Pediatrician says kids shouldn't have rats
A Montreal pediatrics resident has expressed concern about rat bite fever in kids. Dr. Karine Khatchadourian described three cases of this bacterial infection in a paper called "The rise of the rats: a growing paediatric issue," published last year in the journal Paediatrics and Child Health. The article didn't really present any evidence that this is a "growing" issue, but it is a disease of concern.
Rat bite fever is a bacterial infection most commonly (but not exclusively) associated with bites from rats. Healthy rats often carry the bacterium that causes the disease (Streptobacillis moniliformis in North America), and infection can occur when the bacterium is inoculated into the body by a bite, or when it's spread to mucous membranes like the mouth through direct mouth-mouth contact with pet rats (yes, some people kiss their rats).
The disease can be serious, and even fatal, if not properly diagnosed and treated. It's also a classic example of why physicians need to ask their patients about pet contact and why people need to take bites from pets seriously. Knowing that a rat is in the house, and particularly if a bite has occurred, is a key factor in helping make the diagnosis. If the physician doesn't ask the question, this critical piece of information may be missed, along with the diagnosis.
Being concerned about rat bite fever (and other zoonoses) is good, and ways to educate pet owners and physicians about such diseases are needed. However, extrapolating "rat bite fever is bad" to "rats are bad" is a stretch. The statement in the paper "Should we, as health care professionals, advocate to have rats banned from being sold in pets stores?" is over the top.
Every animal carries many microorganisms that can cause disease in people, given the right circumstances. Similarly, every person you meet is carrying something infectious. The key things to consider are:
- What is the likelihood of infection?
- How severe is the disease that may occur?
- What can be done to reduce the risk of infection?
- What is the cost-benefit, i.e. how do the potential risks compare to the potential benefits?
How can the risks be reduced?
- Rat owners need to be aware of the disease.
- Good handling practices are needed to reduce the risk of bites.
- Any bites that occur should be promptly cleaned and a physician contacted if there are concerns.
- Contact of rat saliva with broken skin or mucous membranes (e.g. kissing the rat) should be avoided.
- Physicians need to know whether their patients own pets, including rats, and know what diseases may be associated with those types of animals.
With this type of approach, the risk of infection can be reduced and the ability to properly and promptly diagnose the disease, in the odd case that it occurs, can be maximized.
I don't want to downplay rat bite fever. It certainly can cause illness, particularly in children under the age of 12. A recent paper reported a fatal case in a 14-month-old boy, however in that case the infection was associated with ferrets, not a rat.
Parents of small children need to think about the risks of zoonotic diseases, as well as injuries (e.g. bites) when deciding whether to get a pet, and what type of pet to get. If people like rats, take care of them properly and communicate well with their physician (and if their physician is aware of the issues), then the risks of serious disease are quite low.
Dr. Khatchadourian suggests that parents "should stick to cats and dogs, and steer clear of rats." However, that's no assurance that a zoonotic infection will not occur. There's no evidence indicating the risk of disease is less with those species. It doesn't even eliminate the risk of rat bite fever, since Streptobacillus moniliformis can be found in the mouths of dogs too.
Rather than banning rats from pet stores, we should focus on educating pet owners, veterinarians and physicians about zoonotic diseases.
Cowpox in a dog
Cowpox virus is an example of a virus with a misleading name. It's place in history is from Jenner's observation that milkmaids who had been infected with cowpox were resistant to smallpox, leading to the use of cowpox (which causes very mild disease) to protect against smallpox (which is very, very bad). While cattle can be infected, they are not the true host of this virus, and infections in cattle are actually quite rare.
Various rodents are the true reservoir of cowpox. Other species can be infected from contact with infected rodents, including people and pets. Among pets, cats are most commonly infected, with most reports coming from central Europe. Cats may be infected more often because they may more often have close encounters with rats, but they are probably also inherently more susceptible to the disease than dogs.
Cowpox infections in dogs are very rare, but a case was recently described in Veterinary Dermatology (von Bomhard et al 2011). It involved a five-month-old Rottweiller from Germany that developed a very mild case of cowpox, with a single nodule on its muzzle. The dog recovered uneventfully, but it was an interesting case of a rare disease in a dog, and one that has some human health considerations.
