The possibility of childhood arthritis or reactive arthritis was discussed with the parents. Although the usual transmission of infection is by rat bite, there was no history of a bite but the mother did recall several scratches on the child's hands. Disease in rats was discussed and recommendations were offered to help prevent further exposures. Streptobacillus moniliformis is an uncommon human pathogen acquired from exposure to rodents. It usually produces a mild, protracted illness that responds to antibiotic therapy but can resolve spontaneously.
Signs can include fever, malaise, cough, maculopapular rash, and occasional arthritis.
Rat-bite fever is rare in the United States, with cases occurring mainly in children and laboratory personnel. Delay in diagnosis may occur due to the difficulty in culturing the organism, which has fastidious growth requirements and lack of a history of a rat bite. In particular, San Diego County has investigated two cases of reptile-associated salmonellosis in children in recent weeks. In one of these cases, Salmonella jangwani , a rare serotype, was isolated from both the child and a pet iguana. As reptiles and rats become more popular as pets, and unless education to reduce exposure is forthcoming, risk of zoonotic disease to infants and children may be increasing.