Ver el código de «Rat bite fever»

==Background==
*Bacteria: ''Streptobacillus moniliformis'' - gram negative rod
**Part of the normal respiratory flora of rodents.<ref>Pickering LK, Baker CJ, Kimberlin DW, et al. Red book: 2009 report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2009:299-300.</ref>
*Spread via a rat bite, scratch, or saliva<ref>Rat-Bite Fever’s Non-Specific Symptoms Make Patient History Important for Diagnosis. Vetter N. March 16, 2015. http://www.acepnow.com/article/rat-bite-fevers-non-specific-symptoms-make-patient-history-important-for-diagnosis/</ref>
*3-21 days post exposure
*Misdiagnosed or left untreated: 13% mortality rate.<ref>US Department of Health and Human Services. Rat-bite fever (RBF). 2012. Available at: www.cdc.gov/rat-bite-fever/health-care-workers/index.html. Accessed Feb. 16, 2015.</ref>

==Clinical Features==
*Fever
*Fatigue
*Headache
*Pharyngitis
*Nausea and vomiting
*Rash: maculopapular, though can be petechial or purpuric
**Most prominent on the extremities, palms, and soles
*Polyarticular and asymmetric arthralgias in up to 50% of patients

==Differential Diagnosis==
*Viral Infections
*Palms/soles rash: 
*[[Meningococcemia]]/[[Neisseria meningitidis]]
*[[Rocky mountain spotted fever]]
*[[Hand-foot-and-mouth disease]]
*[[Syphilis]]

==Labs==
*CBC
*Electrolytes
*CRP
*LFTs
*Blood Cultures
**Notify the lab: requires enriched trypticase soy agar or broth, and request that the cultures be held for up to two weeks, as the bacteria grow very slowly.<ref>Elliott SP. Rat bite fever and Streptobacillus moniliformis. Clin Microbiol Rev 2007;20:13-22.</ref>
*Consider Infectious cultures: [[Syphilis]]
*Consider Isolation: [[Neisseria meningitidis]]

==Management==
*Difficulty to confirm the diagnosis by culture: empiric antibiotic treatment should be started immediately due to the high complication and fatality rate. 
*'''Adults'''
**IV penicillin G: 200,000 units q4 hours for 5–7 days (can be switched to PO once patient shows clinical improvement)
**PO penicillin V: 500mg QID, to complete a 14-day treatment course
**Doxycycline (for PCN-allergic patients): IV or PO 100mg BID for 14 days
*'''Pediatrics'''
**IV penicillin G: 100,000–150,000 units/kg/day, divided in 4 doses, up to maximum 8 million units/day, for 5–7 days (can be switched to PO once patient shows clinical improvement)
**PO penicillin V: 25–50mg/kg/day, divided in 4 doses, up to maximum 2g/day, to complete a 14-day treatment course
**Doxycycline (for PCN-allergic patients): 2–4mg/kg/day IV or PO, divided in 2 doses, for 14 days

==References==
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==Case Reports==
*Ojukwu IC1, Christy C. Rat-bite fever in children: case report and review. Scand J Infect Dis. 2002;34(6):474-7.
*Sean P. Elliott et al. Rat Bite Fever and Streptobacillus moniliformis Clin Microbiol Rev. 2007 Jan; 20(1): 13–22. doi:  10.1128/CMR.00016-06 PMCID: PMC1797630

==See Also==
*[[Tick borne illnesses]]

[[Category:ID]]