The long list of diseases that humans could potentially contract after being bitten by a horse gives new meaning to the old adage, “Don’t look a gift horse in the mouth.”

According to the report, “That Horse Bit Me: Zoonotic Infections of Equines to Consider After Exposure Through the Bite or the Oral/Nasal Secretions,” more than 100,000 emergency room visits per year are due to injuries from horses, and an estimated 3% to 4.5% of these visits are related to bites.

“In addition to the blunt trauma, breaks in skin, lacerations with tissue loss, and amputation of digits and noses, there are multiple bacterial and viral pathogens (disease-causing organisms) that can spread from horses to humans through biting,” explained study co-author Rick Langley, MD, MPH from the North Carolina Department of Health and Human Services, Occupational and Environmental Epidemiology Branch in Raleigh, N.C