Journal of the American Board of Family Medicine
Iguana Bites to the Face
Charles S. Bibbs, MD, Floyd B. Willis, MD, Robert L. Bratton, MD,
Department of Family Medicine, Mayo Clinic Jacksonville, Jacksonville,
Pet reptiles have increased in popularity in the United States to
the extent that 3% of households now contain these animals. The
most common pet reptile is the iguana, and the most common of these
lizards is the green iguana (Iguana iguana). As the popularity of
these creatures in US households continues to grow, so will the
threat of bites. To date, little North American medical literature
has been devoted to nonvenomous reptile bites, and particularly
little has been devoted to iguana bites.
of the available medical literature on iguana bites uncovered four
published cases.[2,3] There is no information on frequent injuries
to the head or facial areas. Two cases are reported here because
of their striking similarities with respect to location and appearance
of the bites.
A 42-year-old woman was seen 2 days after having been bitten by
a large (51/2-foot) pet iguana that belonged to her neighbor. The
patient was attempting to pet the animal while gently blowing air
from her mouth onto the iguana's back (she was under the impression
that this was soothing to the animal). The iguana suddenly lunged
forward and bit her twice on the nose. There was immediate moderate
pain, which resolved within several minutes to a dull pain with
minimal swelling. When examined, the patient had two small puncture
wounds on each side of her nose (Figure 1). The nares were patent,
there was no evidence of cellulitis or adenopathy, her neck was
supple, and there were no systemic findings. The wound was cleaned,
and a triple antibiotic ointment was applied. Ibuprofen and cefadroxil
were prescribed. When the patient's wound was observed several days
later, it was healing properly, and there was no evidence of infection.
A 16-year-old boy was seen 1 day after being bitten by his pet iguana
as he attempted to pet it. As with the first patient, the lizard
unexpectedly lunged forward to bite him on the nose. The patient
called the veterinarian and was advised to seek medical attention.
He was also informed that iguanas are particularly aggressive during
the mating season. When examined, he had two superficial lacerations
on his nose (Figure 2). The nares were patent, and there was no
evidence of cellulitis, adenopathy, or systemic involvement. After
the wound was cleaned and triple antibiotic ointment was applied,
the patient was sent home with a prescription for cephalexin. On
reevaluation, the wounds were healing with no evidence of infection.
1. A 42-year-old woman with two puncture wounds on each side of
the nose 2 days after being bitten by an iguana.
2. A 16-year-old boy with two superficial lacerations on his nose
1 day after being bitten by his pet iguana.
The literature currently describes no specific diseases that are
commonly caused by inoculation from iguana bites. One case report
documents Serratia marcescens cellulitis after an iguana bite.
There is, however, a considerable amount of information on salmonellosis
in humans that has resulted from exposure to iguana feces. More
than 80% of captive iguanas shed Salmonella in the feces, which
can create health risks for those who are bitten by or exposed to
the feces of these animals.[1,6]
nonvenomous pet reptile bites are not frequently seen in the primary
care physician's office or the emergency department, the choice
of iguanas as pets is increasing (795,000 of these animals were
imported to the United States in 1995, compared with 139,000 in
1989) and could well lead to more treatment for bites. Treatment
of iguana bites can include prophylactic antibiotics if the depth
or severity of the wound is serious. Thorough cleaning, review of
tetanus immunization, and observation might suffice as long as there
is careful monitoring for signs of infection. Because iguanas and
Salmonella are so strongly linked, the choice of antibiotics should
include agents that are specific for Salmonella species as well
as normal human skin flora.
also exists a risk of nontraumatic illnesses from exposure to iguanas
and their nearly ubiquitous infection with Salmonella. Serious illness
leading to fever, loose stools, vomiting, and even death can result
from Salmonella infection.
There is currently no information to suggest that iguana or other
nonvenomous reptile bites should be evaluated and treated any more
aggressively than other types of mild trauma to the skin. Appropriate
therapy with antibiotics and a tetanus booster are prudent if the
wound clinically appears to be at risk for superficial or deep tissue
infection. If antibiotics are considered to be necessary, it might
be prudent to select a quinolone or other antibiotic that will treat
Salmonella as well as human skin flora infections.
of the potential morbidity and mortality from Salmonella infection,
the following recommendations have been posted by the Centers for
Persons at increased risk for infection or serious complications
of salmonellosis (eg, pregnant women, children less than 5 years
of age, and immunocompromised persons such as those with acquired
immunodeficiency syndrome) should avoid contact with reptiles
Reptiles should not be kept in child care centers and might not
be appropriate pets in households in which residents are at increased
risk for infection.
Veterinarians and pet store owners should provide information to
potential purchasers and to owners of reptiles about the increased
risk of acquiring salmonellosis from reptiles.
Veterinarians and operators of pet stores should advise reptile
owners to wash their hands every time they have handled reptiles
or reptile cages.
Reptiles should be kept out of food preparation areas (kitchens,
etc) and other selected sites to prevent contamination. In particular,
kitchen sinks should not be used to bathe reptiles or to wash reptile
dishes, cages, or aquariums.
this time, we do not have sufficient information to predict when
an iguana or other nonvenomous reptile might be more aggressive
and more prone to bite. Certain aggressive behavior, such as head
bobbing, nodding, or charging, might warn of an impending bite.[1,8]
Further case reports and medical documentation of iguana and other
nonvenomous pet bites might yield trends that allow pet owners and
physicians to formulate preventive strategies.
Mermin J, Hoar B, Angulo FJ. Iguanas and Salmonella marina infection
in children: a reflection of the increasing incidence of reptile-associated
salmonellosis in the United States. Pediatrics 1997;99:399-402.
Kelsey J, Ehrlich M, Henderson SO. Exotic reptile bites. Am J Emerg
Teitel AD. B(n)ite of the iguana. Am J Emerg Med 1990;8:567-8.
Hsieh S, Babl FE. Serratia marcescens cellulitis following an iguana
bite. Clin Infect Dis 1999;28:1181-2.
Austin CC, Wilkins MJ. Reptile-associated salmonellosis. J Am Vet
Med Assoc 1998;212:866-7.
Burnham BR, Atchley DH, DeFusco RP, et al. Prevalence of fecal shedding
of Salmonella organisms among captive green iguanas and potential
public health implications. J Am Vet Med Assoc 1998;213:48-50.
Reptile-associated salmonellosisMselected states, 1994-1995. MMWR
Morb Mortal Wkly Rep 1995;44:347-50.
Chiodini RJ, Sundberg JP. Salmonellosis in reptiles: a review. Am
J Epidemiol 1981;113:494-9.
Address reprint requests to Floyd B. Willis, MD, Department of Family
Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville,
Am Board Fam Med. 2001;14(2) 2001 American Board of Family Medicine