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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Rat Bite Fever The first report of rat bite fever was given by Whitman Wilcox in 1840, and Streptobacillus monoliformis was shown as its cause by Henry Vandyke Carter (1831–1897) in 1887. See Haverhill fever.
Unexplained Fever In Infectious Diseases: Section 2: Commonly Encountered Aerobic, Facultative Anaerobic, And Strict Anaerobic Bacteria, Spirochetes, And Parasites
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Rat-bite fever represents two febrile diseases caused by two distinct Gram-negative rods, Streptobacillus moniliformus and Spirillum minor, both following a rodent bite. When a definite history of rodent or cat bite is obtained, the abrupt appearance of fever, local wound and a rash, after an incubation of 3 to 21 days, obviously suggest the diagnosis. Problems of unexplained fever may arise when the patient is unaware of the bite or when the infection is associated with ingestion of milk contaminated by rats (Haverhill fever). The infection in laboratory workers also may be overlooked as a viral illness. The diagnosis is difficult on clinical grounds alone. The characteristics of these infections are Streptobacillus moniliformis — Incubation 3 to 10 days, abrupt onset with fever, chills, headache, myalgias, weakness. After several days, a morbiliform or petechial rash appears involving the palms and soles. Arthritis, with joint effusion and lymphadenopathy, develop frequently. The primary wound usually heals. Fever may subside after 3 to 4 days, but arthritis may persist. After an apyrexia of 3 to 6 days, the temperature may rise again with return of constitutional symptoms, rash and lymphadenopathy. If untreated, relapses may occur for weeks or months. Febrile complications may also appear, such as: bacterial endocarditis, pericarditis, broncho-pneumonia, parotitis, and brain abscess.Spirillum minor — Incubation of 7 to 21 days. The clinical picture resembles the preceding form: onset with a viral-like syndrome, with rash and evolution in relapses. The difference is that, with the onset of fever, pain returns at the site of the bite, scar breaks down and becomes an ulcer with lymphangitis and lymphadenitis. Arthritis is uncommon. Confirmation of the diagnosis is based on the recovery of the organism for Streptobacillus, culture of blood or joint fluid and serology (agglutination test); for Spirillum, darkfield examination of exudate from an infected site, or intraperitoneal inoculation of mice or guinea pigs with blood or exudate. The differential diagnosis includes: rocky mountain spotted fever, Coxsackie B virus infection, malaria, meningococcemia, relapsing fever (Borrelia), infective endocarditis, acute rheumatic fever, rickettsial infection, secondary syphilis, and drug fever.79
Rat bite fever: some comments on a case report review
Published in Acta Clinica Belgica, 2023
Thirdly, RBF may indeed be a misnomer, approximately 30% of patients do not report having been bitten or scratched by rodents [6]. Transmission occurs by a bite or scratch of a rodent or a predator of rats; mucocutaneous contact with the saliva, urine, or feces of a rat; as well as by ingestion of food or water contaminated by a rat. The infection may be acquired by handling rats, without any apparent breach of intact skin or with a portal of entry, such as varicella lesions. So, non-traumatic transmission has been reported more frequently, e.g. via mucous membranes (kissing a rat) [8]. The cases without clear rat bite or scratch exposure highlight the need for a thorough history before removing RBF from the differential diagnosis [9]. Ingestion leads to the gastrointestinal form of disease known as ‘Haverhill fever’, characterized by pharyngitis and vomiting.