A Rodential Reckoning: A Case Report and Systematic Review of Streptobacillary Endocarditis





Rat Bite Fever, Streptobacillus moniliformis, Spirillum minus, Endocarditis


Introduction: Endocarditis is a rare, often fatal complication of rat bite fever caused by Streptobacillus moniliformis. Only 39 cases have been reported (including this case) as of 2022. We describe a case and aim to perform this entity’s first systematic literature review. Methods: We performed a systematic review in CENTRAL, EMBASE, MEDLINE, SciELO, and LILACS. The terms used were terms used were (but not limited to) rat bite fever, Streptobacillus moniliformis, Spirillum minus, and endocarditis. We included all abstracts and articles with patients with echocardiographic or histologicproven endocarditis. In case of discordance, a third reviewer was involved. Our protocol was submitted to PROSPERO (CRD42022334092). We also performed searches for studies on the reference list of included articles. Results: We retrieved 108 and included 36 abstracts and articles. A total of 39 patients (including our report) were identified. The mean age was 41.27, and 61.5% were males. The most common findings were fever, murmur, arthralgias, fatigue, splenomegaly, and rash. Underlying heart disease was present in 33%. Exposure to rats was noted in 71.8% of patients, with 56.4% recalling a rat bite. Anemia was seen in 57%, leukocytosis in 52%, and elevated inflammatory markers in 58% that had lab work performed. The mitral valve was most affected, followed by the aortic, tricuspid, and pulmonary valves. Surgical intervention was required in 14 (36%) cases. Of those, 10 required valve replacement. Death was reported in 36% of cases. Unfortunately, the literature available is limited to case series and reports. Conclusion: Our review allows clinicians to suspect better, diagnose, and manage Streptobacillary endocarditis.


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Roughgarden JW. Antimicrobial therapy of ratbite fever. A review. Arch Intern Med. 1965;116(1):39-54. http://dx.doi.org/10.1001/archinte.1965.03870010041007. PMid:14338952.

Elliott SP. Rat bite fever and Streptobacillus moniliformis. Clin Microbiol Rev. 2007;20(1):13-22. http://dx.doi.org/10.1128/CMR.00016-06. PMid:17223620.

Graves MH, Janda JM. Rat-bite fever (Streptobacillus moniliformis): a potential emerging disease. Int J Infect Dis. 2001;5(3):151-4. http://dx.doi.org/10.1016/S1201-9712(01)90090-6. PMid:11724672.

Eisenberg T, Poignant S, Jouan Y, et al. Acute tetraplegia caused by rat bite fever in snake keeper and transmission of Streptobacillus moniliformis. Emerg Infect Dis. 2017;23(4):719-21. http://dx.doi.org/10.3201/eid2304.161987. PMid:28322713.

Adam JK, Varan AK, Pong AL, McDonald EC. Notes from the field: fatal rat-bite fever in a child - San Diego County, California, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(50):1210-1. PMid:25522092.

Parker F, Hudson NP. The etiology of haverhill fever (Erythema Arthriticum Epidemicum). Am J Pathol. 1926;2(5):357-80. PMid:19969709.

Crofton KR, Ye J, Lesho EP. Severe recurrent Streptobacillus moniliformis endocarditis in a pregnant woman, and review of the literature. Antimicrob Resist Infect Control. 2020;9(1):119. http://dx.doi.org/10.1186/s13756-020-00789-4. PMid:32727581.

Blake FG. The etiology of rat-bite fever. J Exp Med. 1916;23(1):39-60. http://dx.doi.org/10.1084/jem.23.1.39. PMid:19867970.

Stuart-Harris CH, Wells AQ, Rosher HB, Mackie FP, Wilson GS. Four cases of infective endocarditis due to organisms similar to Haemophilus parainfluenzae, and one case due to a pleomorphic streptobacillus. J Pathol Bacteriol. 1935;41(3):407-21. http://dx.doi.org/10.1002/path.1700410305.

Rountree PM, Rohan M. A fatal human infection with Streptobacillus moniliformis. Med J Aust. 1941;1(12):359-61. http://dx.doi.org/10.5694/j.1326-5377.1941.tb95302.x.

McDermott W, Leask MM, Benoit M. Streptobacillus moniliformis as a cause of subacute bacterial endocarditis: report of a case treated with penicillin. Ann Intern Med. 1945;23(3):414-23. http://dx.doi.org/10.7326/0003-4819-23-3-414.

Petersen ES, McCullough NB, Eisele CW, Goldinger JM. Subacute bacterial endocarditis due to Streptobacillus moniliformis. J Am Med Assoc. 1950;144(8):621-2. http://dx.doi.org/10.1001/jama.1950.62920080007006f. PMid:14774150.

