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| '''For patient information click [[Rat-bite fever (patient information)|here]]''' | | '''This page is about clinical aspects of the disease. For microbiologic aspects of specific causative organisms:''' |
| | {{Seealso|Streptobacillus moniliformis}} |
| | {{Seealso|Spirillum minus}} |
| {{Rat-bite fever}} | | {{Rat-bite fever}} |
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| ==[[Rat-bite fever causes|Causes]]== | | ==[[Rat-bite fever causes|Causes]]== |
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| Normal commensal of rodent oropharynx also in ferrets, weasels, gerbils.
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| Risk factors for acquisition: crowded urban dwellings (especially kids), lab workers.
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| Transmission: bite/scratch from rat, mice, squirrels—also cats, dogs, pigs.
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| Symptoms: incubation ˜10-day fever, chills, HA, N/V, migratory arthralgias, leukocytosis (˜30 K).
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| Days 2-4 days: nonpruritic maculopapular, petechial, or pustular rash (palms soles, extremities). May be purpuric/confluent.
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| In 50% pts, polyarthritis (even septic arthritis) with or after onset rash (knees>ankles>elbows>hips). Most symptoms resolve within 2 weeks (even if no abx). Arthritis can persist for 2 years. Nonzoonotic transmission (orally): aka Haverhill Fever (similar manifestations as RBF). Rodent excrement contaminating water, milk, turkey meat. Milk contamination associated w/ epidemics.
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| Differential diagnosis: rash on palms/soles consider RMSF, syphilis. Arthritis: disseminated gonorrhea, Lyme, brucella, endocarditis, rheumatological dz, and rheumatic fever.
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| Diagnosis: Gram or Giemsa stain blood, joint fluid, pus. Perform culture using TSA or blood agar. ELISA or agglutinins (sero-negative within 5 months-2 yrs); PCR.
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| ==[[Rat-bite fever differential diagnosis|Differentiating Rat-bite fever from other Diseases]]== | | ==[[Rat-bite fever differential diagnosis|Differentiating Rat-bite fever from other Diseases]]== |
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| [[Rat-bite fever medical therapy|Medical Therapy]] | [[Rat-bite fever primary prevention|Prevention]] | [[Rat-bite fever cost-effectiveness of therapy|Cost-effectiveness of Therapy]] | [[Rat-bite fever future or investigational therapies|Future or Investigational Therapies]] | | [[Rat-bite fever medical therapy|Medical Therapy]] | [[Rat-bite fever primary prevention|Prevention]] | [[Rat-bite fever cost-effectiveness of therapy|Cost-effectiveness of Therapy]] | [[Rat-bite fever future or investigational therapies|Future or Investigational Therapies]] |
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| ::* (1) Migratory arthropathy and arthritis (joints)
| | ==Related Chapters== |
| :::* Preferred regimen: [[Penicillin G]] IV uncomplicated disease—2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
| | * [[Streptobacillus moniliformis]] |
| | | * [[Spirillum minus]] |
| ::* (2) Diarrhea, especially kids. Liver or spleen abscess (gastrointestinal)
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| :::* Preferred regimen: [[Penicillin G]] IV uncomplicated disease—2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
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| ::* (3) Undifferentiated fever
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| :::* Preferred regimen: [[Penicillin G]] IV uncomplicated disease—2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
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| ::* (4) Endocarditis, myocarditis, pericarditis (cardiac)
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| :::* Preferred regimen: [[Penicillin]] 20 mU/day IV divided q4h. Optimal duration recommendation for IE is 4 wks.
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| :::* Alternative regimen: [[Cephalosporins]]-[[Ceftriaxone]] {{or}} [[Clindamycin]] {{or}} [[Erythromycin]] {{or}} [[Chloramphenicol]] {{and}} [[Streptomycin]].
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| ::* (5) Meningitis, brain abscess
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| :::* Preferred regimen: [[Penicillin]] 20 mU/day IV divided q4h. Optimal duration recommendation for IE is 4 wks.
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| :::* Alternative regimen: [[Cephalosporins]]-[[Ceftriaxone]] {{or}} [[Clindamycin]] {{or}} [[Erythromycin]] {{or}} [[Chloramphenicol]] {{and}} [[Streptomycin]].
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| ::* (6) Anemia
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| :::* Preferred regimen: [[Penicillin G]] IV uncomplicated disease—2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
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| ::* (7) Pneumonia
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| :::* Preferred regimen: [[Penicillin G]] IV uncomplicated disease—2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
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| ::* (8) Amnionitis (pregnancy)
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| :::* Preferred regimen: [[Penicillin G]] IV uncomplicated disease—2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
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| ::* (9) Renal abscess
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| :::* Preferred regimen: [[Penicillin G]] IV uncomplicated disease—2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
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| ==External Links== | |
| *[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5351a2.htm Case report of fatal incidence in the USA] | |
| *http://www.cdc.gov/rat-bite-fever/
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| {{Bacterial diseases}}
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| [[hr:Vrućica štakorskog ugriza]] | |
| [[it:febbri da morso di ratto]]
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| [[ja:鼠咬症]] | |
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Infectious diseases]] | | [[Category:Infectious diseases]] |
| [[Category:Overview complete]]
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