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Rat Bite Fever: A Difficult Bug to Catch

Hartog, Nicholas L. MD; Wiblin, Raymond Todd MD, MS

Infectious Diseases in Clinical Practice: May 2014 - Volume 22 - Issue 3 - p 174–176
doi: 10.1097/IPC.0b013e31828aff15
Case Reports

Rat bite fever is a rare zoonotic infection caused by the pleomorphic gram-negative rod, Streptobacillus moniliformis. Schottmuler first identified S moniliformis as the causative organism of rat bite fever in 1914. Although a bite is not required to contract rat bite fever, it seems that the risk of infection after a rat bite is approximately 10%. In fact, 34% of the reported cases did not report a known bite. The disease is typically characterized by vague symptoms such as fever, rigors, maculopapular to petechial rash, migratory polyarthralgias, headache, nausea/vomiting, sore throat, and severe myalgias. Detailed social history and exposure to rats are key to the diagnosis. Untreated, rat bite fever can carry a mortality rate of 10%. Patients with endocarditis carry a 53% mortality rate. Other known complications of rat bite fever include myocarditis, pericarditis, systemic vasculitis, polyarteritis nodosa, meningitis, hepatitis, nephritis, pneumonia, and focal abscesses.

From the University of Iowa Hospital and Clinics.

Correspondence to: Nicholas Hartog, MD, Department of Internal Medicine, University of Iowa Hospital and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins.