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Case report
Rat bite fever in senior health medicine
  1. Lucile Wei-Xi Pannetier1 and
  2. Emma Lombard2
  1. 1Emergency Department, Epsom Hospital, Epsom, UK
  2. 2Respiratory and General Internal Medicine, St. George's Hospital Atkinson Morley Regional Neuroscience Centre Epilepsy Group, London, UK
  1. Correspondence to Dr Lucile Wei-Xi Pannetier; lucile.pannetier{at}nhs.net

Abstract

A 71-year-old man was admitted with confusion having been discovered on the floor of his unkempt home. Social services would later confirm that the home was infested by rats. An infection of unclear origin was suspected, and he was immediately started on broad spectrum antibiotics. He subsequently developed a swollen left knee. Two knee aspirates showed a raised white cell count but no microbiological or cytological diagnosis. Finally, samples sent for 16S rDNA PCR identified Streptobacillus monilliformis. Fastidious organisms and early treatment with antibiotics can limit microbiological diagnosis through standard laboratory analysis. Newer techniques such as sequence-based testing can overcome these limitations; however, they are not widely available and require the clinician to have a high index of suspicion. Crucially, the patient continued to be treated for his clinical sepsis despite initial laboratory results being negative and conflicting specialist opinions.

  • bone and joint infections
  • exposures

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Footnotes

  • Contributors Both authors were part of the patient’s clinical team during his admission at St George’s Hospital, and they are the sole coauthors of this case report and contributed equally to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.