Skip to main content Accessibility help
  • Print publication year: 2008
  • Online publication date: December 2009

22 - Hand Infections: Fight Bite, Purulent Tenosynovitis, Felon, and Paronychia

from Part I - Systems
    • By Michael Kohn, Associate Clinical Professor of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, CA; Attending Emergency Physician, Mills-Peninsula Medical Center, Burlingame, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Publisher: Cambridge University Press
  • DOI:
  • pp 121-126



Introduction – Agents

The most notorious of all nonvenomous bite wounds is the fight bite. As the name implies, this injury occurs when the subject punches an adversary in the teeth, lacerating the dorsum of one or more metacarpal-phalangeal (MCP) joints (Figure 22.1). Other names for this injury, such as “morsus humanus” or “clenched fist injury,” have been proposed, though “fight bite” is more descriptive and widely used. The fight bite gave human bites their reputation for being more prone to infection than other animal bites. This has more to do with the location of the bite and the typical delay in treatment than with the mix of organisms in the human mouth. Common fight bite infections include cellulitis, subcutaneous abscesses, septic MCP joint, and purulent tenosynovitis. In the preantibiotic era, fight bite infections commonly necessitated finger and occasionally arm amputations. Fight bite infections are usually polymicrobial and often involve Streptococcus species, Staphylococcus species, Eikenella, and oral anaerobic bacteria.

The first two fight-bite patients reported in the medical literature were described by William H. Peters in 1911. He was primarily concerned with culturing mouth organisms, specifically Fusobacteria, from the infected wounds. Various other studies emphasizing the symbiosis of spirochetes and fusiform organisms in fight bites appeared afterwards.

Related content

Powered by UNSILO
Boland, F.Morsus humanus. JAMA 1941;116:127.
Boles, S D, Schmidt, C C. Pyogenic flexor tenosynovitis. Hand Clin 1998 Nov;14(4):567–78.
Bowling, J C, Saha M, , Bunker, C B. Herpetic whitlow: a forgotten diagnosis. Clin Exp Dermatol 2005 Sep;30(5):609–10.
Gill, M J, Arlette J, , Buchan K, . Herpes simplex virus infection of the hand. A profile of 79 cases. Am J Med 1988 Jan;84(1):89–93.
Kanavel, A B. Infections of the hand; a guide to the surgical treatment of acute and chronic suppurative processes in the fingers, hand, and forearm, 7th ed. Philadelphia: Lea & Febiger, 1939.
Karanas, Y L, Bogdan, M A, Chang J, . Community acquired methicillin-resistant Staphylococcus aureus hand infections: case reports and clinical implications. J Hand Surg [Am] 2000 Jul;25(4):760–3.
Mason M, , Koch S, . Human bite infections of the hand. Surg Gynecol Obstet 1930;51:591–625.
Peters, W.Hand infection apparently due to Bacillus fusiformis. J Infect Dis 1911;8:455–62.
Rockwell, P G. Acute and chronic paronychia. Am Fam Physician 2001 Mar 15;63(6):1113–6.
Schmidt, D R, Heckman, J D. Eikenella corrodens in human bite infections of the hand. J Trauma 1983 Jun;23(6):478–82.
Welch C, . Human bite infections of the hand. N Engl J Med 1936;215:901.
Lamb, D W, Hooper, G. Hand conditions. New York: Churchill Livingstone, 1994.
Clark, D C. Common acute hand infections. Am Fam Physician 2003 Dec 1;68(11):2167–76.
Talan, D A, Abrahamian, F M, Moran, G J, et al. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis 2003 Dec 1;37(11):1481–9.