Bite marks on arm

Photo by VIN Staff

A few weekends ago my boyfriend Erik woke up to discover two tiny little bite marks on his wrist. Bats are the first thing that came to my worrywart mind. No, wait; as my eyes focused, I saw there were three tiny bite marks, not two. So do we worry that it could be a bat bite anyway? Do bats ever leave a single bite? Could one fang not hit the mark, perhaps slipping off sweat or coming in at a bad angle?

And if we don't worry, will he get rabies and die a terrible death because we didn't do anything when we had the chance?

Worrying is an occupational hazard of editing and writing client education material for Veterinary Partner, VetzInsight's companion, just-the-facts-ma'am site. I know a little too much about zoonotic diseases that can be transmitted from animals to people to not be afraid of bat bites. Flip side: I don't know anywhere near enough to have a knowledgeable conclusion. Basically I know that if you have two tiny fang bites close together that you should look up photos of bat bites (scroll down) and then act accordingly: If it looks like you were bitten by a bat, rush to the hospital. If not, don't worry, be happy.

On his own, Erik would not have thought twice about the bites possibly coming from a bat. I just ramped up the worry for both of us.

According to the CDC, Americans' home base for all things medical, "While rabies is rare in people in the United States, with only 1 to 3 cases reported annually, about 55,000 Americans get post-exposure prophylaxis (PEP) each year to prevent rabies infection after being bitten or scratched by an infected or suspected infected animal.... Contact with infected bats is the leading cause of human rabies deaths in this country; 7 out of 10 Americans who die from rabies in the US were infected by bats."

So you see the dilemma involved in blowing off teeny tiny bites. It's also clear why vaccination for rabies is required for dogs.

Choosing to not panic but also not to ignore, he contacted some virtual urgent care thing at his HMO. I took a photo of the bite marks and we sent it to them. Three hours later, someone called. She said they certainly looked like fang bites, which could be from a bat or a spider, but that they had no way of knowing. She didn't know if a bat could leave three bite marks or not. All she could say was that if he was worried, we should go to the ER now: not wait for his regular doctor the next day, and not urgent care because they don't have the PEP that would be given.

Not to add any pressure, but the CDC also says "Decisions should not be delayed." And: "To date less than 20 cases of human survival from clinical rabies have been documented."

To wrap up: His health provider told him he had to choose between the ER, likely incurring significant costs because he has not yet met his deductible, or potentially facing the irreversible and fatal rabies. Alrighty then!

I could not find anything anywhere on whether or not bats can miss one fang while chomping down.

Doesn't seem likely, but are you willing to bet your actual life on it?

We did not see a bat anywhere the day before. No dead bats on the floor, no bats flying around. He had been working in the garage where he saw several spiders, so we decided to go with spider bites as the cause rather than bats because it was more logical in the absence of any bats.

Generally speaking, people capture the bat that is flying around, or pick it up from the floor: you should wear gloves when handling a live or deceased bat, and don't kill it yourself for safety and humane reasons, plus you don't want to ruin the brain. The bat is then sent off to a state lab where they euthanize it and then chop its little head off and dissect brain tissue to see if it has rabies. Better its head than yours. But without a bat corpse, testing is impossible and you end up getting the rabies series of four doses in your arm (the long series of painful shots in the stomach is thankfully from an era gone by). The bonus is that you don't have to worry about rabies for the next 10-20 years, but should get a booster if you get bitten again.

In my quest for an answer to the 3-fang question, I emailed a photo of the triple bite to my favorite veterinary infectious diseases guy, Dr. Scott Weese of Worms and Germs fame.

"That sounds more like insect bites to me, based on the pattern and redness. Bat bites are often very hard to find and usually don't have a remarkable appearance (swelling around a small bite would be more consistent with a reaction to an insect bite). But, obviously I can't say that with much confidence. With no clear chance of exposure to a bite, it gets even less likely. If he hasn't handled a bat or worked in a place like an attic where bats were present, the risk of exposure would presumably just be in the house while sleeping. If a bat hasn't been seen in the house, then that likelihood drops further. The problem here is it's one of these ‘basically zero' risk situations where we can't say ‘zero' because there's no way to definitely know what happened."

Doctors of all stripes are leery of saying yes or no to such specificity.

My best friend and her husband are physicians. They were underwhelmed with the idea that it could be a bat bite.

I emailed the CDC asking if bats could leave just one bite. I received, a couple of days later, a lengthy chunk of pre-written info about rabies and how exposure happens. They said to contact them with any other questions, so I did because I am just that kind of annoying person. I said you didn't actually answer my question. The response that came a week later was bumped up to medium priority, and it said, I kid you not: "Thank you for your inquiry, we recommend you contact your local or state health department for a risk assessment and further guidance on the matter. With love from the CDC's Rabies Team." (Okay, they didn't say with love, but I know they meant to.)

They told me what I already knew and nothing more, bumping it to a local level. I was asking a specific question of a group not best qualified to answer it. Knowing that there are different bat species in different geographic areas and different species may well have different bite patterns, it makes sense that they'd refer me to my local health department. But I was still disappointed.

It's been almost three weeks and so far he has not turned into a zombie, but I'm keeping my eye on him because the incubation period lasts anywhere from 3-12 weeks. You realize that most zombie stories begin with a mutant form of rabies, right? Think about the symptoms of rabies in people: Delirium, abnormal behavior, aggression, hallucinations, fear of water, paranoia, and insomnia? And then a slow, painful, hideous death that takes about 1-3 weeks. Zombies!

I still have no idea if any bat can leave three bite marks. I doubted it early on, and still do. But are you willing to bet your life on a doubt?

And you wonder why a worrywart worries.

Update: Three months later, he is no more zombie-like than he was before. Life is good.