Advertisement

Rat-bite fever septic arthritis: illustrative case and literature review

  • C. Dendle
  • I. J. Woolley
  • T. M. Korman
Article

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 × 109/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.

Keywords

Synovial Fluid Infective Endocarditis Septic Arthritis Leucocyte Count Leptospirosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

Jenny Davis and Margaret Whipp at the Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne are acknowledged for identification of the isolate, for the photograph in Fig. 1 (JD) and for 16S rRNA gene sequencing (MW).

Kristine Roney at Dorevich Pathology, Frankston, is acknowledged for initial culture and characterisation of the isolate. Dr. J. Honig at Eramosa Family Medical Centre, Somerville is acknowledged for providing clinical details.

References

  1. 1.
    Fordham JN, McKay-Ferguson E, Davies A, Blyth T (1992) Rat bite fever without the bite. Ann Rheum Dis 51:411–412PubMedGoogle Scholar
  2. 2.
    Shanson DC, Gazzard BG, Midgley J, Dixey J, Gibson GL, Stevenson J, Finch RG, Cheesbrough J (1983) Streptobacillus moniliformis isolated from blood in four cases of Haverhill fever. Lancet 2:92–94PubMedCrossRefGoogle Scholar
  3. 3.
    Rountree PM, Rohan M (1941) A fatal human infection with Streptobacillus moniliformis. Med J Aust 1:359–361Google Scholar
  4. 4.
    Gilbert GL, Cassidy JF, Bennett NM (1971) Rat-bite fever. Med J Aust 2:1131–1134PubMedGoogle Scholar
  5. 5.
    Maynard JH, McNaughton WM, Travis T (1986) Streptobacillus moniliformis cellulitis with bacteraemia following a dog bite. Communicable Diseases Intelligence 10:2–3Google Scholar
  6. 6.
    Kadan D, Chih D, Brett A, Segasothy M (2002) A case of rat-bite fever. Internal Medicine Journal 32:193–194PubMedCrossRefGoogle Scholar
  7. 7.
    Graves MH, Janda JM (2001) Rat-bite fever (Streptobacillus moniliformis): a potential emerging disease. Int J Infect Dis 5:151–155PubMedCrossRefGoogle Scholar
  8. 8.
    Washburn RG (2000) Streptobacillus moniliformis (rat-bite fever). In: Mandell GL, Douglas RG, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases. Churchill Livingstone, Philadelphia, pp 2422–2423Google Scholar
  9. 9.
    Roughgarden JW (1965) Antimicrobial therapy of ratbite fever. A review. Arch Intern Med 116:39–54PubMedGoogle Scholar
  10. 10.
    Rupp ME (1992) Streptobacillus moniliformis endocarditis: case report and review. Clin Infect Dis 14:769–772PubMedGoogle Scholar
  11. 11.
    Centers for Disease Control (2005) Fatal rat-bite fever—Florida and Washington, 2003. Morb Mort Wkly Rep 53:1198–1202Google Scholar
  12. 12.
    Brown TM, Nunemaker JC (1942) Rat bite fever. A review of American cases with re-evaluation of etiology. Bull Johns Hopkins Hosp 70:201–237Google Scholar
  13. 13.
    Mandel DR (1985) Streptobacillary fever. An unusual cause of infectious arthritis. Cleve Clin Q 52:203–205PubMedGoogle Scholar
  14. 14.
    Anderson D, Marrie TJ (1987) Septic arthritis due to Streptobacillus moniliformis. Arthritis Rheum 30:229–230PubMedGoogle Scholar
  15. 15.
    Rumley RL, Patrone NA, White L (1987) Rat-bite fever as a cause of septic arthritis: a diagnostic dilemma. Ann Rheum Dis 46:793–795PubMedCrossRefGoogle Scholar
  16. 16.
    Holroyd KJ, Reiner AP, Dick JD (1988) Streptobacillus moniliformis polyarthritis mimicking rheumatoid arthritis: an urban case of rat bite fever. Am J Med 85:711–714PubMedCrossRefGoogle Scholar
  17. 17.
    Anglada A, Comas L, Euras JM, Sanmarti R, Vilaro J, Brugues J (1990) Arthritis caused by Streptobacillus moniliformis: a case of fever induced by a rat bite. Med Clin 94:535–537Google Scholar
  18. 18.
    Ban R, Bajolet-Laudinat O, Eschard JP, David C, Pennaforte JL, Seignon B, Etienne JC (1991) Acute purulent polyarthritis induced by Streptobacillus moniliformis. Presse Med 20:1515–1516PubMedGoogle Scholar
  19. 19.
    Saez Villaverde R, Alvarez Lario B, Alegre Lopez J, Alonso Valdivielso JL, Ojeda Fernandez E, Marne Trapero C (1996) Streptobacillus moniliformis septic oligoarthritis (fever caused by rat bite). Rev Clin Esp 196:413–415PubMedGoogle Scholar
  20. 20.
    Hockman DE, Pence CD, Whittler RR, Smith LE (2000) Septic arthritis of the hip secondary to rat bite fever: a case report. Clin Orthop Relat Res 380:173–176PubMedCrossRefGoogle Scholar
  21. 21.
    Downing ND, Dewnany GD, Radford PJ (2001) A rare and serious consequence of a rat bite. Ann R Coll Surg Engl 83:279–280PubMedGoogle Scholar
  22. 22.
    Hambridge SJ, Ogle JW (2001) Index of suspicion. Case 1. Diagnosis: rat-bite fever. Pediatr Rev 22:95–103PubMedGoogle Scholar
  23. 23.
    Thong BY, Barkham TM (2003) Suppurative polyarthritis following a rat bite. Ann Rheum Dis 62:805–806PubMedCrossRefGoogle Scholar
  24. 24.
    Wallet F, Savage C, Loiez C, Renaux E, Pischedda P, Courcol RJ (2003) Molecular diagnosis of arthritis due to Streptobacillus moniliformis. Diagn Microbiol Infect Dis 47:623–624PubMedCrossRefGoogle Scholar
  25. 25.
    Stehle P, Dubuis O, So A, Dudler J (2003) Rat bite fever without fever. Ann Rheum Dis 62:894–896PubMedCrossRefGoogle Scholar
  26. 26.
    Legout L, Senneville E, Mulleman D, Solau-Gervais E, Flipo RM, Mouton Y (2005) Rat bite fever mimicking rheumatoid arthritis. Scand J Infect Dis 37:532–533PubMedCrossRefGoogle Scholar
  27. 27.
    Shanson DC, Pratt J, Greene P (1985) Comparison of media with and without ‘Panmede’ for the isolation of Streptobacillus moniliformis from blood cultures and observations on the inhibitory effect of sodium polyanethol sulphonate. J Med Microbiol 19:181–186PubMedCrossRefGoogle Scholar
  28. 28.
    Berger C, Altwegg M, Meyer A, Nadal D (2001) Broad range polymerase chain reaction for diagnosis of rat-bite fever caused by Streptobacillus moniliformis. Pediatr Infect Dis J 20:1181–1182PubMedCrossRefGoogle Scholar
  29. 29.
    Clement J, Frans J, Van Ranst M (2003) Human Tula virus infection or rat-bite fever? Eur J Clin Microbiol Infect Dis 22:332–333 (author reply 334–335)PubMedGoogle Scholar
  30. 30.
    Frans J, Verhaegen J, Van Noyen R (2001) Streptobacillus moniliformis: case report and review of the literature. Acta Clin Belg 56:187–190PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Infectious DiseasesMonash Medical CentreClaytonAustralia
  2. 2.Department of MedicineMonash UniversityClaytonAustralia

Personalised recommendations