People can be infected with cowpox from pets. In particular, infections from pet rats have been a problem in central Europe over the past few years. Outbreaks of human infections have been identified associated with widespread dissemination of infected rats from infected breeding or distribution facilities. Infections have also been reported from cats, and cats are a significant concern because of their ability to be a bridge between wild rodents and people, and because of the close contact they tend to have with people.
It's not surprising that disease was so mild in this Rottweiller puppy, and the risk to people in contact with the dog was probably limited because of the mild nature of the infection. No human cases were reported associated with this dog. Human infections from dogs have not been reported, largely because the disease is so rare in dogs and perhaps because when they are infected, dogs tend to have very mild disease. Cowpox is of minimal concern for most pet owners, but it something to be aware of when obtaining a new rodent, especially in regions where cowpox is an issue, and when dealing with cats in areas where cowpox is endemic in wild rodents. Some basic preventive measures include:
- Pet rodents and cats (especially newly obtained rodents) that develop skin lesions should be handled with care and be examined promptly by a veterinarian.
- Wild rodents should never be caught and kept as pets (for various other reasons, as well).
- Contact between domestic pets (particularly pet rodents and cats) and wild rodents should be prevented.
Rat bite fever leads to pet store lawsuit
A Phoenix, Arizona man is suing a pet store after he contracted rat bite fever from a rat he had purchased. It's not surprising to see a lawsuit following a serious illness, considering people in the US often try to sue for just about anything, but I'm not sure it won't get very far. I don't doubt that the man had rat bite fever, or that he got it from the rat he purchased - the question is, is the pet store really liable? Specifically, did they do anything inappropriate?
"Rats being sold to people should not have rat-bite fever," Heitzman's lawyer, M.E. "Buddy" Rake Jr., tells New Times.
Actually, the rats don't have rat bite fever... rats are healthy carriers of the bacteria that cause rat bite fever. There are two different bacteria that can cause the disease, Streptobacillus moniliformis and Spirillum minus. Streptobacillus moniliformis is presumably the cause here since it's the main cause of rat bite fever in the US. This bacterium is very commonly found in healthy rats, with upwards of 100% of healthy rats being carriers. You have to assume that every rat is carrying this bacterium.
"It wouldn't be any different if they sold someone a dog with rabies," he says. "I'm not in the nuisance-lawsuit business - he was in rough shape."
It would certainly be a different story if the store sold someone a dog that had signs of rabies. It's possible that someone could buy a dog that had been exposed to rabies but which was healthy at the time of sale, but that's pretty unlikely. However, a big difference is that there is a highly effective vaccine against rabies. There is no such thing for rat bite fever. If a pet store sells an unvaccinated dog of unknown origin that could have been exposed, despite knowing the need for rabies vaccination, there certainly could be liability issues. Selling a rat that is carrying a bacterium that we assume most or all rats carry anyway is different.
PetCo did not immediately return telephone calls this afternoon, but in its defense, there is an information pamphlet explaining exactly how to avoid contracting rat-bite fever available on the company's Web site. ...though it seems the pamphlet's best suggestion is to not get bitten in the first place.
It would be better if everyone who bought a rat was given the information sheet, but it's a start. The fact is, the best way to avoid rat bite fever IS to avoid getting bitten by a rat! Proper rat handling is a very important aspect of disease prevention, since you can never rule out the possibility that a rat is a carrier.
Our suggestion: Don't have a disgusting rat for a pet.
Whoa. Rats can make excellent pets. They can also carry infectious diseases. However, EVERY animal can carry infectious diseases, and rats are probably no more risky than most other domestic pets. The key is to take common sense precautions to reduce the risk of injury and infection (though the risk can never be completely eliminated). For rats, this includes selection of a rat that is not aggressive or fearful, knowing how to properly take care of a rat, knowing how to take care of a bite should it happen and being aware of some diseases for which you might be at increased risk because you own a rat.
Image source: http://commons.wikimedia.org
Rabid rat attack
Cab drivers have to put up with a lot of risks, but attacks from marauding rats probably aren't high on their list of concerns. However, a Ukrainian cab driver was recently attacked by a rat, and the rat was subsequently killed and found to be positive for rabies. The cab driver is now undergoing post-exposure treatment, and authorities are vaccinating pets and trying to eliminate mice and rats in the nearby neighbourhoods.
