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Rat bite fever, a diagnostic challenge: case report and review of 29 cases
Till Kämmerer1, Tony Lesmeister1, Andreas Wollenberg1
1Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) of Munich, Munich, Germany.
Abstract:
Rats can transmit Streptobacillus moniliformis, which may cause rat-bite fever (RBF), a rare and potentially lethal zoonosis. Fastidious in vitro growth and unspecific symptoms, including fever, arthralgia, and polymorphous skin lesions, complicate the diagnosis. Rat-bite fever follows exposure to contaminated bodily fluids of infected rodents; however, reports on Streptobacillus moniliformis-related infections are few so far. A female patient presented with painful hemorrhagic pustules and purpuric lesions on hands and feet. She developed fever and migratory polyarthralgia. Blood culture yielded growth with Streptobacillus moniliformis. The patient owned rats and handled contaminated rat feces and urine, making this the most likely etiology of infection. We report a case of RBF due to Streptobacillus moniliformis in a rat handling-patient. Difficulties in clinical and microbiological diagnosis highlight the need for a thorough and complete history-taking and a greater understanding of this rare infectious disease.
Insights
Rat-bite fever (RBF) is a rare zoonosis transmitted by rats. This case highlights diagnostic challenges and the importance of patient history in identifying Streptobacillus moniliformis infections.
Area of Science:
- Infectious Diseases
- Zoonosis
- Microbiology
Background:
- Streptobacillus moniliformis causes rat-bite fever (RBF), a rare zoonotic disease.
- Diagnosis is challenging due to fastidious in vitro growth and nonspecific symptoms.
Observation:
- A patient presented with fever, migratory polyarthralgia, and painful hemorrhagic pustules and purpuric lesions on extremities.
- The patient owned rats and had exposure to rodent excreta.
Findings:
- Blood culture confirmed Streptobacillus moniliformis infection.
- The clinical presentation and patient history strongly suggested RBF from rat exposure.
Implications:
- This case underscores the importance of thorough patient history in diagnosing rare zoonotic diseases.
- Increased awareness of Streptobacillus moniliformis and RBF is needed for timely diagnosis and treatment.
