The Case Files: Culling through Diagnoses to Get to Rat Bite Fever

By Dyer, Alexandra; Berg, Kenneth MD; King, Andrew MD Rat bite fever (RBF) is a fairly rare illness caused by Streptobacillus moniliformis or Spirillum minus. It can be a devastating and even fatal illness if left undiagnosed or untreated. Despite its name, RBF is not only transmitted by rat bites but also by contact with rat feces, ingestion of rat-contaminated food and water, or simply through direct contact with rats. (Clin Microbiol Rev 2007;20[1]:13; Vet Microbiol 2009;133[3]:211; BMJ Case Rep 2009; Epub Dec 17.) The first documented outbreak in Haverhill, MA, in 1926 was believed to be caused by a pathogen named Haverhillia multiformis. It was later determined to be identical to S. moniliformis. Other outbreaks with matching symptoms have also been documented and frequently misdiagnosed. (Clin Microbiol Rev 2007;20[1]:13.) RBF is difficult to diagnose. Its sequelae are often nebulous — chills, rigors, and polyarthralgias — and the causative pathogens are difficult to isolate in cultures. RBF is also likely to respond to empiric therapy and it is not a reportable disease, so definitive diagnosis may never be established even if treated appropriately. (Clin Microbiol Rev 2007;20[1]:13; Vet Microbiol 2009;133[3]:211.) Consequently, this condition is often erroneously omitted from the differential when evaluating fevers in the ED unless the history is highly suggestive of a rat bite. Rats are more than pests in today's society. Humans are coming increasingly into co...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research