This is another good example of why it's important not to ignore a bite from any mammal, because rabies can affect any mammal. People often don't consider rodents a concern when it comes to rabies transmission, because most rodents would die from an attack by a rabid animal, thus preventing them from becoming infected and passing on the virus. This is probably true in most circumstances, but there have been enough reports of rabies in rodents, and potential human exposure from contact with rabid rodents, that we have to pay attention to this risk. Overall, the likelihood of acquiring rabies from a rat bite is pretty minuscule, and much less than the risk of contracting other diseases such as rat bite fever, but it's not zero. Since rabies is almost invariably fatal, even seemingly low risk situations need to be carefully assessed. In the case of this cab driver, there was definitely a risk of rabies exposure. If the rat had not been caught and tested, the potential for rabies exposure might have been dismissed, which could have had catastrophic consequences for the cabbie.
More information about rabies can be found on the Worms & Germs Resources page.
Weil's disease from a pet rat
A recent edition of the Veterinary Record contains a case report of Weil's disease in a person that adopted a feral (wild) rat (Strugnell et al, 2009). Weil's disease is a severe disease of the kidneys, liver and other body systems that can develop after acute leptospirosis (infection by Leptospira bacteria). This group of bacteria can infect a wide range of animals and is typically shed in the urine. The person that was affected adopted the rat after it was caught by her neighbour's cat. The paper says that the rat was "urinary incontinent" - not something we usually notice about rats since they are not typically litter or house trained. I presume this means the rat was urinating frequently when out of its cage, including when it was being handled. Because of this, the owner reported that she "aimed" to wash her hands after every time she touched the rat.
A couple of weeks after adopting the rat, the woman was admitted to hospital because of lethargy, muscle aches, mild abdominal pain, cough and a bloody nose. Blood tests showed that she had decreased levels of white and red blood cells, as well as liver and kidney disease. After further testing she was diagnosed with leptospirosis. She had to be treated in the ICU, but eventually made a complete recovery. The adopted rat and the other rat that she owned were euthanized by the owner's partner shortly after she was admitted to hospital. Testing of the adopted rat identified Leptospira in the kidneys.
This is another example of why wild animals should be left in the wild, and another case highlighting the need for veterinarians, physicians and public health personnel to work together.
More information on Leptospira and leptospirosis can be found on the Worms & Germs Resources page and in our archives.
Rat bite fever
Rats can be really interesting pets. They can be quite social and are interesting to watch. Being larger than hamsters and gerbils, they can also be more easily and safely handled. They can still bite, however, particularly if they are not properly socialized and/or they are handled by people who don't know how to do it properly. Even though rats have tiny teeth, bites can still cause problems. One concern is rat bite fever. This disease is actually caused by two completely separate bacteria. Streptobacillus moniliformis is the most common cause in North America and Europe, while Spirillum minus is the main cause in Asia.
I'll focus on Streptobacillus moniliformis today. This bacterium is very commonly found in the mouths of healthy rats. Up to 100% of rats can be carriers. It doesn't cause disease in the rats, but it can be transmitted to people by bites or scratches. It can also be spread simply by handling rats (especially if a person has any cuts or broken skin), and through close contact with rats' mouth, such as kissing and sharing food (yes, some people do).
In most people, rat bite fever causes a high fever, headache, chills, vomiting, joint and muscle pain and a rash, most commonly over the soles of the feet, palms of the hands and the extremities. While the disease will resolve on its own in many cases, treatment with antibiotics is indicated because severe complications such as inflammation of the heart, pneumonia and meningitis can also develop.
Common sense can help reduce the risk of rat bite fever.
- Assume all rats are carrying S. moniliformis in their mouths.
- Only handle rats if you know how to do so properly, and if you know the rat is amenable to being handled. Avoid contact with the rat's mouth (e.g. kissing).
- If you have open sores or cuts on your hands, avoid handling rats or wear gloves.
- Always wash your hands thoroughly after handling a rat or cleaning its cage.
- Thoroughly clean any bites from any rodent immediately with lots of soap and water.
- If you develop signs consistent with rat bite fever after being bitten, consult your physician as soon as possible, and be sure to let your physician know about the bite.
More information about the care of bites can be found in our bites archives and on the Cat Bites information sheet on the Worms&Germs Resources page.
