Rat-bite fever: Difference between revisions
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==Antimicrobial therapy== | ==Antimicrobial therapy== | ||
:: | :* Streptococcus moniliformis treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> | ||
::* ( | ::* (1) '''Migratory arthropathy and arthritis''' | ||
:::* Preferred regimen: [[Penicillin G]] | :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days. | ||
::* ( | ::* (2) '''Diarrhea, (especially kids) liver or spleen abscess''' | ||
:::* Preferred regimen: [[Penicillin G]] | :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days. | ||
::* (4) Endocarditis, myocarditis, pericarditis (cardiac) | ::* (3) '''Undifferentiated fever''' | ||
:::* Preferred regimen: [[Penicillin]] 20 | :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days. | ||
::* (4) '''Endocarditis, myocarditis, pericarditis (cardiac)''' | |||
:::* Preferred regimen: [[Penicillin]] 20 MU/day IV divided q4h. Optimal duration recommendation for infective endocarditis is 4 weeks. | |||
:::* Alternative regimen: [[Cephalosporins]]-[[Ceftriaxone]] {{or}} [[Clindamycin]] {{or}} [[Erythromycin]] {{or}} [[Chloramphenicol]] {{and}} [[Streptomycin]]. | :::* Alternative regimen: [[Cephalosporins]]-[[Ceftriaxone]] {{or}} [[Clindamycin]] {{or}} [[Erythromycin]] {{or}} [[Chloramphenicol]] {{and}} [[Streptomycin]]. | ||
::* (5) Meningitis, brain abscess | ::* (5) '''Meningitis, brain abscess''' | ||
:::* Preferred regimen: [[Penicillin]] 20 | :::* Preferred regimen: [[Penicillin]] 20 MU/day IV divided q4h. | ||
:::* Alternative regimen: [[Cephalosporins]]-[[Ceftriaxone]] {{or}} [[Clindamycin]] {{or}} [[Erythromycin]] {{or}} [[Chloramphenicol]] {{and}} [[Streptomycin]]. | :::* Alternative regimen: [[Cephalosporins]]-[[Ceftriaxone]] {{or}} [[Clindamycin]] {{or}} [[Erythromycin]] {{or}} [[Chloramphenicol]] {{and}} [[Streptomycin]]. | ||
::* (6) Anemia | ::* (6) '''Anemia''' | ||
:::* Preferred regimen: [[Penicillin G]] | :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days. | ||
::* (7) Pneumonia | ::* (7)''' Pneumonia''' | ||
:::* Preferred regimen: [[Penicillin G]] | :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days. | ||
::* (8) Amnionitis (pregnancy) | ::* (8) '''Amnionitis''' (pregnancy) | ||
:::* Preferred regimen: [[Penicillin G]] | :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days. | ||
::* (9) Renal abscess | ::* (9) '''Renal abscess''' | ||
:::* Preferred regimen: [[Penicillin G]] | :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days. | ||
* '''Prevention''' | * '''Prevention''' | ||
| Line 75: | Line 77: | ||
::* Avoid contaminated water. | ::* Avoid contaminated water. | ||
::* Use gloves when handling rodents in lab (can also be carried by hamsters and other laboratory rodents). | ::* Use gloves when handling rodents in lab (can also be carried by hamsters and other laboratory rodents). | ||
::* If bitten: oral | ::* If bitten: oral [[Penicillin]] (2 gs) for 3 days may be beneficial. | ||
==External Links== | ==External Links== | ||
Revision as of 19:16, 29 June 2015
For patient information click here
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Rat-bite fever Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Rat-bite fever On the Web |
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American Roentgen Ray Society Images of Rat-bite fever |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Spirillum minus rat bite fever; spirochaeta morsus minus; spirochaeta muris; sokosho; sodoku.
Overview
Historical Perspective
Pathophysiology
Epidemiology and Demographics
Risk Factors
Causes
Normal commensal of rodent oropharynx also in ferrets, weasels, gerbils. Risk factors for acquisition: crowded urban dwellings (especially kids), lab workers. Transmission: bite/scratch from rat, mice, squirrels—also cats, dogs, pigs.
Differentiating Rat-bite fever from other Diseases
Differential diagnosis: rash on palms/soles consider RMSF, syphilis. Arthritis: disseminated gonorrhea, Lyme, brucella, endocarditis, rheumatological dz, and rheumatic fever.
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Imaging Findings | Other Diagnostic Studies
Symptoms: incubation for 10-day fever, chills, HA, N/V, migratory arthralgias, leukocytosis. Days 2-4 days: nonpruritic maculopapular, petechial, or pustular rash (palms soles, extremities). May be purpuric/confluent. 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.
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.
Treatment
Medical Therapy | Prevention | Cost-effectiveness of Therapy | Future or Investigational Therapies
Antimicrobial therapy
- Streptococcus moniliformis treatment[1]
- (1) Migratory arthropathy and arthritis
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- (2) Diarrhea, (especially kids) liver or spleen abscess
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- (3) Undifferentiated fever
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- (4) Endocarditis, myocarditis, pericarditis (cardiac)
- Preferred regimen: Penicillin 20 MU/day IV divided q4h. Optimal duration recommendation for infective endocarditis is 4 weeks.
- Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.
- (5) Meningitis, brain abscess
- Preferred regimen: Penicillin 20 MU/day IV divided q4h.
- Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.
- (6) Anemia
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- (7) Pneumonia
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- (8) Amnionitis (pregnancy)
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- (9) Renal abscess
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- Prevention
- Eradication of rats.
- Pasteurize milk.
- Avoid contaminated water.
- Use gloves when handling rodents in lab (can also be carried by hamsters and other laboratory rodents).
- If bitten: oral Penicillin (2 gs) for 3 days may be beneficial.
External Links
Template:Bacterial diseases hr:Vrućica štakorskog ugriza it:febbri da morso di ratto
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.