Beware the mongoose

I've been bitten lots of times, some on the job (including the last dog I saw when I was in general practice) and some off (including a dog down the road a couple of years ago). Fortunately, I haven't suffered any serious consequences. That's what happens most of the time. However, bad things can and do occur after bites.

A paper in BMJ Case Reports (Tumram et al 2012) describes a rather unusual and unfortunate situation. It's about a fatal infection in a 55-year-old Indian woman who was bitten by a mongoose. She was bitten (unprovoked, it seems) on the leg by the mongoose while washing dishes. She went to the hospital a couple of hours later because of pain and swelling in her leg. It's not clear what happened there, but she went back to hospital the next day, and then received antibiotics. However, that same day, she suffered cardiac arrest (a heart attack) and died a few days later. The bacterium Streptococcus pyogenes (Group A Streptococcus) was isolated from some lesions on her legs, leading to a suspicion that she developed a severe and rapidly progressive infection from the mongoose bite.

Various aspects of this case are unusual. Fatal bite infections occur, but they are rare. Involvement of streptococci is rarer still.

Why did this woman develop a fatal infection, especially when she sought prompt medical care? It's hard to say, and there is a "bad luck" component of infectious diseases. She had diabetes and high blood pressure, which probably increased her susceptibility to infection (but lots of other people who get bitten also have these conditions and suffer no consequences). It doesn't appear that she received antibiotics when she went to the hospital originally, but a bite over the leg isn't one that would always be treated prophylactically with antibiotics.

Why did the mongoose bite? That's another good question. Unless you're a snake, mongooses are typically not aggressive.

Where did the bacteria come from? We don't know much about the oral bacterial population of mongooses, but Streptococcus pyogenes is a human-associated bacterium. It's rarely found in animals and I suspect that the strep didn't come from the mongoose. Rather, it was probably already on the woman's skin and introduced into her body by the bite, or she contaminated the wound after being bitten. It's just a guess, and it doesn't change anything, but it makes sense.

This report shouldn't make people freak out over a bite. However, it should serve as a reminder that bad things can happen. More information about dealing with bites can be found on the Worms & Germs Resources - Pets page.

Image: Dwarf mongoose (Helogale parvula) in Korkeasaari zoo (photo credit: Miika Silfverberg, click image for source)

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