Rat Bite Fevers

Dr.T.V.Rao MD

Rat-bite Fever (RBF)
Rat-bite fever (RBF) is an infectious disease that
can be caused by two different bacteria.
Streptobacillary RBF is caused by Streptobacillus
moniliformis in North America while spirillary RBF
or sodoku is caused by Spirillum minus and
occurs mostly in Asia. People usually get the
disease from infected rodents or consumption of
contaminated food or water..
If not treated, RBF can be a serious or even
fatal disease.

Rat-bite fever
Rat-bite fever is an
acute, febrile human
illness caused by
bacteria transmitted by
rodents, rats or mice in
most cases, which is
passed from rodent to
human via the rodent's
urine or mucous
secretions.
Risk Factors
Any person who is exposed
to the bacteria that cause
RBF is at risk for getting the
disease. Some people who
may be at increased risk
include those who:
Live in rat-infested buildings
Have pet rats at their home
Work with rats in
laboratories or pet stores

Infected Rodents Spread
the Disease
.It is a rare
disease spread
by infected
rodents and can
be caused by two
specific types of
bacteria.

Spirillum Minus
Short Gram negative spiral
organism3 5 microns
Stains with Giemsa stain
Dark field microscope
useful
Not cultured- Can be
isolated by inoculating the
specimen Intraperitoneally
into Mic
Geographic location of Rat
bite fevers
Most cases occur in Japan, but specific
strains of the disease are present in the
United States, Europe, Australia, and
Africa. Some cases are diagnosed after
patients were exposed to the urine or
bodily secretions of an infected animal.

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Signs and Symptoms
Symptoms do not manifest for two to four
weeks after exposure to the organism,
and the wound through which it entered
exhibits slow healing and marked
inflammation. The fever lasts longer and
is recurring, for months in some cases.
Rectal pain and gastrointestinal
symptoms are less severe or are absent.
Penicillin is the most common treatment.

Streptobacillus
moniliformis
Symptoms depend on the
bacteria that caused the
infection. Symptoms due to
Streptobacillus
moniliformis may include:
Chills
Fever Joint pain, redness,
or swelling Rash
Spirillum minus
Symptoms due to Spirillum
minus may include: Chills
Fever
Open sore at the site of the
bite
Rash -- may be red/purple
plaques
Swollen lymph nodes near
the bite
Streptobacillosis
The Streptobacillosis form of rat-
bite fever is known by the
alternative names Haverhill Fever
and epidemic arthritic erythema. It
is a severe disease caused by
Streptobacillus moniliformis,
transmitted either by rat bite or
ingestion of contaminated
products (Haverhill fever).
Dr.T.V.Rao MD 12
Streptobacillosis
After an incubation period of 210 days,
Haverhill fever begins with high prostrating
fevers, rigors (shivering), headache and
polyarthralgia (joint pain). Soon an exanthem
(widespread rash) appears, either
maculopapular (flat red with bumps) or
petechial (red or purple spots) and arthritis of
large joints can be seen. The organism can
be cultivated in blood or articular fluid.

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Transmission
S. moniliformis and S. minus are part of the
normal respiratory flora of rodents. Either
organism may be transmitted to humans through
bites or scratches. Infection can also result from
handling an infected rodent (even with no
reported bite or scratch), or ingestion of food or
drink contaminated with these bacteria (Haverhill
fever). Rats are considered the natural reservoir
of RBF, but the bacterium has also been found in
other rodent species such as, mice and gerbils.
Person-to-person transmission has not been
reported.
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Pathogenesis

S.minus enters the
body through rat urine
Incubation period 1-4
weeks
Clinically present with
swelling of lymph
nodes near the site of
bite with relapsing
fever and skin rash
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Severe illnesses can
include:
Infections involving the heart (endocarditis,
myocarditis, or pericarditis)
Infections involving the brain (meningitis)
Infections involving the lungs (pneumonia)
Abscesses in internal organs
While death from RBF is rare, it can occur if it
goes untreated.
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Diagnosis
This condition is
diagnosed by
detecting the
bacteria in skin,
blood, joint fluid,
or lymph nodes.
Blood antibody
tests may also be
used.
Other Methods of
Diagnosis
To diagnose
streptobacillary rat bite
fever, blood or joint fluid
is extracted and the
organisms living in it are
cultured. Diagnosis for
spirillary rat bite fever is
by direct visualization or
culture of spirillum from
blood smears or tissue
from lesions or lymph
nodes.

Prevention
Whilst obviously preventable by staying away from
rodents, otherwise hands and face should be
washed after contact and any scratches both
cleaned and antiseptics applied. Prompt cleaning
of wounds with antiseptic solution, and reducing
the risk of rat bites. The effect of
chemoprophylaxis following rodent bites or
scratches on RBF is unknown. No vaccines are
available for these diseases. Improve conditions to
minimize rodent contact with humans is the best
preventative measure for RBF.
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Avoid Contact with Rats
Improve conditions
to minimize rodent
contact with humans
is the best
preventative
measure for RBF.

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Prevention
Animal handlers, laboratory workers,
sanitation and sewer workers must take
special precautions against exposure. Wild
rodents, dead or alive, should not be touched
and pets must not be allowed to ingest
rodents. Those living in the inner cities where
overcrowding and poor sanitation cause
rodent problems are at risk for RBF. Half of all
cases reported are children under 12 living in
these conditions.

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Treatment
Responds to penicillin
antibiotics or where
allergic to this
erythromycin or
tetracycline's for
respectively
streptobacillary or
spirillary infections.

Programme Created by Dr.T.V.Rao
MD for Medical and Paramedical
students in the Developing world
Email
doctortvrao@gmail.com