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| {{Infobox_Disease |
| | __NOTOC__ |
| Name = {{PAGENAME}} |
| | '''This page is about clinical aspects of the disease. For microbiologic aspects of specific causative organisms:''' |
| Image = |
| | {{Seealso|Streptobacillus moniliformis}} |
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| | {{Seealso|Spirillum minus}} |
| DiseasesDB = 32803 |
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| DiseasesDB_mult = {{DiseasesDB2|30717}} |
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| ICD10 = {{ICD10|A|25||a|20}} |
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| ICD9 = {{ICD9|026}} |
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| OMIM = |
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| eMedicineSubj = |
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| MeshID = D011906 |
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| }} | |
| {{Rat-bite fever}} | | {{Rat-bite fever}} |
| '''For patient information click [[Rat-bite fever(patient information)|here]]'''
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| {{CMG}} | | {{CMG}} |
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| | {{SK}} Spirillum minus rat bite fever; spirochaeta morsus minus; spirochaeta muris; sokosho; sodoku. |
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| ==[[Rat-bite fever overview|Overview]]== | | ==[[Rat-bite fever overview|Overview]]== |
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| ==[[Rat-bite fever pathophysiology|Pathophysiology]]== | | ==[[Rat-bite fever pathophysiology|Pathophysiology]]== |
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| ==[[Rat-bite fever epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Rat-bite fever epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Rat-bite fever risk factors|Risk Factors]]== | | ==[[Rat-bite fever risk factors|Risk Factors]]== |
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| ==[[Rat-bite fever screening|Screening]]==
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| ==[[Rat-bite fever causes|Causes]]== | | ==[[Rat-bite fever causes|Causes]]== |
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| ==[[Rat-bite fever differential diagnosis|Differentiating Rat-bite fever]]== | | ==[[Rat-bite fever differential diagnosis|Differentiating Rat-bite fever from other Diseases]]== |
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| ==[[Rat-bite fever natural history|Complications & Prognosis]]==
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| ==Diagnosis==
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| [[Rat-bite fever history and symptoms|History and Symptoms]] | [[Rat-bite fever physical examination|Physical Examination]] | [[Rat-bite fever laboratory tests|Laboratory tests]] | [[Rat-bite fever electrocardiogram|Electrocardiogram]] | [[Rat-bite fever x ray|X Rays]] | [[Rat-bite fever CT|CT]] | [[Rat-bite fever MRI|MRI]] [[Rat-bite fever echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Rat-bite fever other imaging findings|Other images]] | [[Rat-bite fever other diagnostic studies|Alternative diagnostics]]
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| ==Treatment==
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| [[Rat-bite fever medical therapy|Medical therapy]] | [[Rat-bite fever surgery|Surgical options]] | [[Rat-bite fever primary prevention|Primary prevention]] | [[Rat-bite fever secondary prevention|Secondary prevention]] | [[Rat-bite fever cost-effectiveness of therapy|Financial costs]] | [[Rat-bite fever future or investigational therapies|Future therapies]]
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| ==Overview== | |
| '''Rat-bite fever''' is an acute, [[fever|febrile]] human illness caused by [[bacterium|bacteria]] transmitted by rodents, rats in most cases. Two types of [[gram-negative]] [[facultative anaerobe|facultatively anaerobic]] bacteria can cause the infection, which is passed from rodent to human via the rodent's urine or mucous secretions.Rat-bite fever (RBF) is an infectious disease caused by two different organisms, Streptobacillus moniliformis and Spirillum minus. In the United States, Rat-bite fever is primarily due to infection with S. moniliformis. Spirillum minus causes Rat-bite fever cases in countries such as Asia and Africa. S. moniliformis and S. minus are part of the normal respiratory flora of rats. Both organisms may be transmitted to humans through rat bites or scratches. Infection can also result from handling an infected rat, with no reported bite or scratch. Infection with S. moniliformis can also occur through ingestion of food or drink contaminated with rat excrement (Haverhill fever). Other rodents (e.g. mice, gerbils) may also be reservoirs. Person-to-person transmission has not been reported.
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| ==Spirillosis ==
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| Rat-bite fever transmitted by the gram-negative [[spirochaete]] ''[[Spirillum]] minus'' is more rare, and is found most often in Asia. In Japan the disease is called '''[[Sodoku]]'''. Symptoms do not manifest for two to four weeks after exposure to the organism, and the wound through which it entered exhibits slow healing and marked [[inflammation]]. The fever lasts longer and is recurring, for months in some cases. Joint pain and gastrointestinal symptoms are less severe or are absent. Penicillin is the most common treatment.
