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Giraudon E, Larranaga Lapique E, Wallemacq S, Dalborgo M, Yin N, Hites M, Martiny D. Septic arthritis complicating Streptobacillus moniliformis rat bite fever: a case report and review of its pathophysiology and diagnosis. Front Med (Lausanne) 2024; 11:1345354. [PMID: 39267964 PMCID: PMC11390419 DOI: 10.3389/fmed.2024.1345354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/25/2024] [Indexed: 09/15/2024] Open
Abstract
Rat bite fever is characterized by a clinical triad of symptoms, fever, rash and arthritis. It is transmitted by rodents and mainly due to infection by Streptobacillus moniliformis, a fastidious bacterium carried by Rattus norvegicus. This case report presents the case of a patient who developed septic arthritis and fever after a wild rat bite, with subsequent isolation of S. moniliformis from the joint fluid. Upon reviewing 45 other published case reports of S. moniliformis osteoarticular infections following contact with either a rat or its secretions, it was firstly observed that the rat bite fever clinical triad was incomplete in over half of the cases, mainly because rash was infrequently observed among adult patients. Secondly, the clinical presentation of rat bite fever is quite non-specific and rodent exposure is not mentioned by patients in a third of cases upon admission. Altogether, diagnosing rat bite fever is a significant clinical challenge suggesting that it might be significantly underdiagnosed. In addition to these clinical aspects, no evidence was found supporting immunological mechanisms, as suggested in some literature. Instead, when excluding five improperly performed cultures, S. moniliformis was cultured in 25 reported cases and identified twice by direct PCR sequencing amounting to a detection rate of 90% (n = 27/30) on joint fluids. Cultures should be performed in medium containing yeast extract, complete peptic digest of animal tissue and at least 5% blood. Knowing that S. moniliformis is very sensitive to many antibiotics thereby making the culture negative, direct 16S rRNA gene sequencing on joint fluid is an alternative method in the case of clinical and cytological evidence of osteoarticular infections with sterile culture of joint fluid.
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Affiliation(s)
- Emmanuelle Giraudon
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Brussel Universitair Laboratorium (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eva Larranaga Lapique
- Clinique des Maladies Infectieuses, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Silvio Wallemacq
- Clinique des Maladies Infectieuses, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Dalborgo
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Brussel Universitair Laboratorium (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Yin
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Brussel Universitair Laboratorium (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Maya Hites
- Clinique des Maladies Infectieuses, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Delphine Martiny
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Brussel Universitair Laboratorium (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Faculty of Medicine and Pharmacy, University of Mons (UMONS), Mons, Belgium
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Błaż A, Zalewski J, Masiak A, Kujawa MJ, Gosz M, Buda N. Rat bite fever mimicking ANCA-associated vasculitis. Rheumatol Int 2023; 43:1957-1964. [PMID: 37450033 PMCID: PMC10435600 DOI: 10.1007/s00296-023-05369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
Rat bite fever (RBF) is a rare infectious zoonotic disease caused by two bacterial species: the Gram-negative rod Streptobacillus moniliformis and the Gram-negative coiled rod Spirillum minus. The association between RBF and skin vasculitis and arthritis has been observed. The aim of this paper was to present a case of rat-bite fever with symptoms of skin vasculitis and arthritis, associated with high titers of ANCA antibodies and anti-endothelial cell antibodies suggestive of primary vasculitis. The patient was successfully treated with antibiotics and non-steroidal anti-inflammatory drugs, leading to significant improvement. Based on the presented case, we discuss the differential diagnosis of the signs and the role of infection in the induction of ANCA antibodies. We reviewed the English language literature for cases of RBF presenting with symptoms of vasculitis and/or antibody presence. A literature review was performed in PubMed and Google using the keywords "rat bite fever" AND "vasculitis", "systemic vasculitis", "ANCA", "antiendothelial antibodies". No cases of rat-bite fever with the presence of ANCA antibodies or AECA antibodies in its course have been described thus far. Rat bite fever is a rare disease with nonspecific symptoms. In its course, general weakness, intermittent fever, leukocytoclastic vasculitis, and arthritis are reported. To our knowledge, this is the first reported case of ANCA positivity associated with RBF.
