Rat-bite fever: Difference between revisions

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==Treatment==
==Treatment==
[[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]]
==Antimicrobial therapy==


::* (1) Migratory arthropathy and arthritis (joints)
::* (1) Migratory arthropathy and arthritis (joints)
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::* (9) Renal abscess
::* (9) Renal abscess
:::* 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.
:::* 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.
* '''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 PCN (2 gs) × 3 days may be beneficial. No clinical data available.


==External Links==
==External Links==

Revision as of 19:08, 29 June 2015

For patient information click here

Rat-bite fever Microchapters

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Overview

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Differentiating Rat-bite fever from other Diseases

Epidemiology and Demographics

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Physical Examination

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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

  • (1) Migratory arthropathy and arthritis (joints)
  • 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.
  • (2) Diarrhea, especially kids. Liver or spleen abscess (gastrointestinal)
  • 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.
  • (3) Undifferentiated fever
  • 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.
  • (4) Endocarditis, myocarditis, pericarditis (cardiac)
  • (5) Meningitis, brain abscess
  • (6) Anemia
  • 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.
  • (7) Pneumonia
  • 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.
  • (8) Amnionitis (pregnancy)
  • 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.
  • (9) Renal abscess
  • 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.
  • 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 PCN (2 gs) × 3 days may be beneficial. No clinical data available.

External Links

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