Big cats and you

Many people own pets. Somewhere around 30% of US households have dogs, and nearly the same amount have cats. There is certainly some overlap. However, these are the normal people. There are also between 5000 and 7000 tigers in captivity, and only 400 are kept at accredited zoos. Las Vegas shows only account for a small amount of the rest.

This creates a problem, as in the US alone there were >300 incidents involving large felines between 1990 and 2011, with 20 fatalities. The likelihood of an escape or attack from an unaccredited facility is higher than that from a zoo. The literature on these attacks is also sparse, with mostly case reports or case series. Media reports are pretty common, since these are sensational events.

Enter this paper, which combed through articles and book chapters (groan) from 1950 to 2013 looking for pretty much everything related to big cats. This was then of course reviewed and narrowed down to ostensibly useful medical information, which was then written up in the review.

A few interesting tidbits:

• Tigers are the most frequent killers of humans worldwide, killing 600-800 per year in Asia
• Man eating lions are much less common
• The fabled lion pair that the movie “The Ghost and the Darkness” was based on was reported to have killed 130, but actual analysis shows has only found 3 deaths
• Cheetahs rarely attack people. As in, almost never.
• In some locales in India, leopards kill more humans than all other cats combined
• Jaguars attack people more in captivity than in the wild
• Perhaps you shouldn’t just stand still when a mountain lion attacks, but more on that in a future post.

The good news is that you don’t have to memorize a whole bunch of species specific treatment plans. Basically you want ATLS, and for significant wounds, broad spectrum antibiotics. Big cats are just that, big, and their teeth and claws do a number on our fleshy, unprotected bodies. If a tiger, jaguar, or mountain lion wants you dead (as opposed to just wanting you to leave it alone), it’s probably big enough and smart enough to do it right, by biting your neck so hard that your spinal cord is severed. They typically bite from the back. Conversely, cheetahs, leopards, and lions often bite from the front and crush the larynx. You’re still dead, but it’s a different kind of dead. Even getting swiped with a paw is enough to fracture your skull. So image most injuries, to look for fractures, pneumothoraces, or retained foreign bodies. Angiography is a good idea as well if you’re concerned for vascular injury. Since the animals typically go after Zone 2 of the neck, remember your workup for those injuries.

Data for the use of broad spectrum antibiotics isn’t as good, but since these are rare events, it’s likely less harmful here than for, say, household cat bites. Reports of purulent meningitis after head bites, septic joints, mycotic aneurysms, and other serious suppurative complications gives one pause, even without strong evidence for their use. So use pip/tazo, cefepime, or whatever gram negative/anaerobe combo antibiotic you use at your institution. And yes, people have gotten tetanus from big cat bites, so once again the lifesaving Tdap is recommended. Of note, rabies has been detected in mountain lions, but there isn’t data for the other big cats. The CDC says go ahead and treat unless no potential for being a vector. Also, don’t forget about cat scratch disease, as zoo workers have developed this after contact withbig cats.

Shepherd SM, Mills A, Shoff WH. Human attacks by large felid carnivores in captivity and in the wild. Wilderness Environ Med. 2014 Jun;25(2):220-30 [PMID 24864068]

Finally, the psychiatric component is addressed. Survivors often have PTSD symptoms, and will likely need counseling. There’s quite a bit more in the 11 page review article, so it’s worth a look.

Further Reading

• Which fatal blow finished off escaped leopard? Big cat knifed and beaten after going on the rampage in village. Daily Mail 2011
• Hensley J. What do you do if a puma attacks? EBM Gone Wild