The onset of the first bout of fever occurred in the infant under observation exactly fifteen days after the bite. Four days prior to this, twelve days after the bite, the local lesion at the site of the tooth perforations on the hand made its first appearance with the evolution of a deep-seated induration associated with edema of the thumb and index finger and a lymphadenitis involving the epitrochlear and axillary glands. With the onset of the fever a generalized macular erythematous lesion appeared, lasting several days. After an afebrile interval a second bout of fever and erythema occurred, and then, unfortunately, an intercurrent infection of the respiratory tract supervened which terminated in hemorrhagic bronchopneumonia and death.When the first febrile episode occurred an effort was at once made to isolate the specific etiologic factor by animal inoculation, since direct examination of the infant's blood failed to reveal the spirochete. This procedure was successful, and the organism was demonstrated in stained smears of the peripheral blood of the mice inoculated. The organism is a spiral called Spirochaeta morsus muris and was first described by Futaki and his associates.3 It is a short spiral from 2 to 5 microns long with about four curves. The Wassermann reaction may be positive in cases of rat-bite fever but is not consistently so. A positive Kahn reaction was obtained in this child before death, which was due to an intercurrent sepsis. In uncomplicated cases the prognosis is usually good. Therapy is by the use of arsenicals.
SUMMARY AND CONCLUSIONS1. An infant Negress aged 11 days was bitten by a rat, and rat-bite fever developed.