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.

Complications aigues de l'envenimation par morsures de serpent au service de Réanimation du chu mère enfant ''le Luxembourg'' de Bamako

L'envenimation par morsure de serpent reste un problème de santé publique en Afrique. Notre travail avait pour objectif d'étudier les complications aigues de l'envenimation par morsure de serpent, ainsi que les facteurs de risque de ses complications. Méthode : Il s'agissait d'une étude rétrospective et prospective sur une période de 07 ans, qui a été réalisée dans le département d'anesthésie réanimation et des urgences du CHU-Mère enfant le « Luxembourg » de Bamako. Résultats : Durant cette période, 76 cas d'envenimations ophidiennes ont été enregistrés. L'âge moyen des patients était de 34±12 ans.La famille des vipéridés (Echis et Bitis) était la plus incriminée 84,61% des cas. Les complications hémorragiques ont été observées chez 78,94% des patients, d'autres complications (cardiovasculaire, neurologique, dermatologique, ophtalmologique…) ont été observées chez 21,05% des patients. Le principal facteur de risque de survenu de complication observé, était le retard de prise en charge (délai> 6heures) Chez 100% des patients. L'absence de la sérothérapie et ou le recours initial à un traitement traditionnel ont été des facteurs de risques de complication. La presque totalité des victimes par morsures d'Elapidés soit 89,9% (5/6 cas) sont décédées. La sérothérapie a été effectuée en urgence chez 97,4% des cas. La morbidité dans notre étude a été de 10,52% avec une mortalité à 7,8%. Conclusion : dans notre contexte, la prise en charge des envenimations par morsure de serpent reste tributaire d'une multitude de complications. Le pronostic est conditionné par l'administration précoce d'un traitement symptomatique et d'un antidote spécifique

Artritis reactiva secundaria a fiebre por mordedura de rata: reporte de un caso clínico / Reactive arthritis secondary to rat-bite fever: report on a clinical case

Caso clínico: Paciente de sexo masculino, de 69 años, sin otros antecedentes. Debuta con dolor en zona de la cadera derecha transitorio, evolucionando con cuadro de seis días de desarrollo de fiebre hasta 39,2ºC, calofríos, artralgias en tarso derecho, rodillas, hombros y astenia, por lo que fue hospitalizado. Al examen destacaba aumento de volumen doloroso en rodilla izquierda y hombro derecho. El estudio de líquido articular descartó artritis infecciosa y presencia de cristales intraarticulares. Los exámenes séricos mostraban parámetros inflamatorios alterados con leucocitosis, VHS y PCR elevados. Panel viral negativo. Sin otro foco inflamatorio evidente, se inició manejo antibiótico empírico con Ceftriaxona y Cloxacilina, con buena respuesta, mejorando su sintomatología y parámetros inflamatorios. Cultivos articulares negativos. El Gram de hemocultivos demostró la presencia de bacilos Gram negativos, aislando en los hemocultivos Streptobacillus moniliformis. El paciente evoluciona favorablemente, con regresión total de su cuadro articular. Discusión y conclusión: La Fiebre por Mordedura de Rata es una enfermedad sistémica que típicamente se presenta con fiebre, rash cutáneo y poliartralgias migratorias. Uno de sus principales agentes causales es el Streptobacillus moniliformis, que coloniza la nasofaringe de ratas y otros roedores. Casos aislados han sido reportados en Chile. En la Fiebre por Mordedura de Rata hasta un 50 por ciento de los pacientes desarrolla artritis con derrame articular o sin él. Puede afectar cualquier articulación, pero la más comúnmente comprometida es la rodilla. El dolor articular disminuye en las primeras tres semanas del uso de antibióticos, pero la articulación en ocasiones puede llegar a ser destruida. En sujetos sanos se han reportado tasas de mortalidad de 10 por ciento a 15 por ciento. Mientras todos los síntomas se resuelven puede haber recaídas con graves complicaciones, como meningitis, endocarditis...

