Rat-Bite Fever in Human with <i>Streptobacillus notomytis</i> Infection, Japan

Ogawa, Yoshihiko; Kasahara, Kei; Lee, Sang-Tae; Ito, Takamitsu; Hasegawa, Hideo; Hirose, Sachie; Santo, Shigeru; Yoshida, Atsushi; Nakano, Ryuichi; Yano, Hisakazu; Mikasa, Keiichi

doi:10.3201/eid2407.171580

Cited by 17 publications

(16 citation statements)

References 8 publications

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“…Streptobacillus notomytis is a novel species in the Streptobacillus genus that can cause rat bite fever; however, human infection by this species is rare. Only three cases have been reported since its discovery, and all three cases were reported from Japan [ 4 – 6 ]. The case reported herein is the first human case of S. notomytis infection reported from outside of Japan, and the first case reported from Thailand.…”

Section: Discussionmentioning

confidence: 99%

Rat bite fever due to Streptobacillus notomytis complicated by meningitis and spondylodiscitis: a case report

et al. 2021

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Background Only three other cases of rat bite fever caused by Streptobacillus notomytis in humans have been reported since this species was identified in 2015. Data specific to the differences in clinical features and geographic distribution between S. notomytis infection and S. moniliformis infection are scarce. All previous cases of human S. notomytis infection were reported from Japan. This is the first case of S. notomytis infection reported from outside of Japan. Case presentation A 72-year-old Thai woman was admitted to Siriraj Hospital (Bangkok, Thailand)—Thailand’s largest university-based national tertiary referral center—in August 2020 with fever, myalgia, and polyarthralgia for 3 days, and gradually decreased consciousness for the past 1 day. Physical examination and laboratory investigations revealed septic arthritis of both knee joints, meningitis, and hepatitis. She was initially misdiagnosed as rheumatoid arthritis in the elderly since the initial investigations were unable to detect a causative pathogen. However, S. notomytis infection was later confirmed by polymerase chain reaction amplification of a part of the 16S rRNA gene and sequencing from synovial fluid. Her clinical course was also complicated by spondylodiscitis and epidural abscess caused by S. notomytis, which was detected from tissue biopsy. Therefore, rat bite fever in this patient manifested as meningitis, septic polyarthritis, hepatitis, and spondylodiscitis. The patient was treated with intravenous ceftriaxone then switched to oral amoxicillin with complete recovery. Conclusions The clinical manifestations of S. notomytis infection are similar to those demonstrated in S. moniliformis infection. This case also showed that arthritis caused by S. notomytis mimics rheumatoid arthritis, and that meningitis and spondylodiscitis are potential coexisting complications that can be found in S. notomytis infection.

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Section: Discussionmentioning

confidence: 99%

Rat bite fever due to Streptobacillus notomytis complicated by meningitis and spondylodiscitis: a case report

et al. 2021

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“…Streptobacillus moniliformis is a pleomorphic, fastidious, Gram-negative bacillus and etiologic agent of rat bite fever (RBF) in the United States (1). Causative agents of RBF in other areas of the world include Spirillum minus throughout Asia and Streptobacillus notomytis in Japan (1,2). S. minus is uncultivable, a distinguishing feature from Streptobacillus spp.…”

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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“…ratti are closely associated with black rats ( Rattus rattus ), and S. notomytis has recently been found to also cause RBF in humans [10, 11]. Whereas S.…”

Section: Full-textmentioning

confidence: 99%