The rise of the rats: A growing paediatric issue

Khatchadourian, Karine; Ovetchkine, Philippe; Minodier, Philippe; Lamarre, Valérie; LeBel, Marc; Tapiéro, Bruce

doi:10.1093/pch/15.3.131

Cited by 30 publications

(31 citation statements)

References 12 publications

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“…When left untreated, it carries a substantial risk of mortality. Due to the nonspecific nature of the presenting symptoms, the disease has a high potential for misdiagnosis, especially when exposure to the rodent is not obvious or known (2,4). Our patient presented with two of the three classic signs and symptoms of RBF: fever and rash.…”

Section: Rbf Is a Bacterial Infection Caused By Either Streptobacillumentioning

confidence: 92%

Septic Arthritis and Concern for Osteomyelitis in a Child with Rat Bite Fever

Flannery

Akinboyo

et al. 2013

J Clin Microbiol

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bRat bite fever is a rare infection usually caused by Streptobacillus moniliformis. A case of septic arthritis and possible osteomyelitis as sequelae of rat bite fever in a pediatric patient is described. CASE REPORTA 22-month-old male presented during the summer of 2011 to the emergency department of the Alfred I. duPont Hospital for Children with 2 days of upper respiratory tract symptoms followed by 5 days of fever, malaise, and a gradually worsening rash on his upper and lower extremities, including his palms and soles. The rash began to blister, and the toddler became irritable, prompting evaluation. Given his prodrome and rash, the patient was initially thought to have a viral syndrome, such as coxsackievirus. He was admitted for intravenous hydration and pain control. Initial vital signs included mild hypertension, tachycardia, and a fever to 38.0°C.Physical examination revealed a toddler in moderate distress with a tender, erythematous, pustular rash scattered on his feet (Fig. 1), ankles, and hands. No joint swelling or tenderness was initially noted; however, due to patient anxiety, examination was difficult. Initial laboratory results were unremarkable, including a white blood cell (WBC) count of 10,200/l, a hemoglobin concentration of 10.9 g/dl, and a platelet count of 217,000/l, with normal differential values, electrolytes, and urinalysis results. Blood and left-foot pustule fluid were sent for cultures. Over the next few days, his fevers persisted in the setting of a worsening rash and pain. The patient had reportedly been walking less prior to admission, which was attributed to the painful lesions on his feet, but on day 5, he refused to bear any weight and on exam was noted to have pain when his right-hip range of motion was examined. Repeat blood work revealed a WBC count of 18,100/l, a hemoglobin concentration of 10.0 g/dl, a platelet count of 523,000/l, and a neutrophilic predominance. Inflammatory markers revealed a C-reactive protein concentration of 5.4 mg/dl and an erythrocyte sedimentation rate of 94 mm/h. A repeat blood culture was drawn, a lumbar puncture was performed, and an infectious disease specialist was consulted for further evaluation. An ultrasound of the right hip was performed, which found a joint effusion, and the child was started on vancomycin and ceftriaxone for empirical bacterial coverage. Caretakers rereviewed the patient's initial history, and a physical and further discussion revealed that the family had two pet rats. Rat bite fever (RBF) quickly entered the differential.The patient was taken emergently to the operating room due to concern for septic joint, where right-hip joint aspiration revealed a cloudy, green fluid, which was sent for a cell count and culture. Given the clinical scenario and appearance of the fluid, formal open irrigation and debridement of the joint were performed. After 6 liters of irrigation, a sterile Jamshidi needle was used to aspirate the proximal metaphysis of the right femur, and the bone sample was sent for culture. The Gram stain of ...

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Section: Rbf Is a Bacterial Infection Caused By Either Streptobacillumentioning

confidence: 92%

Septic Arthritis and Concern for Osteomyelitis in a Child with Rat Bite Fever

Flannery

Akinboyo

et al. 2013

J Clin Microbiol

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“…Although the rash may be generalised, it is typically acral affecting the palms and soles2 (figure 1). It may evolve by desquamation, the formation of purpura or vesicles 5. A skin biopsy typically shows a leucocytoclastic vasculitis 2…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis of the rash is wide including Henoch-Schönlein purpura, autoimmune vasculitis, meningococcaemia, gonococcaemia, staphylococcal and streptococcal infections and leptospirosis 5. The diagnosis can be hard to elucidate as rat bites heal quickly, often absent by the time of presentation1 and seemingly innocuous rat exposures such as kissing or faecal exposure can transmit S monoliformis resulting in RBF 5.…”

Section: Discussionmentioning

confidence: 99%

Rat bite fever: an unusual cause of a maculopapular rash

Rosser

Wiselka

Pareek

2014

Postgraduate Medical Journal

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“…The natural course of the infection includes relapsing symptoms that last for 2 to 3 weeks, and the majority of cases resolve spontaneously. Serious complications of untreated rat bite fever have been reported, and they include myocarditis, pericarditis, meningitis, soft tissue abscesses, fulminant sepsis, and death (4,5). At the disease onset, fevers typically begin abruptly, ranging from low grade to 39°C, and the majority of patients (75%) develop a rash that may be maculopapular, petechial, purpuric, or vesicular.…”

mentioning

confidence: 99%