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| {{About1|Streptobacillus moniliformis}} | | '''This page is about clinical aspects of the disease. For microbiologic aspects of specific causative organisms:''' |
| '''For patient information click [[Rat-bite fever (patient information)|here]]'''
| | {{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 is crowded urban dwellings (especially kids), lab workers.
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| Transmission by bite/scratch from rat, mice, squirrels—also cats, dogs, pigs.
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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]]== |
| Differential diagnosis is rash on palms/soles consider RMSF, syphilis. Arthritis- disseminated gonorrhea, Lyme, brucella, endocarditis, rheumatological disease, and rheumatic fever.
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| ==[[Rat-bite fever natural history, complications and prognosis|Natural History, Complications and Prognosis]]== | | ==[[Rat-bite fever natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| [[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]] | | [[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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| '''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.
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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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| ==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]] |
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| ==Antimicrobial therapy==
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| :* 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>
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| ::* (1) '''Migratory arthropathy and arthritis'''
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| :::* 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.
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| ::* (2) '''Diarrhea, (especially kids) liver or spleen abscess'''
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| :::* 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.
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| ::* (3) '''Undifferentiated fever'''
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| :::* 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.
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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 infective endocarditis is 4 weeks.
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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.
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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 (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.
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| ::* (7)''' Pneumonia'''
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| :::* 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.
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| ::* (8) '''Amnionitis''' (pregnancy)
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| :::* 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.
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| ::* (9) '''Renal abscess'''
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| :::* 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.
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| * '''Prevention'''
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| ::* Eradication of rats.
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| ::* Pasteurize milk.
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| ::* Avoid contaminated water.
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| ::* Use gloves when handling rodents in lab (can also be carried by hamsters and other laboratory rodents).
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| ::* If bitten: oral [[Penicillin]] (2 gs) for 3 days may be beneficial.
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| ==References==
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| {{reflist|2}}
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| ==External Links==
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| *[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5351a2.htm Case report of fatal incidence in the USA]
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| *http://www.cdc.gov/rat-bite-fever/
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| {{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:Disease]] |
| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Infectious diseases]] | | [[Category:Infectious diseases]] |
| [[Category:Overview complete]]
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| [[Category:Infectious Disease Project]]
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