UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Rat bite fever

Author
Katherine Yudeh King, MD, PhD
Section Editors
Daniel J Sexton, MD
Morven S Edwards, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Rat bite fever (RBF) is a rarely diagnosed, systemic illness caused by infection with either Streptobacillus moniliformis or Spirillum minus. S. moniliformis causes most cases of the disease in the United States. S. minus causes RBF primarily in Asia, although it is probably present worldwide.

EPIDEMIOLOGY

In the United States, rat bite fever (RBF) is typically caused by S. moniliformis. The disease is rare, with only several cases documented each year. As an example, between 2000 and 2012, only 17 cases were identified in California [1]. However, its actual incidence is unknown because RBF is not a nationally notifiable disease, and many cases go undiagnosed since these bacteria are difficult to identify and are likely to respond to empiric antibiotic therapy. (See 'Treatment' below.)

The risk of RBF due to S. moniliformis after a rat bite is reported to be 10 percent [2], and an estimated 20,000 rat bites occur in the United States each year [2]. Historically, over 50 percent of reported cases occurred in children, and RBF was most likely to be seen in those living in poverty [3]. However, the demographics have changed, and now include pet store workers and laboratory technicians as rats have become popular pets and research subjects [4,5].

In Asia, RBF is known as sodoku (so: rat, and doku: poison) and it is primarily caused by S. minus [2].

MICROBIOLOGY

S. moniliformis — S. moniliformis is a pleomorphic fastidious branching gram-negative bacillus (picture 1). It stains irregularly and can be mistaken for gram-positive pleomorphic rods. The bacteria are microaerophilic; they require specific media for isolation (10 to 20 percent serum) and incubation in a 5 to 10 percent CO2 environment. Sodium polyanethol sulfonate (SPS), an anticoagulant added to most aerobic blood culture bottles, inhibits growth of S. moniliformis. However, anaerobic culture bottles, resin bead culture systems, and trypticase soy agar and broth may demonstrate growth since they do not contain SPS.

