182 There’s a rat in the lab – rat bite and rat bite fever in the occupational healthcare setting

Abstract

Introduction Ratborne diseases are a.o. leptospirosis, hantavirosis, tulaeremia, plague, rickettsiosis, pasteurellosis, rat bite fever and parasitical infections. Up to 10 percent of all ratbites results in ‘rat bite fever’ (RBF). RBF is a designation for 2 diseases caused by different gram negative bacteria: streptobacillary RBF, by Streptobacillus moniliformis , a rod-shaped bacteria and less common spirillary RBF or ‘ sodoku ’, by Spirillum minor , a spiral-shaped bacteria which occurs more in Asia (Japan). Streptobacillary RBF presents as a local skin lesion, followed abruptly by flu-like illness with fever, chills, headache, vomiting, pain of joints or muscles about 3–10 days after the initial injury. Within 2–4 days a diffuse maculopapular or petechial rash involving the extremities, especially palms and soles, appears. Transmission occurs by a bite or scratch of a rodent or predator of rats, as well as by ingestion of food or water contaminated by a rat. Ingestion leads to the gastrointestinal form of disease known as ‘ Haverhill fever ’, characterised by pharyngitis and vomiting. Relapsing fever and polyarthritis develop in 30 and 50 percent respectively. Methods We studied the literature from the past 100 years to search for the occupational risk factors of rat bites and rat bite fever. Result Numerous laboratories use rats as experimental animals, so we retrieved numerous cases from the lab. Other occupations at risk were pest control workers, cleaning workers, manual labourers in a warehouse, pet stores employees, veterinarians and vet personnel, farmers and rat breeders. As pet rats are becoming more popular, RBF rates are rising. Discussion Ratbites are probably underreported. The diagnosis of RBF can be challenging and easily be overlooked. Unspite its name, nearly 30% of patients report no recognisable rat bite. Precise history-taking related to contact with rats and other rodents and detection of skin eruptions can be clues to diagnosis of this infection.