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CASE REPORT article

Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1345354
This article is part of the Research Topic Rodent-borne Diseases: "One Health" Perspectives View all 3 articles

Septic arthritis complicating Streptobacillus moniliformis rat bite fever: a case report and review of its pathophysiology and diagnosis

Provisionally accepted
Emmanuelle Giraudon Emmanuelle Giraudon 1,2*Eva Larranaga Lapique Eva Larranaga Lapique 3Silvio Wallemacq Silvio Wallemacq 3Marie Dalborgo Marie Dalborgo 2Nicolas Yin Nicolas Yin 2,3Maya Hites Maya Hites 3Delphine Martiny Delphine Martiny 2,4
  • 1 Hôpital Saint-Pierre, Brussels, Belgium
  • 2 Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Bruxelles, Brussels, Belgium
  • 3 Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
  • 4 University of Mons, Mons, Hainaut, Belgium

The final, formatted version of the article will be published soon.

    Rat bite fever is characterized by a clinical triad of symptoms, fever, rash and arthritis. It is transmitted by rodents and mainly due to infection by Streptobacillus moniliformis, a fastidious bacterium carried by Rattus norvegicus. This case report presents the case of a patient who developed septic arthritis and fever after a wild rat bite, with subsequent isolation of S. moniliformis from the joint fluid. Upon reviewing 45 other published case reports of S. moniliformis osteoarticular infections following contact with either a rat or its secretions, it was firstly observed that the rat bite fever clinical triad was incomplete in over half of the cases, mainly because rash was infrequently observed among adult patients. Secondly, the clinical presentation of rat bite fever is quite nonspecific and rodent exposure is not mentioned by patients in a third of cases upon admission. Altogether, diagnosing rat bite fever is a significant clinical challenge suggesting that it might be significantly underdiagnosed. In addition to these clinical aspects, no evidence was found supporting immunological mechanisms, as suggested in some literature. Instead, when excluding five improperly performed cultures, S. moniliformis was cultured in 25 reported cases and identified twice by direct PCR sequencing amounting to a detection rate of 90% (n = 27/30) on joint fluids. Cultures should be performed in medium containing yeast extract, complete peptic digest of animal tissue and at least 5% blood. Knowing that S. moniliformis is very sensitive to many antibiotics thereby making the culture negative, direct 16S rRNA gene sequencing on joint fluid is an alternative method in the case of clinical and cytological evidence of osteoarticular infections with sterile culture of joint fluid.

    Keywords: Streptobacillus moniliformis, rat bite fever, septic arthritis, asymmetric polyarthritis, Rodent zoonosis, Discitis, Microbiological diagnosis, Seronegative polyarthritis

    Received: 27 Nov 2023; Accepted: 25 Jul 2024.

    Copyright: © 2024 Giraudon, Larranaga Lapique, Wallemacq, Dalborgo, Yin, Hites and Martiny. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Emmanuelle Giraudon, Hôpital Saint-Pierre, Brussels, Belgium

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