RÉSUMÉ
Rat bite fever is an acute illness caused by bacteria from rodents. In the United States, rat bite fever is considered rare; however, actual incidence is unknown because of lack of mandatory disease reporting requirements. Risk of development of rat bite fever after being bitten by a rat is approximately 10%. Early treatment is imperative as death is a potential complication. The following case study demonstrates the gravity of the syndrome.
Sujet(s)
Morsures et piqûres , Fièvre par morsure de rat , Streptobacillus , Morsures et piqûres/complications , Service hospitalier d'urgences , Humains , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/diagnostic , Fièvre par morsure de rat/traitement médicamenteuxRÉSUMÉ
Rat bite fever is a systemic illness most commonly caused by Streptobacillus moniliformis that is classically characterized by fever, rash and migratory polyarthritis. Here, we highlight the highly variable clinical presentations of rat bite fever in children and the importance of maintaining a high degree of suspicion so appropriate treatment can be promptly initiated.
Sujet(s)
Prise en charge de la maladie , Fièvre par morsure de rat/diagnostic , Streptobacillus/pathogénicité , Adolescent , Animaux , Arthrite infectieuse/microbiologie , Enfant , Enfant d'âge préscolaire , Exanthème/microbiologie , Femelle , Fièvre/microbiologie , Humains , Nourrisson , Nouveau-né , Mâle , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/microbiologie , Rats , Études rétrospectivesRÉSUMÉ
BACKGROUND: Rat bite fever (RBF) is a rare systemic febrile illness transmitted by rats. Streptobacillus moniliformis is a pleomorphic Gram-negative bacillus which is the usual etiologic organism for rat bite fever in the United States. CASE PRESENTATION: Here we present a case of rat bite fever complicated by vertebral osteomyelitis and discitis. The patient revealed an exposure history of being bitten by pet rats. The patient's symptoms dramatically improved with a six-week course of cephalexin therapy. CONCLUSIONS: It is important to obtain a thorough zoonotic exposure history and maintain rat bite fever in the differential when considering potential causes of discitis and osteomyelitis.
Sujet(s)
Discite/étiologie , Ostéomyélite/étiologie , Fièvre par morsure de rat/complications , Animaux , Animaux domestiques , Antibactériens/administration et posologie , Morsures et piqûres/complications , Céfalexine/administration et posologie , Humains , Mâle , Adulte d'âge moyen , Fièvre par morsure de rat/diagnostic , Fièvre par morsure de rat/traitement médicamenteux , Rats , Streptobacillus/effets des médicaments et des substances chimiques , Streptobacillus/isolement et purification , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: Fever in combination with a rash is a presentation regularly seen in medicine. The causes clinicians must consider include infections, medications, autoimmune diseases. CASE PRESENTATION: A previously healthy young woman presented with a 3 to 4 day history of fever, headache and a maculopapular rash that also affected her palms. She was in a stable condition and was admitted for observation and further investigations without initiating antibiotic treatment. During the next two days her condition improved spontaneously, and her symptoms were initially interpreted as a viral infection. On day 3, blood cultures taken on the day of admission came back positive for Streptobacillus moniliformis, the causative agent of rat-bite fever. A more detailed patient history was taken, and the patient reported that she had several pet rats and one of them had given her some superficial scratches a few days before she fell ill. INTERPRETATION: Rats and other rodents are often colonised by Streptobacillus moniliformis in their oropharynx. Many people keep such animals as pets, and it is important to be aware of this disease as a differential diagnosis when a patient presents with fever and rash. Untreated, the disease might have a fatal course and the treatment of choice, penicillin, is usually easily available.
Sujet(s)
Exanthème , Fièvre par morsure de rat , Streptobacillus , Animaux , Exanthème/diagnostic , Exanthème/étiologie , Femelle , Céphalée/diagnostic , Céphalée/étiologie , Humains , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/diagnostic , Fièvre par morsure de rat/traitement médicamenteux , RatsRÉSUMÉ
Rat-bite fever (RBF) is characterized by fever, rash and arthritis, mainly caused by Streptobacillus moniliformis. We present a case of inflammatory erosive polyarthritis with sepsis caused by Streptobacillus notomytis, a novel species isolated from S. moniliformis. A 67-year-old man presented with fever, purpura and peripheral arthritis. After blood cultures were performed, loxoprofen administration was initiated. Arthritis partially improved, but left first metatarsophalangeal (MTP) arthritis persisted. A gram-negative rod was detected in the blood culture, and meropenem administration was started that improved arthritis. Ultrasonography and computed tomography revealed bone erosion in the left first MTP joint, leading to the diagnosis of septic arthritis. 16S rRNA gene sequence analysis revealed that this strain was S. notomytis. Further questioning revealed the patient may have had contact with rats. It is essential to consider Streptobacillus infection in the differential diagnosis of erosive polyarthritis.