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| ==Streptobacillosis== | | ==[[Rat-bite fever natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The Streptobacillosis form of rat-bite fever is known by the alternate names '''[[Haverhill Fever]]''' and '''epidemic arthritic erythema'''. It is a severe disease caused by Streptobacillus moniliformis , transmitted either by rat bite or ingestion of contaminated products ( Haverhill fever). After a incubation period of around 10 days, Haverhill fever begins with high prostrating fevers, rigors, headache and polyarthralgia. Soon a exanthem appears, either maculopapular or petechial and arthritis of large joints can be seen. The organism can be cultivated in blood or articular fluid. The disease can be fatal if untreataed in 10% of cases due to malignant endocarditis, meningoencephalitis or septic shock.
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| The treatment is with penicillin or tetracycline
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| == Epidemiology and Demographics ==
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| Rat-bite fever is rare in the United States. However, since RBF is not a notifiable disease, exact numbers of cases are not known. | |
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| Rat-bite fever is not a reportable disease in any state. However, unexplained deaths or critical illnesses or rare diseases of public health importance may be reportable in certain states. If RBF is suspected in a severe illness or death but a diagnosis has not been made, physicians can consider reporting the case to their state or local health department.
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| Since Rat-bite fever is not a reportable disease, trends in disease incidence are not available. However, recent reports have highlighted the potential risk for RBF among persons having contact with rats at home or in the workplace.
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| == Risk Factors ==
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| Persons who are at risk for infection include those who work with animals in labs or pet stores and persons living in dwellings infested with wild rats. People who have pet rats may also be at risk for infection.
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| ==Symptoms==
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| Initial symptoms are non-specific and include fever, chills, myalgias, arthralgias, headache, vomiting. Patients may develop a maculopapular rash on the extremities or septic arthritis 2-4 days after fever onset. The incubation period typically ranges from 2-10 days. If not appropriately treated, severe manifestations may include endocarditis, myocarditis, meningitis, pneumonia and sepsis. In rare cases, death occurs.
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| ==Diagnosis== | | ==Diagnosis== |
| The findings of rash, fever, and arthritis in individuals with a history of rat exposure suggest the diagnosis of Rat-bite fever.
| | [[Rat-bite fever history and symptoms|History and Symptoms]] | [[Rat-bite fever physical examination|Physical Examination]] | [[Rat-bite fever laboratory findings|Laboratory Findings]] | [[Rat-bite fever imaging findings|Imaging Findings]] | [[Rat-bite fever other diagnostic studies|Other Diagnostic Studies]] |
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| Diagnosis of S. moniliformis is typically made by isolating the organism from blood or synovial fluid. Specific media and incubation conditions should be used. In the absence of a positive culture, identification of pleomorphic gram-negative bacilli in appropriate specimens supports a preliminary diagnosis. Since the organism does not grow in artificial media, diagnosis of S. minus is made by identifying characteristic spirochetes in appropriate specimens using darkfield microscopy or differential stains.
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| ==Risk Stratification and Prognosis==
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| Severe complications such as endocarditis, myocarditis, pericarditis, pneumonia, meningitis, and focal organ abscesses may occur. Rapidly fatal cases have been reported. Untreated RBF is associated with a mortality of 7%-10%. With appropriate antimicrobial therapy, the clinical course may be shortened and severe complications may be prevented.
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| ==Treatment== | | ==Treatment== |
| Responds to [[penicillin]] antibiotics or where allergic to this [[erythromycin]] or [[tetracyclines]] for repectively streptobacillary or spirillary infections.
| | [[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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| ==Prevention==
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| Whilst obviously preventable by staying away from rodents, otherwise hands and face should be washed after contact and any scratches both cleaned and antiseptics applied.
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| ==References==
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| http://www.cdc.gov/ncidod/dbmd/diseaseinfo/ratbitefever_g.htm
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| ==External links== | | ==Related Chapters== |
| *[http://www.chclibrary.org/micromed/00063170.html Rat-bite fever description]<br> | | * [[Streptobacillus moniliformis]] |
| *[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5351a2.htm Case report of fatal incidence in the USA]
| | * [[Spirillum minus]] |
| *[http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/rat-bite_fever.jsp Rat-bite fever (healthAtoZ.com)] | |
| {{Bacterial diseases}}
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| [[hr:Vrućica štakorskog ugriza]]
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| [[it:febbri da morso di ratto]]
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| [[ja:鼠咬症]] | |
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| | [[Category:Disease]] |
| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Infectious disease]] | | [[Category:Infectious diseases]] |
| [[Category:Overview complete]]
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