Toe Gangrene Revealing Septicaemical Rat-bite Fever: About a 41 Day Old Infant

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Ouajid Bakkali
S. Benchekroun
A. Asermouh
F. Benbrahim
N. Elhafidi
C. Mahraoui


Rat-bite fever (RBF) is a systemic infectious disease. It is due to Streptobacillus moniliformis, a commensal bacterium of the nasopharyngeal mucosa of small rodents, in particular rats. This anthropozoonosis is rare in urban areas. The first clinical sign of infection is a fever, followed by polyarthritis and a rash. It can only start with skin signs, as in our observation. We report the case of a 41-day-old female infant who was the victim of a rat bite at one month of life in the upper nasal and labial areas. A rabies vaccine with local care has been made. The clinical course at 3 days after the bite was marked by a non-pruritic papulopustular rash, the vesiculo-bullous lesions in the bilateral and symmetrical legs evolved into inflammatory ulcerative necrotizing lesions in a geographic map of the lower 1/3 of the lower limbs with gangrenous lesions in the toes, an erythematous base on the face, hands and feet and discreet oral erosions, associated with generalized purpuric spots and fevers at 40°C. The biological assessment was carried out objectifying an inflammatory syndrome made of a leukocytosis at 26770/mm3, with neutrophils at 10842/mm3, CRP = 215 mg/L. The diagnosis of RBF was made by the isolation of a Gram-negative bacillus in a blood culture. The final identification of the germ was carried out by molecular biology (PCR of 16S rRNA). The lumbar puncture was negative and the cardiac ultrasound was without abnormality. Arterial and venous Doppler ultrasound of the lower limbs was normal. The diagnosis of rat bite fever having been retained. The infant was put on cefpodoxime IV for 3 weeks and metronidazole IV for 10 days. The clinical course at 3 months later, spontaneous amputation of gangrenous toes with residual skin scars was noted.

Rat-bite fever, Streptobacillus moniliformis, anthropozoonosis, zoonotic infection

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Bakkali, O., Benchekroun, S., Asermouh, A., Benbrahim, F., Elhafidi, N., & Mahraoui, C. (2020). Toe Gangrene Revealing Septicaemical Rat-bite Fever: About a 41 Day Old Infant. Asian Journal of Pediatric Research, 3(2), 33-36.
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Dendle C, Woolley IJ, Korman TM. Rat-bite fever septic arthritis: Illustrative case and literature review. Eur J Clin Microbiol Infect Dis. 2006;25(12):791–7.
DOI:https://doi. org/10.1007/s10096-006-0224-x. PubMed

Suzuki K, Hirai Y, Morita F, Nakamura A, Uehara Y, Naito T. Streptobacillus moniliformis bacteremia in a pet shop employee: Case report and literature review. Open Forum Infect Dis. 2017;4 (2):ofx038.
DOI: ofid/ofx038. PubMed
Available: pubmed/28730157? dopt=Abstract)

Centers for Disease Control and Prevention (CDC). Rat-bite fever--New Mexico. MMWR Morb Mortal Wkly Rep. 1998;47 (5):89–91.
Available: pubmed/28730157?dopt=Abstract

Elliott SP. Rat bite fever and Streptobacillus moniliformis. Clin Microbiol Rev. 2007;20 (1):13–22.
DOI: CMR.00016-06
Available: pubmed/17223620?dopt=Abstract

Graves MH, Janda JM. Rat-bite fever (Streptobacillus moniliformis): A potential emerging disease. Int J Infect Dis. 2001; 5(3):151–5.
DOI: 9712(01)90090-6
Available: pubmed/11724672?dopt=Abstract

Hirschhorn RB, Hodge RR. Identification of risk factors in rat bites incidents involving humans. Pediatrics. 1999;104(3):e35.
DOI: peds.104.3.e35
Available: dopt=Abstract

Centers for Disease Control and Prevention (CDC). Fatal rat-bite fever - Florida and Washington, 2003. MMWR Morb Mortal Wkly Rep. 2005;53(51):1198–202.

Ordog GJ, Balasubramanium S, Wasserberger J. Rat bites: Fifty cases. Ann Emerg Med. 1985;14(2):126–30.

Eisenberg T, Ewers C, Rau J, Akimkin V, Nicklas W. Approved and novel strategies in diagnostics of rat bite fever and other Streptobacillus infections in humans and animals. Virulence. 2016;7(6):630–48.
DOI: 4.2016.1177694
Available: pubmed/27088660? dopt=Abstract

Ojukwu IC, Christy C. Rat-bite fever in children: Case report and review. Scand J Infect Dis. 2002;34(6):474–7.

Carbeck RB, Murphy JF, Britt EM. Streptobacillary rat-bite fever with massive pericardial effusion. JAMA 1967 Aug;201(9):703–4.
DOI: jama.1967.03130090067024

Faro S, Walker C, Pierson RL. Amnionitis with intact amniotic membranes involving Streptobacillus moniliformis. Obstet Gynecol. 1980;55(3 Suppl):9S–11S.

Tattersall RS, Bourne JT. Systemic vasculitis following an unreported rat bite. Ann Rheum Dis. 2003;62(7):605–6.
DOI: 62.7.605

Kondruweit M, Weyand M, Mahmoud FO, Geissdörfer W, Schoerner C, Ropers D, Achenbach S, Strecker T. Fulminant endocarditis caused by Streptobacillus moniliformis in a young man. J Thorac Cardiovasc Surg. 2007;134(6):1579–80.

Vetter NM, Feder HM, Ratzan RM. Rat bite fever caused by a kiss. Am J Emerg Med. 2016;34(6):1190.e3-4.