                        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Jul 18 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Adam JK, Varan AK, Pong AL, et al. Notes from the field: fatal rat-bite fever in a child - San Diego County, California, 2013. MMWR Morb Mortal Wkly Rep 2014; 63:1210.
  2. Elliott SP. Rat bite fever and Streptobacillus moniliformis. Clin Microbiol Rev 2007; 20:13.
  3. Hirschhorn RB, Hodge RR. Identification of risk factors in rat bite incidents involving humans. Pediatrics 1999; 104:e35.
  4. Khatchadourian K, Ovetchkine P, Minodier P, et al. The rise of the rats: A growing paediatric issue. Paediatr Child Health 2010; 15:131.
  5. Crews JD, Palazzi DL, Starke JR. A teenager with fever, rash, and arthralgia. Streptobacillus moniliformis infection. JAMA Pediatr 2014; 168:1165.
  6. Pins MR, Holden JM, Yang JM, et al. Isolation of presumptive Streptobacillus moniliformis from abscesses associated with the female genital tract. Clin Infect Dis 1996; 22:471.
  7. Torres L, López AI, Escobar S, et al. Bacteremia by Streptobacillus moniliformis: first case described in Spain. Eur J Clin Microbiol Infect Dis 2003; 22:258.
  8. Rowbotham TJ. Rapid identification of Streptobacillus moniliformis. Lancet 1983; 2:567.
  9. Eisenberg T, Nicklas W, Mauder N, et al. Phenotypic and Genotypic Characteristics of Members of the Genus Streptobacillus. PLoS One 2015; 10:e0134312.
  10. Mackey JR, Melendez EL, Farrell JJ, et al. Direct detection of indirect transmission of Streptobacillus moniliformis rat bite fever infection. J Clin Microbiol 2014; 52:2259.
  11. Anderson LC, Leary SL, Manning PJ. Rat-bite fever in animal research laboratory personnel. Lab Anim Sci 1983; 33:292.
  12. Centers for Disease Control and Prevention (CDC). Rat-bite fever--New Mexico, 1996. MMWR Morb Mortal Wkly Rep 1998; 47:89.
  13. Miraflor AP, Davallow Ghajar L, Subramaniam S, et al. Rat-bite fever: An uncommon cause of fever and rash in a 9-year-old patient. JAAD Case Rep 2015; 1:371.
  14. Vetter NM, Feder HM Jr, Ratzan RM. Rat bite fever caused by a kiss. Am J Emerg Med 2016; 34:1190.e3.
  15. Nei T, Sato A, Sonobe K, et al. Streptobacillus moniliformis bacteremia in a rheumatoid arthritis patient without a rat bite: a case report. BMC Res Notes 2015; 8:694.
  16. Centers for Disease Control and Prevention (CDC). Fatal rat-bite fever--Florida and Washington, 2003. MMWR Morb Mortal Wkly Rep 2005; 53:1198.
  17. Place, EH, Sutton, LE Jr. Erythema athriticum epidemicum (Haverhill fever). Arch Intern Med 1934; 54:659.
  18. Parker F, Hudson NP. The Etiology of Haverhill Fever (Erythema Arthriticum Epidemicum). Am J Pathol 1926; 2:357.
  19. McEvoy MB, Noah ND, Pilsworth R. Outbreak of fever caused by Streptobacillus moniliformis. Lancet 1987; 2:1361.
  20. McHugh TP, Bartlett RL, Raymond JI. Rat bite fever: report of a fatal case. Ann Emerg Med 1985; 14:1116.
  21. Sens MA, Brown EW, Wilson LR, Crocker TP. Fatal Streptobacillus moniliformis infection in a two-month-old infant. Am J Clin Pathol 1989; 91:612.
  22. Stehle P, Dubuis O, So A, Dudler J. Rat bite fever without fever. Ann Rheum Dis 2003; 62:894.
  23. Mandel DR. Streptobacillary fever. An unusual cause of infectious arthritis. Cleve Clin Q 1985; 52:203.
  24. Tandon R, Lee M, Curran E, et al. A 26-year-old woman with a rash on her extremities. Clin Infect Dis 2006; 43:1585.
  25. Dendle C, Woolley IJ, Korman TM. Rat-bite fever septic arthritis: illustrative case and literature review. Eur J Clin Microbiol Infect Dis 2006; 25:791.
  26. Wang TK, Wong SS. Streptobacillus moniliformis septic arthritis: a clinical entity distinct from rat-bite fever? BMC Infect Dis 2007; 7:56.
  27. Shanson DC, Gazzard BG, Midgley J, et al. Streptobacillus moniliformis isolated from blood in four cases of Haverhill fever. Lancet 1983; 2:92.
  28. Shvartsblat S, Kochie M, Harber P, Howard J. Fatal rat bite fever in a pet shop employee. Am J Ind Med 2004; 45:357.
  29. Rordorf T, Züger C, Zbinden R, et al. Streptobacillus moniliformis endocarditis in an HIV-positive patient. Infection 2000; 28:393.
  30. Chen PL, Lee NY, Yan JJ, et al. Prosthetic valve endocarditis caused by Streptobacillus moniliformis: a case of rat bite fever. J Clin Microbiol 2007; 45:3125.
  31. Rupp ME. Streptobacillus moniliformis endocarditis: case report and review. Clin Infect Dis 1992; 14:769.
  32. http://www.cdc.gov/rat-bite-fever/health-care-workers/index.html#diagnosis (Accessed on September 23, 2013).
  33. Kondruweit M, Weyand M, Mahmoud FO, et al. Fulminant endocarditis caused by Streptobacillus moniliformis in a young man. J Thorac Cardiovasc Surg 2007; 134:1579.
  34. Eisenberg T, Ewers C, Rau J, et al. Approved and novel strategies in diagnostics of rat bite fever and other Streptobacillus infections in humans and animals. Virulence 2016; 7:630.