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Affiliation(s)
- Aleksandra Błaż
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland.
| | - Jan Zalewski
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland.
| | - Mariusz J Kujawa
- Division of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Monika Gosz
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland
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Suzuki K, Hirai Y, Morita F, Nakamura A, Uehara Y, Naito T. Streptobacillus moniliformis Bacteremia in a Pet Shop Employee: Case Report and Literature Review. Open Forum Infect Dis 2017; 4:ofx038. [PMID: 28730157 PMCID: PMC5510459 DOI: 10.1093/ofid/ofx038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/28/2017] [Indexed: 11/26/2022] Open
Abstract
A 39-year-old pet shop employee who sustained a bite from one of his store’s rats developed fever and arthritis. Streptobacillus moniliformis was cultured from the patient’s blood, confirming a diagnosis of rat-bite fever. Treatment with standard antibiotics was successful. Although rat-bite fever is commonly considered a zoonosis transmitted by wild or laboratory rats, our case emphasizes that it may be transmitted by pet animals as well.
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Affiliation(s)
- Kiyozumi Suzuki
- Department of General Medicine, Juntendo University Faculty of Medicine
| | - Yuji Hirai
- Department of General Medicine, Juntendo University Faculty of Medicine
| | - Fujiko Morita
- Department of General Medicine, Juntendo University Faculty of Medicine
| | - Ayako Nakamura
- Department of Clinical Laboratory, Juntendo University Hospital, and
| | - Yuki Uehara
- Department of General Medicine, Juntendo University Faculty of Medicine.,Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine.,Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Eisenberg T, Ewers C, Rau J, Akimkin V, Nicklas W. Approved and novel strategies in diagnostics of rat bite fever and other Streptobacillus infections in humans and animals. Virulence 2016; 7:630-48. [PMID: 27088660 DOI: 10.1080/21505594.2016.1177694] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rat bite fever (RBF), a worldwide occurring and most likely under-diagnosed zoonosis caused by Streptobacillus moniliformis, represents the most prominent disease of Streptobacillus infections. Recently, novel members have been described, from which a reservoir in rats and other animal species and a zoonotic potential can be assumed. Despite regularly published case reports, diagnostics of RBF continues to represent a 'diagnostic dilemma', because the mostly applied 16S rRNA sequence analysis may be uncertain for proper pathogen identification. Virtually nothing is known regarding prevalence in humans and animal reservoirs. For a realistic assessment of the pathogen's spread, epidemiology and virulence traits, future studies should focus on the genomic background of Streptobacillus. Full genome sequence analyses of a representative collection of strains might facilitate to unequivocally identify and type isolates. Prevalence studies using selective enrichment mechanisms may also enable the isolation of novel strains and candidate species of this neglected group of microorganisms.
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Affiliation(s)
| | - Christa Ewers
- b Institut für Hygiene und Infektionskrankheiten der Tiere, Justus-Liebig-Universität Gießen , Gießen , Germany
| | - Jörg Rau
- c Chemisches und Veterinäruntersuchungsamt Stuttgart , Fellbach , Germany
| | - Valerij Akimkin
- c Chemisches und Veterinäruntersuchungsamt Stuttgart , Fellbach , Germany
| | - Werner Nicklas
- d Deutsches Krebsforschungszentrum , Heidelberg , Germany
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Rat Bite Fever Resembling Rheumatoid Arthritis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:7270413. [PMID: 27366177 PMCID: PMC4904585 DOI: 10.1155/2016/7270413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 03/30/2016] [Indexed: 11/20/2022]
Abstract
Rat bite fever is rare in Western countries. It can be very difficult to diagnose as blood cultures are typically negative and a history of rodent exposure is often missed. Unless a high index of suspicion is maintained, the associated polyarthritis can be mistaken for rheumatoid arthritis. We report a case of culture-positive rat bite fever in a 46-year-old female presenting with fever and polyarthritis. The clinical presentation mimicked rheumatoid arthritis. Infection was complicated by discitis, a rare manifestation. We discuss the diagnosis and management of this rare zoonotic infection. We also review nine reported cases of rat bite fever, all of which had an initial presumptive diagnosis of a rheumatological disorder. Rat bite fever is a potentially curable infection but can have a lethal course if left untreated.
