Abstract
BackgroundStreptobacillus moniliformis is a zoonotic agent associated with rodent contacts. Although it is more commonly reported to cause rat-bite fever with reactive arthritides, it can also lead to pyogenic infection of the joints.Case presentationWe present a lady with past history of osteoarthritis developing streptobacillary septic arthritides of the right knee and left wrist, and required antibiotic and arthrotomy for treatment. We also review 11 previously reported cases of streptobacillary septic arthritis to discuss the characteristics, treatment, prognosis of the infection, and illustrates the differences between streptobacillary rat-bite fever and septic arthritis. Among this patient population, most patients had potential contact with rats (91.6%). The knee is the most commonly affected joint (58.3%), and 83.3% patients having polyarticular involvement. As opposed to rat-bite fever, fever and rash was only present in 58.3% and 16.7% of patients respectively. S. moniliformis bacteremia is uncommon (8.4%) and the prognosis is good.ConclusionArthrocentesis is useful in distinguishing streptobacillary septic arthritis from reactive arthritis of rat-bite fever. The sole use of commercial media containing sodium polyanethol sulfonate may render the bacterial culture negative. A detailed history of possible exposure to rodents should be elicited from patients with arthritis in order to facilitate microbiologic diagnosis.
Highlights
Streptobacillus moniliformis is a zoonotic agent associated with rodent contacts
Arthrocentesis is useful in distinguishing streptobacillary septic arthritis from reactive arthritis of rat-bite fever
A detailed history of possible exposure to rodents should be elicited from patients with arthritis in order to facilitate microbiologic diagnosis
Summary
Streptobacillary septic arthritis is an infection caused by S. moniliformis differing from traditional rat-bite fever and Haverhill fever after exposure to rats or other rodents. Asymmetrical polyarticular involvement of the peripheral joints is typical for streptobacillary arthritis. In contrary to streptobacillary rat-bite fever, skin rash and bacteremia is uncommon. Joint aspiration is important in making the diagnosis. Repeated examination of the bacterial culture plus recognition of the characteristic microscopic morphology is essential for identification of this bacterium. Diagnosis requires a high index of suspicion and eliciting the relevant occupational, recreational, animal and pet exposure histories. Penicillin is the current recommended treatment, but the best regime is yet to be determined. Surgical intervention is essential in pediatric patients and those failed to respond to antibiotic treatment alone, and is associated with good outcome
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