Priest WS, Smith JM, McGee CJ. Penicillin therapy of subacute bacterial endocarditis: a study of the end results in 34 cases, with particular reference to dosage, methods of administration, criteria for judging adequacy of treatment and probable reasons for failures. Arch Intern Med. 1947;79(3):333-59. http://dx.doi.org/10.1001/archinte.1947.00220090093006. PMid:20294551.

Stokes JF, Gray IR, Stokes EJ. Actinomyces muris endocarditis treated. with chloramphenicol. Br Heart J. 1951;13(2):247-51. http://dx.doi.org/10.1136/hrt.13.2.247. PMid:14821208.

Hamburger M, Knowles HC. Streptobacillus moniliformis infection complicated by acute bacterial endocarditis; report of a case in a physician following bite of laboratory rat. AMA Arch Intern Med. 1953;92(2):216-20. http://dx.doi.org/10.1001/archinte.1953.00240200066008. PMid:13079342.

McCormack RC, Kaye D, Hook EW. Endocarditis due to Streptobacillus moniliformis. JAMA. 1967;200(1):77-9. http://dx.doi.org/10.1001/jama.1967.03120140135036. PMid:6071862.

Carbeck RB, Murphy JF, Britt EM. Streptobacillary rat-bite fever with massive pericardial effusion. JAMA. 1967;201(9):703-4. http://dx.doi.org/10.1001/jama.1967.03130090067024. PMid:5340333.

Chulay JD, Lankerani MR. Splenic abscess. Report of 10 cases and review of the literature. Am J Med. 1976;61(4):513-22. http://dx.doi.org/10.1016/0002-9343(76)90331-4. PMid:973645.

Rey JL, Laurans G, Pleskof A, et al. Les endocardites à Streptobacillus moniliformis. A propos de deux cas. Ann Cardiol Angeiol. 1987;36(6):297-300. PMid:3619383.

McHugh TP, Bartlett RL, Raymond JI. Rat bite fever: report of a fatal case. Ann Emerg Med. 1985;14(11):1116-8. http://dx.doi.org/10.1016/S0196-0644(85)80936-7. PMid:4051282.

Simon MW, Wilson HD. Streptobacillus moniliformis endocarditis. A case report. Clin Pediatr. 1986;25(2):110-1. http://dx.doi.org/10.1177/000992288602500211. PMid:3943256.

Sens MA, Brown EW, Wilson LR, Crocker TP. Fatal Streptobacillus moniliformis infection in a two-month-old infant. Am J Clin Pathol. 1989;91(5):612-6. http://dx.doi.org/10.1093/ajcp/91.5.612. PMid:2718962.

Rupp ME. Streptobacillus moniliformis endocarditis: case report and review. Clin Infect Dis. 1992;14(3):769-72. http://dx.doi.org/10.1093/clinids/14.3.769. PMid:1562665.

Rordorf T, Züger C, Zbinden R, von Graevenitz A, Pirovino M. Streptobacillus moniliformis endocarditis in an HIV-positive patient. Infection. 2000;28(6):393-4. http://dx.doi.org/10.1007/s150100070012. PMid:11139161.

Shvartsblat S, Kochie M, Harber P, Howard J. Fatal rat bite fever in a pet shop employee. Am J Ind Med. 2004;45(4):357-60. http://dx.doi.org/10.1002/ajim.10359. PMid:15029568.

Balakrishnan N, Menon T, Shanmugasundaram S, Alagesan R. Streptobacillus moniliformis endocarditis. Emerg Infect Dis. 2006;12(6):1037-8. http://dx.doi.org/10.3201/eid1206.060069. PMid:16752478.

Kondruweit M, Weyand M, Mahmoud FO, et al. Fulminant endocarditis caused by Streptobacillus moniliformis in a young man. J Thorac Cardiovasc Surg. 2007;134(6):1579-80. http://dx.doi.org/10.1016/j.jtcvs.2007.08.010. PMid:18023687.

Forster DH, Becker A, Stahlhut P, Elgas M, Kniehl E. P1457 Streptobacillus moniliformis endocarditis diagnosed by 16S rRNA gene PCR and direct sequencing applied to a resected heart valve. Int J Antimicrob Agents. 2007;29(Suppl 2):S407. http://dx.doi.org/10.1016/S0924-8579(07)71296-7.

Chen PL, Lee NY, Yan JJ, et al. Prosthetic valve endocarditis caused by Streptobacillus moniliformis: a case of rat bite fever. J Clin Microbiol. 2007;45(9):3125-6. http://dx.doi.org/10.1128/JCM.01169-07. PMid:17652475.

