Rat-bite fever: Difference between revisions
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Normal commensal of rodent oropharynx also in ferrets, weasels, gerbils. | Normal commensal of rodent oropharynx also in ferrets, weasels, gerbils. | ||
Risk factors for acquisition | Risk factors for acquisition is crowded urban dwellings (especially kids), lab workers. | ||
Transmission | Transmission by bite/scratch from rat, mice, squirrels—also cats, dogs, pigs. | ||
==[[Rat-bite fever differential diagnosis|Differentiating Rat-bite fever from other Diseases]]== | ==[[Rat-bite fever differential diagnosis|Differentiating Rat-bite fever from other Diseases]]== | ||
Revision as of 19:32, 29 June 2015
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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 is crowded urban dwellings (especially kids), lab workers. Transmission by bite/scratch from rat, mice, squirrels—also cats, dogs, pigs.
Differentiating Rat-bite fever from other Diseases
Differential diagnosis is rash on palms/soles consider RMSF, syphilis. Arthritis- disseminated gonorrhea, Lyme, brucella, endocarditis, rheumatological disease, 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 is 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) are 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.
References
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
External Links
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