Rat-Bite Fever Due to Streptobacillus moniliformis: A Case Series from New South Wales, Australia, and Literature Review

Introduction Rat-bite fever due to Streptobacillus moniliformis is an uncommon infection, which seems to have been increasingly diagnosed in the Hunter New England-Central Coast area of New South Wales, Australia, in recent years. 

Method A case series was presented and a review of the literature since 2007 was performed. 

Results Our case series includes 11 patients with a median age of 27 years (range, 8-61 years), all of whom were diagnosed with bacteremia. All patients reported rat exposure, although only 4 of 11 were bitten. Common features included fever, rash, joint pains, headache, and vomiting. Patients were mostly treated with 2 to 4 weeks of antibiotic therapy; complications were rare with resolution of symptoms at last follow-up in most cases. There have been 87 patients with rat-bite fever described in the literature since 2007. Clinical findings were similar to our case series although complications, particularly endocarditis and septic arthritis, occurred in approximately a third of cases. 

Conclusions The case series and literature review of rat-bite fever describe a characteristic clinical picture with fever, arthritis, and rash; a history of rat exposure is supportive, and blood cultures with current laboratory techniques are usually diagnostic.