Rat-Bite Fever Due to Streptobacillus moniliformis: A Case Series From New South Wales, Australia, and Literature Review

Abstract

Introduction Rat-bite fever due to Streptobacillus moniliformis is an uncommon infection, which seems to have been increasingly diagnosed in the Hunter New England–Central Coast area of New South Wales, Australia, in recent years. Method A case series was presented and a review of the literature since 2007 was performed. Results Our case series includes 11 patients with a median age of 27 years (range, 8–61 years), all of whom were diagnosed with bacteremia. All patients reported rat exposure, although only 4 of 11 were bitten. Common features included fever, rash, joint pains, headache, and vomiting. Patients were mostly treated with 2 to 4 weeks of antibiotic therapy; complications were rare with resolution of symptoms at last follow-up in most cases. There have been 87 patients with rat-bite fever described in the literature since 2007. Clinical findings were similar to our case series although complications, particularly endocarditis and septic arthritis, occurred in approximately a third of cases. Conclusions The case series and literature review of rat-bite fever describe a characteristic clinical picture with fever, arthritis, and rash; a history of rat exposure is supportive, and blood cultures with current laboratory techniques are usually diagnostic.