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I had one. A 6 year old girl who got bit on her finger
Her pet slept with her, ate with her.

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On Nov 11, 2017, at 19:37, Amy Roy <[log in to unmask]<mailto:[log in to unmask]>> wrote:

There has been at least one case of rat bite fever in a domesticated rat in the US:

http://www.sandiegouniontribune.com/news/courts/sd-me-rat-verdict-20170420-story,amp.html

Interesting case. There is always a new twist on the newborn with a possible infection, but this is a doozy!

Amy Roy
Elliot Hospital
Manchester NH


On Nov 10, 2017, at 10:18 PM, Alicia Tezel <[log in to unmask]<mailto:[log in to unmask]>> wrote:

This from a peds ID friend

Hi Alicia,
Interesting case!

I'm not really sure I would trust that rat-bite fever can be ruled out in a
rat from a "reputable breeder". I would need to look into this further.

I'm also nervous when people describe skin findings in a newborn without
actually seeing them. It sounds like it was very soon after the bite though
that the child was seen, so unlikely to be cellulitis. A baby this age with
cellulitis- I would recommend admitting for IV antibiotics and close
observation.

To answer some of the questions that were posed,

1. A protective maternal antibody titer against tetanus can be presumed to
be protective for baby. However, it often takes a while for this test to
result, so I would rather rely on maternal vaccination history.

2. I don't think that you can totally rule out rat bite fever. There are
cases of initial recovery from very minor clinical illness, only to be
followed by relapsing fever for weeks or months. Furthermore, the
incubation period can be up to 3 weeks.

3. I definitely would have given 3 doses of amox-clav or maybe even IM
penicillin (considering unreliable gut absorption in this age group), for
peace of mind if nothing else.


🌷 Alicia 🌷
Sent from my iPhone


On Nov 10, 2017, at 11:29, George Kristinsson <[log in to unmask]<mailto:[log in to unmask]>>
wrote:

Question to the group, especially the infectious disease inclined
colleagues of ours:

The other day we've seen here in our regional pediatric ED a 2 (two) day
old baby after a house rat bite. Yes, that‘s a new one for us! Basically
the fresh baked mother and her baby went upon discharge straight from the
maternity ward to a friends home visiting, where at some point someone
noticed the house rat at the newborns hand. (The baby was in a car seat on
the floor next to them)

By the time the baby presented to our ED – thats right after the incident –
the middlefinger oft he left hand  was slightly swollen and red, with what
it seems a superficial abrasion on the lateral nailfold with a little dried
blood on it.

We were hard pressed how to proceed about this case and unfortunately the
ID people oft he regional tertiary care center we contacted, after washing
the wound, wouldnt want to consult without seeing the Baby and asked the
otherwise healthy newborn to be sent to their ED.

Meanwhile the local veterinary authorities rule out that domestic rats from
„reputable breeder“ (?) could transmit rat bite fever.

Instead to sent the kid crosscountry to a busy ED we opted to follow the
newborn and the conditions at home ourselves daily through the visiting
midwife at home and clinical checks at our outpatient clinic. It is day 5
of live, respectively day 4 since the incident and the finger shows only
some minuscule nick oft he cutis in the nailfold. Otherwiese the baby is
doing fine. At this point we do have few questions, and wonder how others
would have gone about this unusual case:

-What about tetanus: is a presumably titer of maternal antibodies enough of
a protection?

-Can rat bite fever truely be ruled out?

-Would anybody had given a preventive 3 day course of Co-Amoxi as many
propably would have done in an older toddler / child?

-How long to follow the newborn?

-Any other thoughts?

Thank you

George Kristinsson

Spital Buelach, Switzerland

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