Sujet(s)
Arthrite/diagnostic , Arthrite/étiologie , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/microbiologie , Sepsie/complications , Sepsie/microbiologie , Streptobacillus , Sujet âgé , Humains , Mâle , ARN ribosomique 16S/génétique , Fièvre par morsure de rat/diagnostic , Fièvre par morsure de rat/transmission , Sepsie/diagnostic , Analyse de séquence d'ADN , Streptobacillus/effets des médicaments et des substances chimiques , Streptobacillus/génétiqueRÉSUMÉ
Rat-bite fever caused by Streptobacillus moniliformis is a rare infection that may be fatal. An adolescent male presented with multiorgan failure, negative blood cultures and Gram-negative rods in blood smear. S. moniliformis was identified by 16S ribosomal RNA gene sequencing from the blood. He developed systemic hyperinflammatory syndrome resembling hemophagocytic lymphohistiocytosis, for which immune-globulins and steroids were added to the antibiotic regimen and he rapidly recovered.
Sujet(s)
Ceftriaxone/usage thérapeutique , Dexaméthasone/usage thérapeutique , Immunoglobulines par voie veineuse/usage thérapeutique , Lymphohistiocytose hémophagocytaire/anatomopathologie , Fièvre par morsure de rat/diagnostic , Streptobacillus/isolement et purification , Adolescent , Antibactériens/administration et posologie , Antibactériens/usage thérapeutique , Anti-inflammatoires/administration et posologie , Anti-inflammatoires/usage thérapeutique , Ceftriaxone/administration et posologie , Dexaméthasone/administration et posologie , Doxycycline/administration et posologie , Doxycycline/usage thérapeutique , Humains , Lymphohistiocytose hémophagocytaire/traitement médicamenteux , Mâle , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/microbiologieRÉSUMÉ
Abstract Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.
Sujet(s)
Humains , Animaux , Mâle , Femelle , Sujet âgé , Rats , Ostéomyélite/étiologie , Fièvre par morsure de rat/complications , Articulation sternoclaviculaire/imagerie diagnostique , Morsures et piqûres/complications , Arthrite infectieuse/étiologie , Vertèbres lombales/imagerie diagnostique , Ostéomyélite/imagerie diagnostique , Fièvre par morsure de rat/diagnostic , Imagerie par résonance magnétique , Arthrite infectieuse/imagerie diagnostiqueRÉSUMÉ
Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.
Sujet(s)
Arthrite infectieuse/étiologie , Morsures et piqûres/complications , Vertèbres lombales/imagerie diagnostique , Ostéomyélite/étiologie , Fièvre par morsure de rat/complications , Articulation sternoclaviculaire/imagerie diagnostique , Sujet âgé , Animaux , Arthrite infectieuse/imagerie diagnostique , Femelle , Humains , Imagerie par résonance magnétique , Mâle , Ostéomyélite/imagerie diagnostique , Fièvre par morsure de rat/diagnostic , RatsSujet(s)
Morsures et piqûres/complications , Exanthème/étiologie , Fièvre par morsure de rat/diagnostic , Rats , Streptobacillus/isolement et purification , Animaux , Diagnostic différentiel , Humains , Nourrisson , Mâle , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/traitement médicamenteux , Synovite/imagerie diagnostique , Synovite/étiologie , ÉchographieRÉSUMÉ
We herein report the case of a 61-year-old Japanese cirrhotic patient who developed rat bite fever (RBF) and whose first presentation was serious clinical features mimicking those of Henoch-Schönlein purpura (HSP). In addition to the critical clinical conditions, since the histopathology from purpuric skin eruptions was not inconsistent with that of HSP, therapy with prednisolone was promptly started in order to prevent his death. However, initial blood culture on admission yielded a small and slow-growing bacterial growth, which was gradually revealed by further subculture to be a peculiar bacterium, Streptobacillus moniliformis, leading to a definitive diagnosis of RBF. After the immediate cessation of prednisolone, the patient was treated with a more appropriate antibiotic and consequently made a full recovery. An immunocompromised condition with seriously decompensated liver cirrhosis together with moderately severe chronic kidney disease (CKD) in this patient probably exacerbated the severity of the disease.