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Rat-bite Fever: A Case in Spain With Skin Lesions. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Barja J, Castelo L, Almagro M, Sánchez-Vidal E, Fernández-González A, Peña-Rodríguez F, García-Silva J, Fonseca E. Fiebre por mordedura de rata. Un caso en España con lesiones cutáneas características. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Streptobacillus moniliformis septic arthritis: a clinical entity distinct from rat-bite fever? BMC Infect Dis 2007; 7:56. [PMID: 17561996 PMCID: PMC1903360 DOI: 10.1186/1471-2334-7-56] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 06/11/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Streptobacillus moniliformis is a zoonotic agent associated with rodent contacts. Although it is more commonly reported to cause rat-bite fever with reactive arthritides, it can also lead to pyogenic infection of the joints. CASE PRESENTATION We present a lady with past history of osteoarthritis developing streptobacillary septic arthritides of the right knee and left wrist, and required antibiotic and arthrotomy for treatment. We also review 11 previously reported cases of streptobacillary septic arthritis to discuss the characteristics, treatment, prognosis of the infection, and illustrates the differences between streptobacillary rat-bite fever and septic arthritis. Among this patient population, most patients had potential contact with rats (91.6%). The knee is the most commonly affected joint (58.3%), and 83.3% patients having polyarticular involvement. As opposed to rat-bite fever, fever and rash was only present in 58.3% and 16.7% of patients respectively. S. moniliformis bacteremia is uncommon (8.4%) and the prognosis is good. CONCLUSION Arthrocentesis is useful in distinguishing streptobacillary septic arthritis from reactive arthritis of rat-bite fever. The sole use of commercial media containing sodium polyanethol sulfonate may render the bacterial culture negative. A detailed history of possible exposure to rodents should be elicited from patients with arthritis in order to facilitate microbiologic diagnosis.
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Dendle C, Woolley IJ, Korman TM. Rat-bite fever septic arthritis: illustrative case and literature review. Eur J Clin Microbiol Infect Dis 2007; 25:791-7. [PMID: 17096137 DOI: 10.1007/s10096-006-0224-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rat-bite fever is a rare zoonotic infection caused by Streptobacillus moniliformis or Spirillum minus, which is characterised by fever, rash and arthritis. The arthritis has previously been described as non-suppurative and isolation of the organism from synovial fluid as very uncommon. This article reports a case of septic arthritis diagnosed as rat-bite fever when the organism was cultured from synovial fluid and reviews another 15 cases of S. moniliformis septic arthritis reported in the worldwide literature since 1985. Articles were included in this review if S. moniliformis was cultured from synovial fluid. Of the published cases, 88% presented with polyarthritis, affecting small and large joints although two had monoarticular hip sepsis. Fever was present in 88%, rash in 25% and 56% had extra-articular features. Synovial fluid analysis revealed high cell counts in all cases (mean 51,000 x 10(9)/l) with a predominance of polymorphonuclear leucocytes, and organisms were found on Gram stain in only 50%. Penicillin was used for treatment in 56% of cases and surgery was required in 30%. All patients recovered. Rat-bite fever arthritis can be suppurative and attempts should be made to isolate the organism from synovial fluid. The diagnosis should be considered when there is arthritis and a high synovial fluid cell count but no apparent organism, especially when the patient has had contact with rats.
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Affiliation(s)
- C Dendle
- Department of Infectious Diseases, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
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Abstract
Rat bite fever, caused by Streptobacillus moniliformis, is a systemic illness classically characterized by fever, rigors, and polyarthralgias. If left untreated, it carries a mortality rate of 10%. Unfortunately, its nonspecific initial presentation combined with difficulties in culturing its causative organism produces a significant risk of delay or failure in diagnosis. The increasing popularity of rats and other rodents as pets, together with the risk of invasive or fatal disease, demands increased attention to rat bite fever as a potential diagnosis. The clinical and biological features of rat bite fever and Streptobacillus moniliformis are reviewed, providing some distinguishing features to assist the clinician and microbiologist in diagnosis.
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Affiliation(s)
- Sean P Elliott
- Department of Pediatrics, University of Arizona Health Sciences Center, 1501 N. Campbell Ave., Tucson, AZ 85724-5073, USA.
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