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A case of streptobacillary rat-bite fever in an 11-year-old boy from rural North Carolina is described. The child's clinical course was unique in that he developed a subglottic mass and bilateral parotid swelling. He responded initially to tetracycline but relapsed after therapy. Cure was ultimately achieved with a three-week course of penicillin. A review of the literature concerning this unusual clinical entity is presented.
A case of rat-bite fever caused by Streptobacillus moniliformis in a gerbil-breeder is described. Such a case has not been previously recorded.
A total of 31 cultures representing 22 different strains of Streptobacillus moniliformis has been characterised by unidimensional SDS-PAGE of cell proteins. The isolates were from sporadic and outbreak cases of human infection in the USA, UK and France, as well as mouse, turkey and rat isolates from various countries. The protein patterns, which contained 40-50 discrete bands, were highly reproducible and were used as the basis for a numerical analysis. Three clusters were obtained at the 86% similarity (S) level and these were further divided to give a total of seven clusters at the 90% S level. S. moniliformis strains, irrespective of the original host or geographical location of isolation, had a characteristic protein profile that enabled them to be easily distinguished from allied unclassifiable organisms. The analysis showed that Haverhill fever strains can be clearly distinguished from rat-bite fever strains. Protein-band differences amongst the latter strains corresponded with different geographical locations. We conclude that high resolution PAGE combined with computerised analysis of protein profiles provides the basis for typing clinical isolates of S. moniliformis. Seven PAGE types were identified and reference strains for each have been designated as a basis for future studies.
Rat-bite fever results from an infection with the organism Spirillum minus. The authors report a symptomatic patient with fever, malaise, and ulcer in forehead after a rodent exposure. The organism was identified in darkfield examination of the ulcer exudate. Penicillin was the drug used with clinical improvement of symptoms.
Streptobacillus moniliformis is an uncommon human pathogen contracted from exposure to rodents. It usually produces a mild, protracted illness (rat-bite fever, Haverhill fever, erythema arthriticum epidemicum) that has either a favorable response to antibiotic therapy or spontaneously resolves. This report describes a fatal case of Streptobacillus moniliformis in an infant bitten by a wild rat. The autopsy findings included an interstitial pneumonia, fibrinous endocarditis, mild mononuclear meningitis, hepatosplenomegaly and lymphadenopathy, erythrophagocytosis, and sinusoidal mononuclear cell infiltrates in regional lymph nodes and the liver. To the authors' knowledge, this is the first report of the autopsy pathology findings of this agent.
A 54-year-old female had fever with chills, polyarthritis and diffuse rash. Anamnesis led to the suspicion of rat-bite fever. The etiology was confirmed when and organism which was identified as Streptobacillus moniliformis was isolated from articular fluid by means of gas chromatography of tissue fatty acids. In our opinion, this is the first case of that condition reported in this country. We review the literature, and we insist on the need to inform the microbiologist of the clinical suspicion to achieve the etiological diagnosis.
A 46-year-old man with rat-bite fever due to Streptobacillus moniliformis that was complicated by endocarditis is reported. Other unusual features of this case include septic arthritis with prominent involvement of the sternoclavicular joint and the absence of a rash. Sixteen cases of streptobacillary endocarditis have previously been described. This condition occurs most often in the setting of previously damaged heart valves, usually as a result of rheumatic heart disease. Echocardiography demonstrated valvular vegetations in two of the four cases in which it was performed. Embolic phenomena are rare, and therapy with adequate doses of penicillin is usually curative.
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A patient who had been exposed to ticks and who had also been bitten by a laboratory rat developed fever, headache, and a rash. He was treated with chloramphenicol for Rocky Mountain spotted fever, and recovered. Blood cultures, however, grew Streptobacillus moniliformis, a causative agent of rat bite fever. The case report illustrates the clinical similarities between rat bite fever and Rocky Mountain spotted fever.
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Fastidious anaerobe broth and brain-heart infusion cysteine broth supplemented with 'Panmede' (a papain digest of ox liver) 2.5% supported the recovery of five Streptobacillus moniliformis strains from simulated blood cultures. Other media tested in parallel--brain heart infusion cysteine broth without 'Panmede' and Brewer's thioglycollate broth--were unreliable. Sodium polyanethol sulphonate (Liquoid) 0.05%, inhibited five isolates of S. moniliformis, including isolates from patients with Haverhill Fever. Occasionally, Liquoid 0.025% was also inhibitory and a heavy inoculum of one strain, NCTC11194, was completely inhibited by Liquoid 0.012% in simulated nutrient-broth blood cultures. These results suggest that the choice of media included in each blood-culture set is critical for the optimal isolation of S. moniliformis. Brain-heart infusion cysteine broth supplemented with 'Panmede', or commercially available fastidious anaerobe broth, without Liquoid, is recommended.
The case is reported of a patient who developed an acute arthropathy, which was initially diagnosed as acute septic arthritis. The true diagnosis of rat bite fever due to Streptobacillus moniliformis was delayed because of difficulty in growing the organism, which has fastidious growth requirements. The patient had no history of rat bite, which is the usual form of transmission of this disease.
Rat bite fever was diagnosed in a 10-year-old boy in a rural area of south-west Greece. The clinical presentation was typical for this disease and the relevant causative agent (Streptobacillus moniliformis) was isolated from blood cultures of the febrile patient. Erythromycin treatment was efficient. Although extremely rare in continental Europe, this infection must be taken into account as a potential hazard of a rat bite.
A 5-year-old girl was admitted to hospital with fever, headache and nausea. Her C-reactive protein raised from less than 11 mg/l to 65 mg/l and she developed a maculopapular, petechial rash, especially pronounced on the soles and palms. After incubation for 3 days, Streptobacillus moniliformis was found in all blood cultures that had been taken. Some weeks before her admission, the girl had been playing with her grandmother's pet rats, which later had died from an unknown disease. There was no history of rat bite. Her condition improved rapidly after treatment with penicillin and chloramphenicol, and she was discharged from hospital after 10 days without sequelae.
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Rat bite fever has not been reported from Kenya previously. A case of 17 year old Kenyan male who was diagnosed to have rat bite fever after a bite of domestic rat is described. The history, clinical features and demonstration of spirillum like organisms from a thick blood film suggest infection due to spirillum minus. The patient recovered completely after a course of penicillin and gentamicin.