Shah S, Fortuna R, Scofield S, Caiola E. Bite the hand that fed you. In: Society of General Internal Medicine 33rd Annual Meeting; 2010; Minneapolis. Alexandria; 2010.

Maroto F, Gallego S, Pérez C, Colon C. Endocarditis infecciosa en enfermedad por mordedura de rata. Med Intensiva. 2011;35(5):317-8. http://dx.doi.org/10.1016/j.medin.2010.07.013. PMid:21122951.

Madhubashini M, George S, Chandrasekaran S. Streptobacillus moniliformis endocarditis: case report and review of literature. Indian Heart J. 2013;65(4):442-6. http://dx.doi.org/10.1016/j.ihj.2013.06.019. PMid:23993005.

Fenn DW, Ramoutar A, Jacob G, Bin Xiao H. An unusual tale of rat-bite fever endocarditis. BMJ Case Rep. 2014;2014:bcr2014204989. http://dx.doi.org/10.1136/bcr-2014-204989. PMid:25414213.

Nathan M. A rare triple threat: rat bite fever, endocarditis of ventricular septal defect patch, and multivalve endocarditis with sinus of Valsalva fistula. J Thorac Cardiovasc Surg. 2017;153(3):e47-8. http://dx.doi.org/10.1016/j.jtcvs.2016.11.012. PMid:27955910.

Torres-Miranda D, Moshgriz M, Siegel M. Streptobacillus moniliformis mitral valve endocarditis and septic arthritis: the challenges of diagnosing rat-bite fever endocarditis. Infect Dis Rep. 2018;10(2):7731. http://dx.doi.org/10.4081/idr.2018.7731. PMid:30344968.

Nelson C, Rawling RA, Granato PA. Streptobacillus moniliformis native valve endocarditis. Clin Microbiol Newsl. 2018;40(9):74-6. http://dx.doi.org/10.1016/j.clinmicnews.2017.11.002.

Ioffe V, Amir G, Zalzstein E, Krymko H, Levitas A. Streptobacillus moniliformis endocarditis: an unusual case of pulmonary valve erosion resulting in free pulmonary regurgitation and aneurysm. World J Pediatr Congenit Heart Surg. 2018;9(4):467-9. http://dx.doi.org/10.1177/2150135116637808. PMid:27154799.

Alemán A, Téllez A, Pereda D, et al. Endocarditis infecciosa por Streptobacillus moniliformis: descripción de un caso y revisión de la literatura. Cirugía Cardiovascular. 2020;27(4):160. http://dx.doi.org/10.1016/j.circv.2020.03.051.

Frederick AR, Fowler BC, Kolluri R. Rat bite fever: a rare case of critical limb ischemia. Vasc Med. 2019;24(5):465-6. http://dx.doi.org/10.1177/1358863X19849619. PMid:31113292.

Winther M, Jensen HS, Tarpgaard IH, Nielsen HL. Case report: a fatal case of aortic and mitral valve endocarditis caused by Streptobacillus moniliformis. Eur Heart J Case Rep. 2020;4(5):1-6. http://dx.doi.org/10.1093/ehjcr/ytaa254. PMid:33426458.

O’Brien J, Paul C, Ridley D. Rat bite fever: a surreptitious cause of infective endocarditis. J Am Coll Cardiol. 2022;79(9 Suppl):2300. http://dx.doi.org/10.1016/S0735-1097(22)03291-0.

Rai D, Tahir M, Mulkareddy V, Chen T, Baibhav B. Rat bite endocarditis: an unusual presentation. J Am Coll Cardiol. 2020;75(11 Suppl 1):2974. http://dx.doi.org/10.1016/S0735-1097(20)33601-9.

Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075-128. http://dx.doi.org/10.1093/eurheartj/ehv319. PMid:26320109.

Castro S, Magni G, Beni S, et al. Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves. Am J Cardiol. 1997;80(8):1030-4. http://dx.doi.org/10.1016/S0002-9149(97)00598-5. PMid:9352973.

Wang A, Gaca JG, Chu VH. Management considerations in infective endocarditis: a review. JAMA. 2018;320(1):72-83. http://dx.doi.org/10.1001/jama.2018.7596. PMid:29971402.






Clinical Case Report and Review

How to Cite

Ashwin Mahesh, Eduardo Messias Hirano Padrao, Ravneet Randhawa, Christi Oommen, Johanna Romo, Ramachandra Illindala, & Henry Anyimadu. (2023). A Rodential Reckoning: A Case Report and Systematic Review of Streptobacillary Endocarditis. Autopsy and Case Reports, 13, e2023423. https://doi.org/10.4322/acr.2023.423