death (UCD) with animal-encounter mentions reported as multiple cause of death (MCD) to determine factors associated with misreporting UCD. Methods We analyzed fatality data from 1999-2016 from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research by UCD and MCD animal-encounter mentions ( International Classification of Diseases, 10th Revision codes W53-59, X20-27 and X29, T63.0-63.6, T63.8-63.9, and T78.2-78.4). We examined differences in reporting by age, sex, race, autopsy (yes, no, unknown), allergic reactions, and toxicities. Results The number of animal-encounter mentions by UCD was 3638 (202 average per year) and by MCD was 4280 (238 average per year), a difference of 18% (n = 642; 36 average per year) by MCD analysis. The number of nonvenomous animal-encounter mentions increased 20% (from 2138 UCD to 2567 MCD), and the number of venomous animal-encounter mentions increased 14% (from 1500 UCD to 1713 MCD). Decedents aged ≥65 had the highest additional number of animal-encounter mentions among all age groups, primarily encounters with other reptiles (n = 113), other mammals (n = 71), and dogs (n = 42). Of 642 MCD additional animal-encounter mentions, heart disease (n = 211, 33%) and infections (n = 146, 23%) represented more than half of the UCD. Of 553 dog-encounter fatalities, 165 (30%) were among children aged ≤4. Conclusions Animal-encounter fatalities, analyzed by UCD alone, may be underreported. An initiating animal injury, complicated by comorbidities and fatality, may obscure the causal chain, resulting in misreporting UCD. Ongoing training for medical certifiers is recommended, highlighting accurate identification of UCD and contributing causes in the causal chain of death.

Investigating the cause of animal death is helpful to understand the reasons behind the interactions and conflicts between humans and animals. To further develop the cause of death investigation, we report a case of a Chinese spot-billed duck (Anas zonorhyncha) which hatched from a rescued duck and died 10 days after release. We inspected the duck's cause of death using an interview of concerned people, external body examination, necropsy, and genetic examinations. Based on the fractures, the main cause of death was determined to be a traffic accident. Furthermore, molecular tests helped to detect raccoon DNA in the visible bite wounds. This case shows that molecular biological method is one of the methods of clarify the animals' cause of death.

Background Dog bites are a common cause of pediatric trauma requiring hospital admission. We aim to describe pediatric bite victims, associated injuries and interventions. Methods Children (≤ 18 years old) were identified with an ICD-9 diagnosis of dog bite in the Kids' Inpatient Database for the years 2006, 2009 and 2012. National estimates were obtained using case weighting. Multivariable logistic regression was performed. Results We identified 6323 admissions for a dog bite with mean age of 6.63 years. Patients were predominately male (56.9%), non-Hispanic white (61.9%), resided in the South (35.1%), and in an urban environment (59.9%). Almost one third underwent a surgical procedure. Open wounds of the head, neck and trunk were the most common injury and decreased in prevalence with increasing age. Open wounds of the extremities were the second most common and the prevalence increased with increasing age. Children aged 1–4 and 5–10 years were both more than three times more likely to be admitted than those more than age 11. Conclusions Dog bite injuries are common for pediatric patients. Children less than age 11 are at greatest risk, particularly in the summer. Dog safety training should be focused on elementary and middle school children close to the start of summer vacation. Level of evidence III.

Objectives Injuries resulting from contact with animals are a significant public health concern. This study quantifies and updates nonfatal bite and sting injuries by noncanine sources using the most recent data available (2011-2015) from the National Electronic Injury Surveillance System-All Injury Program with the purpose of using these updates to better understand public health consequences and prevention techniques. Increased rates of bites and stings can be expected in this study's time frame, possibly caused by the increasing human population expanding into animal territories, as well as changes in animal geographic distribution and pet ownership. Methods The National Electronic Injury Surveillance System-All Injury Program is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal sources of bite and sting injuries being treated. Data from 2011-2015 were weighted to produce national annualized estimates, percentages, and rates based on the US population. Results An estimated 1.17 million people visited EDs for noncanine bite and sting injuries annually. This translates to a rate of 371.3/100,000 people. Insects accounted for 71.0% of noncanine bite and sting injuries, followed by arachnids (19.2%) and mammals (7.8%). The estimated annual total lifetime medical and work cost of unintentional noncanine injuries was $5,755,581,000. Conclusions Various sources of bite and sting injuries had an outsized effect on injury rates and identify potential areas of focus for education and prevention programs to reduce the burden of these injuries on health and healthcare costs. The study describes the diversity of animal exposures based on a national sample of EDs. Noncanine bite and sting injuries significantly affect public health and healthcare resources. Priorities can be focused on animal sources with the most impact on bite and sting injury rates, healthcare costs, and disease burden.

Background Due to their genetic characteristics, their isolation in rainforest areas, and their traditional way of life, Amerindian populations are likely to suffer from a specific spectrum of dermatoses. However, there are few available data on such skin disorders. Our aims were to describe all skin disorders in two Amerindian villages of French Guiana. Methods This retrospective study concerned all patients who consulted in the Health Centres of Camopi and Trois‐Sauts between July 1, 2017, and December 31, 2018. We included all patients classified with an ICD code linked to a skin disorder. All medical records were cross‐checked by two dermatologists to correct misclassifications. Results A total of 639 patients formed the study population, for 866 different skin disorders. Non‐sexually transmitted infections represented 57.6% of all skin disorders, followed by eczema (11.5%) and bites/envenomations (9.1%). Bacteria were responsible for 238 skin infections, followed by fungi (141 cases) and parasites (69 cases, including 43 scabies, nine cutaneous leishmaniasis, and two tungiasis). We reported a low prevalence of sexually transmitted infections (10 cases) and an absence of skin cancers. Conclusions This study revealed the absence of skin cancer in the Amerindian population of the Upper Oyapock and the important burden of infectious and animal‐related diseases. Future studies should assess a possible underestimation of sexually transmitted diseases in this area. Public health policies should target neglected diseases such as cutaneous leishmaniasis, tungiasis, scabies, and envenomations. Atopic dermatitis was a significant and unexpected cause of consultations.

Post-traumatic stress disorder is a debilitating condition that can develop after exposure to any potentially traumatic event (natural disaster, physical assault, and car accident). This study focused on four pediatric patients presenting with an early stress response after a motor vehicle accident who were offered early therapeutic and a preventive management by hypnotherapy shortly after exposure to the traumatic event. All patients improved after one or several sessions of hypnosis. The results indicate that hypnotherapy can immediately help patients during the early period following a traumatic event.

BackgroundOver thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013–2017.MethodsIn this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics.ResultsIn the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55–45.66 per100000 populations during 2013–2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9,P-trendConclusionThe results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.

Background Rabies is endemic in southern Bhutan, associated with 1–2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians’ management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023. Methods A cross-sectional survey of 50 clinicians’ management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February–March 2016. Results Data were collected on clinicians’ management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years’ experience. There was poor agreement between clinicians’ rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals. Conclusions This study highlights important discrepancies between clinicians’ management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician’s management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians’ practices.