A Rodential Reckoning: A Case Report and Systematic Review of Streptobacillary Endocarditis

ABSTRACT Introduction Endocarditis is a rare, often fatal complication of rat bite fever caused by Streptobacillus moniliformis. Only 39 cases have been reported (including this case) as of 2022. We describe a case and aim to perform this entit's first systematic literature review. Methods We performed a systematic review in CENTRAL, EMBASE, MEDLINE, SciELO, and LILACS. The terms used were terms used were (but not limited to) rat bite fever, Streptobacillus moniliformis, Spirillum minus, and endocarditis. We included all abstracts and articles with patients with echocardiographic or histologic-proven endocarditis. In case of discordance, a third reviewer was involved. Our protocol was submitted to PROSPERO (CRD42022334092). We also performed searches for studies on the reference list of included articles. Results We retrieved 108 and included 36 abstracts and articles. A total of 39 patients (including our report) were identified. The mean age was 41.27, and 61.5% were males. The most common findings were fever, murmur, arthralgias, fatigue, splenomegaly, and rash. Underlying heart disease was present in 33%. Exposure to rats was noted in 71.8% of patients, with 56.4% recalling a rat bite. Anemia was seen in 57%, leukocytosis in 52%, and elevated inflammatory markers in 58% that had lab work performed. The mitral valve was most affected, followed by the aortic, tricuspid, and pulmonary valves. Surgical intervention was required in 14 (36%) cases. Of those, 10 required valve replacement. Death was reported in 36% of cases. Unfortunately, the literature available is limited to case series and reports. Conclusion Our review allows clinicians to suspect better, diagnose, and manage Streptobacillary endocarditis.

A rare cause of vertebral osteomyelitis: the first case report of rat-bite fever in Portugal

Abstract Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.

Análisis clínico y epidemiológico de mordeduras de rata en Buenos Aires / Clinical and epidemiological analysis of rat bite in Buenos Aires

Analizamos 62 casos de mordedura de rata asistidos entre los años 2002 y 2008. cuarenta de ellos ocurrieron en la ciudad de Buenos Aires, sin clara relación con las condiciones urbanas o socioeconómicas de los afectados. Las mordeduras producidas durante el día ocurrieron por invasión del hombre al hábitat de los roedores, situación inversa a las sucedidas durante la noche. En el 79% de los casos fueron afectados los miembros y en un 16% la cara. Cinco pacientes desarrollaron manifestaciones clínicas de enfermedad por mordedura de rata. Se discute el valor de la profilaxis post exposición con antibióticos.

We report 62 cases of rat bites that occurred between 2002 and 2008. Forty of these happened in Buenos Aires city, unrelated to social class or urban conditions. The bites occurring in daylight were related to invasion of the animal habitat by man, and to rat activity during the night. In 79% of the cases the rat bite was in the limbs and in 16% in the face. Five patients developed clinical manifestations of rat bite fever. We discuss the value of post exposition prophylaxis with antibiotics.

A Case of Rat Bite Fever Arthritis / 대한류마티스학회지

Rat bite fever is a rare, systemic illness caused by Streptobacillus moniliformis or Spirillum minus following a rat or other rodent bite. Characteristically, fever develops abruptly with maculopapular skin rash after an incubation period of two to ten days, and asymmetric migrating polyarthritis starts later in up to 50% of patients. The arthritis involves the knees, shoulders, elbows, wrists and hands, which may either be suppurative or non-suppurative. Although most cases seem to resolve spontaneously within two weeks, the mortality in untreated cases is around 10~15%. The response to antibiotic treatment is good and early diagnosis is the most important prognostic factor. We report a patient who developed arthritis with fever after biting by rat.