A 15-year-old adolescent boy was cleaning some items in the shed in his backyard in afternoon,when he saw a bat in middle of the shed , the boy was administered to the ED (Emergency Department) With vital signs of 115/70 mm Hg BP, heart rate of 105 beats per minute , respiratory rate of 14 breaths per minute pulse oximetry of 99% on room air, and a temperature of 37.1°C (98.9°F) Inspection of the wound shows deep bite marks with a laceration close to the proximal interphalyngeal joint. The bat escaped after the boy was bitten and was not found.
What Is The Most Likely Diagnosis?
Unprovoked attack by a rabies-infected bat
Analysis : The Bat shows abnormal behaviour ; It was active in the afternoon (while bats are nocturnal creatures) , and it bit the boy -while normal bats may bite when provoked , rabies infected bats are more likely to bite . The strange bat behaviour raises suspicions towards being infected by the rabies .
Treatment And Considerations :
Cleaning of the patient's wound should be the first priority , the medical service provider should keep in mind that the patient was bit close to the joint space of the proximal interphalengeal joint , take care of the possibility of retained teeth . The patient's tetanus status should be constantly checked .
In this patient’s case, postexposure prophylaxis for rabies and delayed primary closure to observe for infection are reasonable. Postexposure prophylaxis for rabies should include a combination of immediate, passive (rabies immunoglobulin) immunization and active immunization (human diploid cell vaccine). Tetanus vaccine should be administered if the patient has not received it within the last 5 years.
The Animal Control agencies should be contacted to notify them of the loose animal so they deal with it , in order to avoid any further bite attacks .
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