Rat-bite fever

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Epidemiology and Demographics

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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. Symptoms: incubation ˜10-day fever, chills, HA, N/V, migratory arthralgias, leukocytosis (˜30 K). 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.

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

Treatment

Medical Therapy | Prevention | Cost-effectiveness of Therapy | Future or Investigational Therapies

  • (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.

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