Sujet(s)
Cirrhose du foie/complications , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/microbiologie , Antibactériens/usage thérapeutique , Diagnostic différentiel , Comportement en matière de santé , Humains , Mâle , Adulte d'âge moyen , Fièvre par morsure de rat/traitement médicamenteux , Insuffisance rénale chronique/complications , Peau/anatomopathologie , StreptobacillusRÉSUMÉ
Rat bite fever due to Streptobacillus moniliformis induces typical but not pathognomonic clinical signs, such as local purulent wound infection followed by maculopapular exanthema, myalgia as well as purulent joint infections. Severe complications, such as osteomyelitis and endocarditis are possible. it seems that this infection is rarely diagnosed but this infection could be much more common because the final diagnostic proof is difficult to achieve. Firstly, the culture of these bacteria is critical because the bacteria are fastidious and secondly the exact differentiation of the isolates is hardly possible by standard laboratory methods. Modern techniques such as mass spectroscopy (MALDI-TOF) and molecular biology allow a precise clarification. Surgical cleansing of infection sites in combination with a rational antibiotic therapy, for example with beta-lactam antibiotics, are generally able to cure the infection if treatment is started early enough. In addition, vaccinations, for example against tetanus and rabies have to be considered in this situation as for all other bite wound infections.
Sujet(s)
Morsures et piqûres/thérapie , Fièvre par morsure de rat/diagnostic , Fièvre par morsure de rat/thérapie , Rats , Streptobacillus/isolement et purification , Animaux , Antibactériens/usage thérapeutique , Morsures et piqûres/complications , Morsures et piqûres/microbiologie , Fièvre par morsure de rat/complications , Fièvre par morsure de rat/microbiologie , Rats/microbiologieSujet(s)
Anticorps monoclonaux humanisés/usage thérapeutique , Polyarthrite rhumatoïde/traitement médicamenteux , Discite/étiologie , Vertèbres lombales , Fièvre par morsure de rat/traitement médicamenteux , Sacrum , Animaux , Polyarthrite rhumatoïde/complications , Polyarthrite rhumatoïde/diagnostic , Cytoponction , Discite/diagnostic , Discite/traitement médicamenteux , Femelle , Humains , Imagerie par résonance magnétique , Adulte d'âge moyen , Fièvre par morsure de rat/complications , RatsRÉSUMÉ
Endocarditis is a consideration in the differential diagnosis when masses are seen on echocardiography in a patient with congenital heart disease. We present a case of insidious development of endocarditis caused by Streptobacillus moniliformis in a seven-month-old baby after a rat bite, when the baby was three months of age.
Sujet(s)
Anévrysme/microbiologie , Endocardite bactérienne/diagnostic , Artère pulmonaire , Insuffisance pulmonaire/microbiologie , Fièvre par morsure de rat/diagnostic , Anévrysme/diagnostic , Diagnostic différentiel , Endocardite bactérienne/complications , Humains , Nourrisson , Mâle , Insuffisance pulmonaire/diagnostic , Fièvre par morsure de rat/complicationsRÉSUMÉ
The authors describe the case of a 40-year-old man suffering from an epidural abscess in the thoracic spine due to a rarely isolated pathogen, Streptobacillus moniliformis, the causative agent of rat bite fever. Besides diffuse abdominal pain, ataxia, paresthesia, hypesthesia, and enhanced reflexes of the lower extremities, the patient suffered from a decreased sensation of bladder filling. His history was also positive for a rat bite 6 weeks earlier. Magnetic resonance imaging showed an epidural, space-occupying lesion compressing the spinal cord at the vertebral levels of T6-8. Neurosurgery revealed an epidural abscess, which was drained via laminectomy (T-7) and excision of the ligamentum flavum (T6-8). The etiological agent S. moniliformis was identified by 16S rRNA-based polymerase chain reaction and sequencing as well as by culture and mass spectrometry. Treatment with penicillin G led to complete resolution of the abscess and clinical recovery of the patient, who regained his bladder-filling sensation and free walking ability. This case demonstrates that careful attention to the patient's history is essential in suspecting unusual bacterial pathogens as the cause of an epidural abscess and initiating the optimal diagnostic procedure and antimicrobial therapy.
Sujet(s)
Abcès épidural/étiologie , Fièvre par morsure de rat/complications , Streptobacillus , Adulte , Antibactériens/usage thérapeutique , Diagnostic différentiel , Abcès épidural/imagerie diagnostique , Abcès épidural/traitement médicamenteux , Abcès épidural/chirurgie , Humains , Mâle , Procédures de neurochirurgie , Fièvre par morsure de rat/imagerie diagnostique , Fièvre par morsure de rat/traitement médicamenteux , Fièvre par morsure de rat/anatomopathologie , Vertèbres thoraciques/imagerie diagnostique , Vertèbres thoraciques/chirurgieRÉSUMÉ
We report acute tetraplegia caused by rat bite fever in a 59-year old man (snake keeper) and transmission of Streptobacillus moniliformis. We found an identical characteristic bacterial pattern in rat and human samples, which validated genotyping-based evidence for infection with the same strain, and identified diagnostic difficulties concerning infection with this microorganism.