Rat bite fever - Revision history

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-20T11:56:24Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 11:56, 20 July 2016
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	*'''Adults'''		*'''Adults'''
	**IV penicillin G: 200,000 units q4 hours for 5–7 days (can be switched to PO once patient shows clinical improvement)		**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: ~~500 mg~~ QID, to complete a 14-day treatment course		**PO penicillin V: 500mg QID, to complete a 14-day treatment course
	**Doxycycline (for PCN-allergic patients): IV or PO ~~100 mg~~ BID for 14 days		**Doxycycline (for PCN-allergic patients): IV or PO 100mg BID for 14 days
	*'''Pediatrics'''		*'''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)		**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: ~~25–50 mg~~/kg/day, divided in 4 doses, up to maximum 2g/day, to complete a 14-day treatment course		**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		**Doxycycline (for PCN-allergic patients): 2–4mg/kg/day IV or PO, divided in 2 doses, for 14 days

Neil.m.young: Text replacement - "4 mg" to "4mg"

2016-07-20T08:19:42Z

Text replacement - "4 mg" to "4mg"

← Older revision		Revision as of 08:19, 20 July 2016
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	**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)		**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: 25–50 mg/kg/day, divided in 4 doses, up to maximum 2g/day, to complete a 14-day treatment course		**PO penicillin V: 25–50 mg/kg/day, divided in 4 doses, up to maximum 2g/day, to complete a 14-day treatment course
	**Doxycycline (for PCN-allergic patients): ~~2–4 mg~~/kg/day IV or PO, divided in 2 doses, for 14 days		**Doxycycline (for PCN-allergic patients): 2–4mg/kg/day IV or PO, divided in 2 doses, for 14 days

	==References==		==References==

Rossdonaldson1: Text replacement - "==Clinical Presentation==" to "==Clinical Features=="

2016-07-12T20:23:25Z

Text replacement - "==Clinical Presentation==" to "==Clinical Features=="

← Older revision		Revision as of 20:23, 12 July 2016
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	*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>		*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 ~~Presentation~~==		==Clinical Features==
	*Fever		*Fever
	*Fatigue		*Fatigue

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-09T00:27:21Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 00:27, 9 July 2016
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	*Consider Isolation: [[Neisseria meningitidis]]		*Consider Isolation: [[Neisseria meningitidis]]

	==~~Treatment~~==		==Management==
	*Difficulty to confirm the diagnosis by culture: empiric antibiotic treatment should be started immediately due to the high complication and fatality rate.		*Difficulty to confirm the diagnosis by culture: empiric antibiotic treatment should be started immediately due to the high complication and fatality rate.
	*'''Adults'''		*'''Adults'''

Arsmd at 17:13, 13 April 2015

2015-04-13T17:13:28Z

← Older revision		Revision as of 17:13, 13 April 2015
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	*Pharyngitis		*Pharyngitis
	*Nausea and vomiting		*Nausea and vomiting
	Rash: maculopapular, though can be petechial or purpuric		*Rash: maculopapular, though can be petechial or purpuric
	**Most prominent on the extremities, palms, and soles		**Most prominent on the extremities, palms, and soles
	*Polyarticular and asymmetric arthralgias in up to 50% of patients		*Polyarticular and asymmetric arthralgias in up to 50% of patients

Arsmd: Created page with "==Background== *Bacteria: ''Streptobacillus moniliformis'' - gram negative rod **Part of the normal respiratory flora of rodents.Pickering LK, Baker CJ, Kimberlin DW, et..."

2015-04-13T17:12:32Z

Created page with "==Background== *Bacteria: ''Streptobacillus moniliformis'' - gram negative rod **Part of the normal respiratory flora of rodents.<ref>Pickering LK, Baker CJ, Kimberlin DW, et..."

New page

==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 Presentation==
*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]]

==Treatment==
*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: 500 mg QID, to complete a 14-day treatment course
**Doxycycline (for PCN-allergic patients): IV or PO 100 mg 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: 25–50 mg/kg/day, divided in 4 doses, up to maximum 2g/day, to complete a 14-day treatment course
**Doxycycline (for PCN-allergic patients): 2–4 mg/kg/day IV or PO, divided in 2 doses, for 14 days

==References==
<references/>

==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]]