A recent rat bite fever death in a six-month-old Pennsylvania baby raises several issues that parents need to consider.
The child died of meningitis and myocarditis (inflammation of the heart) caused by the bacterium Streptobacillus moniliformis. This bacterium is present in the mouths of virtually all rats, and is the cause of rat bite fever. Human infections are uncommon but they can be severe, especially in young children, individuals with compromised immune systems and/or when infection is not diagnosed promptly. Rat bite fever is (not surprisingly, given the name) mainly associated with rat bites, but can also occur if there is other contact of rat (or other rodent) saliva with a person’s mucous membranes (e.g. mouth, nose) or broken skin.
In this case, the baby was bitten by a rat that was to be fed to the family’s snakes. A few days later, a fever and rash were noted (classical rat bite fever signs) and the child was taken to an Emergency Room, but discharged with "medication" (probably just something to lower the fever). Two days later, the baby was returned to hospital with fever and lethargy, and died later that day.
Besides the tragedy of the situation, there are several things about this case worth pointing out:
- Babies should not have any contact with rats. Infants are at increased risk of infection from a lot of things, and they get little benefit from touching a rat. The risks outweigh any benefits.
- If an infant is bitten by any animal, antibiotics are often indicated to prevent infection. Good bite first aid and knowing when to get medical care should be an integral part of pet ownership
- Pet owners need to know about infectious disease risks associated with their animals (and any animals they may feed to their animals, as in this case), especially when there are high risk indiviualds in the household.
- Physicians need to know about bites and other animal exposures. It’s not reported whether the physicians asked, and given the fact that rat bite + fever + rash absolutely screams "RAT BITE FEVER," they must not have.
- Patients/parents need to volunteer information about pet ownership and high risk incidents like bites. If the physician had asked about animal contact, or the parents had mentioned the bite, odds are good that the baby would have been treated for rat bite fever the first time the family went to the hospital, and then likely would have survived.
- Snakes (or any other reptile) should not be kept in households with babies. The risk of Salmonella exposure is too high.
- Live rodents should not be fed to reptiles. There are humane issues for both the rodent and the snake, as snakes can be seriously injured by prey.
People talk about "one medicine" and "one health" all the time, but application of the concept is poor. There needs to be better communication about zoonotic diseases and animal exposure, especially in situations like this.
More information about rat bite fever is available on the Worms & Germs Resources – Pets page.