As mentioned, the majority of mammal bites occur as a result of domestic animals, particularly dogs and cats, biting the individual. With the large number of dogs around the world, the incidence of bites becomes astronomical. Further, the recognition that 15-20% of these bites will become infected, especially in children, should cause one to guard against the high risk of dog bites, particularly by the strange dog. Fifty percent of all dog bites occur in children under the age of 12. Around the world, Somalia with its stray dogs carrying rabies, and Romania, with their large number of strays roaming the streets, demonstrates the potential for harm. Postmen in Taiwan and rabies in India are further examples of the dog menace. One hundred million dollars is the estimated cost per year in the United States for treatment of 15% of the dog bites. Missionaries and Peace Corps volunteers who encounter dogs attack in strange areas should receive initial therapy early. Rabies vaccine and tetanus prophylaxis should be utilized.

The second most common cause of domestic animal bites outside of the human includes the house cat. They have sharp needle-like teeth and cause an estimated 500,000 bites each year in women in the United States. These animals, in particular, may carry such diseases as Bartonella, Tularemia and Pasturella multocida organisms as well as cat scratch fever. Early antibiotic treatment with amoxicillin or cephalexin as well as Cipro and Clindamycin should be considered. These bites occur primarily in the upper extremities, especially the hand and the arm. Most such bites occur in the early adult individual between the age of 21 and 35 years. Usually the cat is known to the individual. But a large percentage of these felines may be wild or stray cats taken in for care.

On almost all continents, one will find the large wild cats as well as the small house cats. However, in certain areas such as Africa and India, the lion and the tiger occur in greater numbers. They are strong, fast and powerful. Recorded history demonstrates that in Kenya 135 rail workers were killed by two lions, and in Tanganyika, 380 people were killed. They may carry their larger prey, such as a cow, on their backs. The human may be injured, particularly at night, when they are searching for water or in the national parks. The puncture by their teeth may cause meningitis or Pasturella infection. Treatment of their injury requires extensive surgical debridement and tetanus antitoxin. Lions tend to kill by grabbing the throat and causing asphyxiation.

The tigers continue to kill each year in the Outback, and again there are stories of the tiger being able to move large carcasses long distances. Particularly in India, these animals may cause shock, blood loss, scalp injuries, fractured ribs and death. The other large cats, such as leopards and cougars, may carry the Pasturella organism and they are very difficult to tame. Their wounds may cause cellulitis, fever, and adenitis and require intensive therapy. Jaguars, cheetahs, ocelots all are fast and cunning. The bear, there being three main types—the black, the brown and the polar— may all be dangerous to the individual. The black bear usually will run from the human but may climb trees and may cause an occasional unprovoked attack. The brown bear may cause skeletal fracture injury, carry rabies, hepatitis, distemper, trichinella and other organisms. The fast, large and powerful polar bear will attack literally anything that moves as a potential food source.

The tree and the forest mammals such as the ape or the monkey, may be used in research, but also occur in the wild, and are scratchers and biters. They teach their young by biting and wrestling with them. Their injuries in the tropics are well documented. They carry a large number of bacteria in their mouth, and they may transmit a number of zoonotic diseases including viruses. The sloth and panda, however, do not appear to cause many bites, whereas the squirrel will bite and scratch on being trapped or cornered. Plains animals, including the rhinoceros and hippopotamus, are large, heavy animals. The hippopotamus may cause injury both on land and in water and may drown their victim or cause crushing injuries.

The rhinoceros and the water buffalo may gore and trample. Other plains animals, such as antelope and zebra, tend to run. But the wild dogs—the wolf, the hyena, the dingo—all may carry rabies and transmit this to the human or to the domestic animal. They tend to bite lower. Prophylaxis against rabies and tetanus should be foremost in the treatment program along with antibiotics.

Marine mammals, such as the whale and the dolphin, uncommonly cause bites - but may. The dolphin may carry Brucellosis. The beaver, the otter and the mink have sharp teeth and bite viciously. Flying mammals, including bats, the vampire bats, or flying squirrels, may all bite, scratch and carry multiple disease organisms such as fungal, bacterial and viral. Encephalomyelitis, histoplasmosis, and the screw worm may all be considerations. Rabies shots and animal autopsy are necessary when one is bitten by bats. Rodents usually bite low, but they carry fleas and other considerations that one must be aware of. These include hantavirus from their droppings, leptospirosis from the non-bite situation, rat bite fever, tularaemia, sporotrichosis and hemorrhagic fever. Fatal rat bites are uncommon unless they are in small children or alcoholics. The plague organism may be carried by the rodent, and therefore elimination of rodents and ratproofing buildings are particularly important. Tularaemia in rodents as well as Brucellosis and Lassa fever may occur. The Australian mammals, including the kangaroo and the wallaby, tend to kick more than bite, but salmonella and pseudomonas as well as staphylococcus and streptococcus organisms have been cultured from these animals.

This is one of the most serious types of bites and they usually occur as a result of three types of trauma—self-inflicted, such as nail biting and thumb sucking, bite wounds from fighting or lovemaking, and clenched fist injuries, which occur as a result of intentional combat. The latter usually occur when striking an individual in the mouth or teeth. The injuries occur far more commonly than one is aware, and many times the treatment of such is ignored for a long period of time. These lovemaking bites may affect the breasts, the lips, the genitals and the neck. The human bite may carry a large number of both anaerobic and aerobic organisms. Infections as a result of staphylococci, streptococci, haemophilus and other organisms are relatively common. Antibiotic therapy, drainage and immobilization all may be necessary, but one should be further aware that hepatitis organisms as well as the HIV organism may be transmitted in the human situation. Most such human injuries, however, occur in the upper portion of the body, particularly the upper extremity, head and neck.

Prevention certainly is a key to avoidance of any serious injury. One should be aware of the potential for injury when around an animal, particularly a strange animal ( Table 3). A number of safety precautions have been recommended, with regard to the dog and the cat ( Table 4).

Treatment of mammal bites is an everyday occurrence in most busy emergency rooms. The treatment may be directed both at the initial injury but also at the potential complications of this attack. Table 5 outlines the treatment of mammal bites and their consequent injury. In addition to the necessity for treatment, one should be aware of the various places around the world where information regarding treatment and prevention is available. Therefore, the Centers for Disease Control and Health Information for the International Traveller should be contacted. The International Medicine Society, Tropical Medicine Society and Travel Medicine Advisory Newsletter should all be good sources of information as well as the World Health Organization (WHO) publications. Recognizing the incidence of these bites, success varies with the magnitude of the bite trauma and the availability of treatment facilities. Therefore, recognition of the problem and appropriate resuscitative efforts must all be a part of the treatment protocol for the individual victim. The overall success may depend on access to intravenous fluid resuscitation, intravenous antibiotics, respirator care, long-time hospitalization and feeding as well as the simple home care protocol. . One should appreciate the necessity of cleanliness and culture, both anaerobic and aerobic, of the wound created. Avoidance and prevention again are of greater importance.