In a correspondence to ProMED Mail, officials with the Sukraraj Tropical and Infectious Disease Hospital in Kathmandu are reporting the first ever case of rat-bite fever (RBF) in Nepal.

According to the message: On 3 Dec 2017, a 56-year-old female from Panauti municipality, (Kavrepalanchok district) visited our hospital (out-patient department, Sukraraj Tropical and Infectious Disease Hospital) presenting with a 3-day history of fever (over 101 F [38 C]), body ache, itching, pain and swelling in her right thumb near the wound, and pain and swollen right axilla lymph node. She developed these signs and symptoms 16 days after the rat bite on her right thumb. She was started on amoxicillin/clavulanic acid as an oral antimicrobial.

Nepal-CIA_WFB_MapSpirillary RBF is commonly known to occur in Asia, and, based on clinical presentations, our patient is more likely to have become infected with this bacterium. However, we do not perform laboratory testing to identify bacteria in patients with RBF in Nepal.

“Rat-bite fever” is a general term to describe two relatively rare bacterial infections: Streptobacillus moniliformis, also known as Haverhill fever, and Spirillum minor, also known as Sodoku.

Both bacteria are normal or commensal organisms found in rats and to a lesser extent other rodents and mammals.

These infections are found worldwide, but seen most commonly in Asia and Africa.

The bacteria are found in the oral and nasal secretions of the infected rat. It can also be found in the rat’s urine.

Transmission to people is most frequently the result of a rat bite, however direct contact with the rats is not always necessary. People who work or live in rat infested buildings are also at risk and it has been transmitted through contaminated water and milk.

After about a week after being exposed, there is an abrupt onset of chills, fever, headache and muscle pains.

With S. moniliformis, a rash on the extremities appears after a few days. Arthritic symptoms may also be present.

On the other hand with S. minor, an ulcerated lesion at the bite site is typical and symptoms of arthritis are rare.

Untreated cases can be fatal in up to 10% of cases. Endocarditis, pericarditis and abscesses of the brain are complications of untreated rat-bite fever.

Penicillin or tetracycline can be used to treat the infection.