Streptobacillus moniliformis Mitral Valve Endocarditis and Septic Arthritis: The Challenges of Diagnosing Rat-Bite Fever Endocarditis

Torres-Miranda, Daisy; Moshgriz, Madhi; Siegel, Marc

doi:10.4081/idr.2018.7731

Cited by 15 publications

(14 citation statements)

References 19 publications

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“…Both rat-bite fever and Haverhill fever have been described as systemic presentations. There have been anecdotal cases of local septic arthritis and osteomyelitis attributed to S. moniliformis, but our case presents the first documented periprosthetic infection [6,7,12,13].…”

Section: Foundations Of Streptobacillus Moniliformismentioning

confidence: 81%

“…It is most commonly known to colonise the nasopharynx and bodily secretions of rodents, with 70-91% of infected individuals documenting contact with rodents [6,7]. There are also reports of contagion through animals that prey on rats (e.g.…”

Section: Foundations Of Streptobacillus Moniliformismentioning

confidence: 99%

“…17% also experience a rash [6]. Typically, these symptoms develop three days to three weeks following initial exposure [7].…”

Section: Clinical Picturementioning

confidence: 99%

“…Septic arthritis and osteomyelitis are known progressions of untreated bacteraemic infection. Further documented complications include malignant pneumonia, hepatitis, discitis, meningoencephalitis and endocarditis -the latter carrying a 43-53% mortality rate [7,8,11,14,15]. Torres-Miranda highlighted the importance of identifying S. moniliformis, as most cases of fatal endocarditis received non-targeted antibiotic therapy.…”

Section: Clinical Picturementioning

confidence: 99%

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Near-fatal Periprosthetic Infection with Streptobacillus moniliformis: Case and Review

Smallbones

Monem

Baganeanu

et al. 2020

J. Bone Joint Infect.

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Abstract. Case presentation of a 66 year old female with penicillin hypersensitivity, who suffered late acute periprosthetic infection of her total knee replacement. After emergency surgery and admission to intensive care, the responsible organism was later identified as Streptobacillus moniliformis.This serves as the first documented case of Streptobacillus moniliformis prosthetic joint infection. As standard culture mediums provide an exceedingly low detection rate, 16S PCR should instead be used as the first line method of identification. As a result, its detection is largely dependent on clinicians recognising relevant factors within the patient's history, namely close contact with rodents. In a patient with penicillin hypersensitivity, carbapenems have demonstrated potential as an effective treatment strategy.

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Section: Foundations Of Streptobacillus Moniliformismentioning

confidence: 81%

Section: Foundations Of Streptobacillus Moniliformismentioning

confidence: 99%

“…17% also experience a rash [6]. Typically, these symptoms develop three days to three weeks following initial exposure [7].…”

Section: Clinical Picturementioning

confidence: 99%

Section: Clinical Picturementioning

confidence: 99%

See 2 more Smart Citations

Near-fatal Periprosthetic Infection with Streptobacillus moniliformis: Case and Review

Smallbones

Monem

Baganeanu

et al. 2020

J. Bone Joint Infect.

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“…If antimicrobial therapy is delayed or not administered, mortality is reported to be 7 to 13% (1). Severe complications, such as endocarditis, can increase the risk of death to 43% (7). Outbreaks of S. moniliformis, referred to as Haverhill fever, a febrile illness often accompanied by vomiting and headache, are associated with consumption of food or water contaminated with rat excrement (1).…”

Section: Discussionmentioning

confidence: 99%

The Brief Case: Rat Bite Fever from a Kiss

et al. 2019

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A 20-year-old otherwise healthy male presented to his primary care clinic with a 1-week history of fevers, rash, and polyarthralgias affecting his knees, elbows, and wrists that began 5 days following an acute diarrheal illness. In the clinic he was febrile to 38.5°C with a petechial rash initially on the palms and soles, which then spread to his trunk. The examination was also notable for cervical lymphadenopathy, two tongue ulcerations with clean bases, and the absence of joint effusion. Testing for influenza virus was negative, and the patient was sent home with a preliminary diagnosis of a nonspecific viral illness. Subsequently, the patient's malaise and migratory arthralgias worsened, resulting in ambulation difficulties, and so he presented to the Emergency Department. He continued to complain of low-grade fevers and rash with intermittent headache and mild dysuria. He reported a monogamous heterosexual relationship, but he denied abnormal urethral discharge, genital lesions, intravenous drug use, tick exposure, or recent travel outside his Midwestern home state. The exam was notable for a whole-body diffuse petechial rash (Fig. 1) but negative for joint effusions or stigmata of endocarditis. Laboratory analysis revealed mildly elevated white blood cells at 11.5 ϫ 10 9 /liter (normal range, 3.4 ϫ 10 9 to 9.6 ϫ 10 9 /liter) with neutrophilia, hemoglobin at 13.0 g/dl (normal range, 13.2 to 16.6 g/dl), and a C-reactive protein level of 79.1 mg/liter (normal range, 3.0 to 8.0 mg/liter). Hepatic enzyme testing, blood chemistry panel, urinalysis, and urine Gram stain were unremarkable. Given his history and lack of overseas travel, the differential for his illness included enterovirus, parvovirus, viral hepatitis, sexually transmitted infection, reactive arthritis, rheumatic disease, and bacteremia. Influenza and tick-borne illness were additional considerations, although the patient presented during the winter months, making influenza more likely than tick-borne illness. However, given a negative outpatient influenza result and the endemic nature of local tick-borne illnesses, a tick-borne panel was obtained that included testing for Lyme disease, Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Babesia microti. In addition, blood cultures, urine studies for Neisseria gonorrhoeae and Chlamydia trachomatis, and a multiplex molecular stool panel for gastrointestinal pathogens (BioFire, Salt Lake City, UT) were performed, and blood for hepatitis, HIV, and syphilis serologies was obtained. Given the absence of joint effusions, no diagnostic joint aspiration was performed. The patient received a single dose of ceftriaxone to cover for sexually transmitted infections before being admitted. The patient received analgesia with naproxen and reported rapid improvement in his arthralgias. Overnight, blood cultures turned positive for Gram-negative rods in four

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