Clinical case: Male patient, 69 years old and no previous record. First episode with transitory pain in the right hip zone, going on to 6 days of fever that evolves to 39.2 ºC, shivers, articular pain in the right tarsus, knees, shoulders and asthenia, so he was hospitalized. Upon examination, painful swellings of the left knee and right shoulder stood out. A study of synovial fluid ruled out infectious arthritis and presence of intra-articular crystals. Blood tests showed altered inflammatory parameters with high leukocytes, VHS and CRP. Negative viral panel. Without another evident inflammatory focus, an empirical management was initiated by means of antibiotics with Ceftriaxone y Cloxaciline, which had a good response relieving symptoms and inflammatory panels. Negative articular culturing. The blood culture Gram showed presence of negative Gram bacilli, with the isolation of Streptobacillus moniliformis in the blood cultures. Patient evolves favorably, with full regression of his articular symptoms. Discussion and conclusion: Rat-bite fever is a systemic sickness that typically presents itself with high fever, skin rash and migratory poly-articular pain. One of its main causing agents is the Streptobacillus moniliformis that colonize the nasopharynx of rats and other rodents. Isolated cases have been reported in Chile. In Rat-bite Fever up to 50 percent of patients develop arthritis with and without joint effusion. It may affect any joint, but that most commonly compromised is the knee. Articular pain subsides in the first 3 weeks of use of antibiotics, but the joint may sometimes even be destroyed. Mortality rates in healthy individuals have been reported at 10 percent to 15 percent. While all symptoms disappear there might be relapses with serious complications such as meningitis, endocarditis, myocarditis, pneumonia and fulminant sepsis that may cause the patient to die. Timely diagnose and treatment are paramount to avoid its serious...

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.

Rat-bite fever presenting with rash and septic arthritis.

Rat-bite fever is an uncommon disease known for its endemicity to occur worldwide. Although most patients tend to develop mild symptoms with improvement from conventional antibiotics, it can progress with severe complications with a mortality rate as high as 13% without proper treatment. The authors report a complicated case of rat bite-fever involving a 61-year old woman who presented with fever petechial rash, and septic arthritis following a rat bite. Initially, multiple antibiotics were administered but were not effective. As a consequence, invasive procedures such as arthrotomy and joint debridement were done and prolonged antibiotic was administered until clinical resolution. Since many cases do not have a history of rat bite and may present with fever, rashes, and arthritis it is essential to distinguish it from other diseases. Here, the authors will provide details on the etiology, clinical manifestations, diagnosis, and management to aid prompt detection and treatment of the disease.

Fiebre por mordedura de rata: Reporte de un caso probable en el Hospital Regional del Cuzco / Rat-bite fever: A case report at the Hospital Regional of Cusco

A 4 year old patient was admitted to the Emergency Department of Hospital Regional de Cusco with 17 days history of a rat bite. One week later, the patient developed fever and rash, wich lasted for 3 days. Fever, an abscess on the forehead with lymphangitis, and cervical lymphadenopathy were observed on admision. The VDRL test was positive but FTA-Abs was negative. He was diagnosed of rat bite fever and treated with IV penicillin G with a favorable response. The case is discussed and pertinent literature is reviewed.

Gatos y ratas: rasguños y mordeduras / Cats and rats: scratches and bites

Numerosas afecciones son transmitidas al hombre por diferentes vectores, sean éstos insectos, pájaros o mamíferos. Entre las transmitidas por estos últimos, en la presente revisión se abordaron: la enfermedad por mordedura de rata que es básicamente un cuadro febril agudo, intenso, de comienzo brusco y de evolución recurrente y la enfermedad por rasguño de gato que se manifiesta por adenopatías sin signos inflamatorios locales, de lenta evolución regresiva y con escasa repercusión sobre el estado general. Ambas afecciones son más comunes en nuestro medio de lo que habitualmente se piensa y responden favorablemente a diversos antibióticos pero inicialmente plantean, con frecuencia, problemas de diagnóstico diferencial con enfermedades de pronóstico más grave

Sodoku: descriçäo de um caso / Sodoku: a case report

A febre por mordida de rato resulta de uma infecçäo causada pelo spirillum minus. Os autores descrevem um caso de paciente com febre, astenia e úlcera na regiäo frontal esquerda, após exposiçäo a um roedor. O microorganismo foi identificado através de exame em campo escuro de material obtido exsudado da úcera. A penicilina foi utilizada, com total regressäo dos sintomas

Febre da mordedura do rato: Sodoku. Relato de um caso. / Rat bite fever: Sodoku Report of a case

Os autores relatam um caso de Sodoku em uma paciente que apresentou dados fisicos e anamnesticos sugestivos, tendo sido o Spirillum minor identificado atraves de hemoculturas com visualizacao em microscopio de campo escuro. Nao ocorreram complicacoes, tendo a penicilina sido eficaz no combate a doenca. Tecem ainda consideracoes teoricas sobre a entidade e chamam a atencao para a sua importancia clinica, nao raramente fatal