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Corresponding author: Buddhika T. B. Wijerathne, MBBS, Dip. Public Health, MRSPH, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka;
The Indian crested porcupine, Hystrix indica, is a large rodent with the unique feature of long quills. These quills are an integral part of its defense mechanism against predators. Injuries resulting from human contact with quills may cause pain, bleeding, and swelling. Quill-related injuries are common among animals such as dogs, cats, and some wild animals. The mechanism of injury, consequences, and management of injuries to humans from H indica quills are rarely described. In this report, we describe the injuries and management of a man who sustained injury from H indica quills.
The Indian crested porcupine, Hystrix indica (Figure 1, A), is a large rodent that has been recorded from southwest and central Asia including India, Nepal, Pakistan, China, and Sri Lanka. It is also found in Turkey and the eastern Mediterranean region.
The IUCN Red List of Threatened Species 2016. Hystrix indica. Amori G, Hutterer R, Kryštufek B, Yigit N, Mitsain G, Palomo LJ, assessors. Available at: http://www.iucnredlist.org/details/10751/0. Accessed May 2017.
Figure 1A, Indian crested porcupine Hystrix indica. B, Injured left foot of the patient. C, Close-up of the injury in B. D, Scanning electron microscopy images of the structure of a Hystrix indica quill with scales on the cortex surface of the black tip. E, Hystrix indica quill.
Injuries caused by quills range from minor peripheral penetrating injuries (eg, limbs) to internal organ penetration subsequently leading to death from peritonitis.
and reported quill-related injuries to humans are most typically from relatively small quill-bearing porcupines (Table 1). However, the mechanism of injury, sequelae, and management of H indica quill-related injuries in humans are rarely described.
Table 1Summary of reports on porcupine quill-related injuries to humans
We describe the case of a man who sustained injuries from contact with H indica quills and recovered with appropriate management without subsequent complications.
Case Presentation
A 50-year-old farmer was on his way home, riding a motorbike at high speed. His left foot collided with a porcupine that was crossing the road, and 6 quills were embedded in the dorsum of his left foot. He experienced severe pain and mild bleeding from the wounds. He sought medical care from a primary care hospital (Galnewa District Hospital) within half an hour of the incident. At Galnewa District Hospital, the quills were removed with pliers, and prophylactic intravenous cefuroxime 750 mg and metronidazole 500 mg were administered every 8 h. Diclofenac sodium (100 mg every 12 h orally) was provided for analgesia.
The patient was transferred to a tertiary care hospital (Teaching Hospital Anuradhapura) the next day due to persistent swelling of the foot. The examination at the Teaching Hospital Anuradhapura revealed that the left foot was swollen, and 6 quill marks were found on the dorsum of the left foot (Figure 1, B and C). No infection, bleeding, or groin lymphadenopathy was observed. Apart from mild pain at the site, the patient was conscious, rational, and all other vital parameters were stable. The previously prescribed medications were continued, and he was advised to keep the foot elevated. Four days later, his symptoms and signs abated and he was discharged. He was reexamined after 3 weeks and no complications from the injury were noted.
Discussion
Porcupines belong to 2 main families: Old World (African or Indian crested porcupine; Hystricidae) and New World (Erethizontidae).
The IUCN Red List of Threatened Species 2016. Hystrix indica. Amori G, Hutterer R, Kryštufek B, Yigit N, Mitsain G, Palomo LJ, assessors. Available at: http://www.iucnredlist.org/details/10751/0. Accessed May 2017.
Quills are made of keratin and connected to a muscle at the base, which allows the porcupine to raise the quills when threatened and make the porcupine appear bigger.
The reported cases of porcupine quill injuries are summarized in Table 1. The majority of cases reported in the literature are from North and South America, and there is one from Turkey. Some reports describe accidental swallowing of quills, leading to penetrating injuries in the gastrointestinal tract. The smaller size of the quill could be the reason for unknowingly swallowing the quills. Other described external injuries have been less severe, and it is notable that these were primarily caused by New World porcupine species (Table 1). External injuries caused by contact with H indica quills can be more serious because of its proportionately larger size.
Porcupine quill injuries often lead to pain, bleeding, swelling, and probably an increased risk of secondary infection due to environmental exposure of the wound to bacteria. Therefore, the affected skin surface should be thoroughly cleansed, and the patient should be administered antibiotics to cover both gram-positive cocci and anaerobes.
Tetanus toxoid is also recommended. Quills should be firmly gripped with pliers and removed by applying a strong force directly opposite to the direction of penetration without twisting or breaking the quills. Radiography (x-ray or computed tomography) may assist in assessing the depth of the penetration and rule out any internal injuries before careful removal of the quills.
Pain management should be based on the severity of pain (visual analogue scale can be used to assess the level of pain). If there is evidence of bleeding, it can be stopped by applying firm pressure on the site or elevating the affected area.
The individuals who are most prone to sustaining porcupine injuries are hunters, hikers, backpackers, and those who visit forests to gather medicinal herbs, honey, firewood, or livestock. All risk groups should be aware of unexpected contact with porcupines because this may cause quill-induced injuries.
People who travel at night should be aware of the nocturnal habits of porcupines and be alert to their potential presence in immediate surroundings. Travelers should carry a light source (head lamp) to visualize the animal at a distance and avoid it. Although porcupines have a keen sense of smell, they have poor eyesight and should be given a wide berth.
Indian crested porcupines are terrestrial animals; hence, most injuries may occur to the lower limbs. Therefore, it is advisable to wear footwear that is impervious to penetrating injuries when traversing the jungle. If faced with an aggressive porcupine, it is advisable to walk slowly away from the porcupine, leaving plenty of room and time for the porcupine to leave the area.
Acknowledgments: The authors thank Mr Ishan Senaverathne for the image of an Indian crested porcupine in captivity at the National Zoological Gardens of Sri Lanka. The authors also acknowledge the help extended by Drs Sunil De Alwis (Deputy Director General of Health Services; Training Research) and N. Ekanayake (Director Medical Research Institute) as well as Mr K. Wickramarathne (Technical Officer-in-Charge of Electron Microscope, Medical Research Institute) for facilitating the electron microscopy photographs of Indian crested porcupine quills. The authors especially thank the editorial team of the Wilderness & Environmental Medicine Journal for their continuous support to improve this manuscript as well as the 2 anonymous reviewers for their constructive comments, which helped to improve the manuscript.
Authors Contributions: Study concept (SPBT); literature review and drafting and editing of the manuscript (SPBT, BTBW); data collection (BDBT).
Financial/Material Support: None.
Disclosures: None.
References
The IUCN Red List of Threatened Species 2016. Hystrix indica. Amori G, Hutterer R, Kryštufek B, Yigit N, Mitsain G, Palomo LJ, assessors. Available at: http://www.iucnredlist.org/details/10751/0. Accessed May 2017.
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