Coeliac disease in adults

Tiger bites Further to the report by Mr Papadopoulos and colleagues (June 1999 JRSM, pp. 303-14), there are at least three other reported cases of severe spinal injuries caused by tiger bites, two of which also cite infective complicationsl-3. The proprioreceptors located in the teeth and jaw allow cats to align their teeth between the cervical vertebrae of their prey, severing the spinal cord as the neck is hyperextended-hence the severity of spinal injuries reported. Like their smaller domestic relatives, most large cats carry Pasteurella multocida in their mouths. Two cases of infection due to P. multocida following cougar bites have been reported4'5, again associated with severe injuries. The first reported case of tiger-bite-associated P. multocida infection stimulated a study of the 'fang flora' in seven tigers, from all of which were isolated Pasteurella1. An 11 year-old girl developed P. multocida meningitis following severe cervical injuries after being bitten by a Bengal tiger3. She recovered fully, apart from residual weakness of the limbs due to spinal cord trauma. In general, cat bites pose a greater risk of infection than dog bites. This is due to a combination of sharp teeth causing deep wounds that are difficult to clean properly, a high inoculation of anaerobic bacteria in the wounds, and inadequate antimicrobial prophylaxis. Where clinically justified (severity of wound, lower limb, immunosuppression, etc), co-amoxiclav is the prophylactic antimicrobial of choice, covering staphylococci, streptococci, pasteurella and anaerobes. I suggest co-amoxiclav would be the best choice of prophylactic antimicrobial after bites by large cats.