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Leptospirosis is a bacterial infection which may cause multiple non-specific symptoms. Transmission of the disease can occur via rats or surface water infected by rats. The Netherlands have seen a record number of cases of leptospirosis in 2019. Diagnosis is often delayed and not always considered because of the variable clinical presentation of the disease. Surveillance of disease prevention concerning rat breeders is inadequate.An 11-year-old girl visited the paediatrician with fever, myalgia and a headache followed by a stiff neck. Two days earlier she was bitten by one of her pet rats. Diagnostic testing confirmed a meningitis caused by leptospirosis-infection. The pet rats were found to be infected with leptospirosis. All rats were euthanized.Consider the diagnosis leptospirosis in patients with unexplained non-specific symptoms following rat exposure. Information regarding visits to tropical areas and animal exposure is vital. More awareness of zoonoses is needed among physicians and pet breeders.

Dog bites are a significant public health problem among children. Primary prevention is important. A majority of the dog bites in children are in or around there own house and/or by a family dog. Therefore, parents should be educated how to handle dog and child. The consequences of dog bites can be dramatic, with on the long term scars, disability and posttraumatic stress disorder. Next to medical treatment it should be well considered if the safety of the child and society are endangered. All involved caregivers, as child health care practitioners and the family doctor, can be consulted to answer this question. Child Protection Services can be consulted if there may be safety issues of the child. Furthermore, it is important to consider behavioral examination of the dog. In the Netherlands, this can be done after reporting the matter to the police or on the initiative of the municipality.

Recent publications on fatal cases of mushroom poisoning and wasp's stings in the Netherlands raised the question how poisonous the Dutch wildlife is. In this article I focus on plants, berries, mushrooms and animals. The annual reports of the National Poison Control Center provide the number of consultations related to mushroom poisoning, toxic plants and animals. The majority of consultations concerns contact with toxic plants in gardens and indoors. In three-quarter of the cases the patient is a child (0-12 years). Serious mushroom poisoning occurs mainly in adults who mistook a poisonous mushroom for an edible one. Although snake bites are reported in the Netherlands, most of these are due to exotic snakes kept in indoor terraria. Fatal reactions to wasp's stings are due to anaphylactic reactions. All in all, poisoning is rare and the Dutch countryside can be considered a safe place.

Infection with the lymphocytic choriomeningitis virus is a human zoonosis caused by a rodent-borne arenavirus and is often seen in autumn and winter when mice retreat into houses. Infection in humans is acquired after inhalation of aerosols or direct contact with excreta of an infected rodent.A 37-year-old woman was referred to St. Elisabeth hospital in Tilburg, Netherlands, complaining of severe progressive headache, nausea and vomiting. Three weeks before presentation a mouse had bitten her finger. On neurological examination there were no abnormalities. Cerebrospinal fluid investigations indicated viral meningitis. Immunofluorescence serological testing confirmed the diagnosis of lymphocytic choriomeningitis.Infection by lymphocytic choriomeningitis virus after contact with rodents can cause viral meningitis. The acquired form of the disease is known to be self-limiting in immunocompetent patients.

A 36-year-old woman presented with a red, itching bump on her back and brought the arthropod that had bitten her. The diagnosis, a bite of a soft tick, was made by determination of the arthropod as a pigeon tick (Argas reflexus). Pigeon ticks only occasionally bite humans and can transmit multiple infectious diseases.

A 24-year old man presented himself to the emergency ward with complaints of fever, nausea, headache, muscle ache and chest pain. Two weeks before presentation he had been bitten by a pet rat. We determined that he had bacteraemia caused by a Streptobacillus moniliformis infection, which led to the development of an illness called rat bite fever. S. moniliformis is a pleomorphic gram-negative rod-shaped bacterium that is considered part of the normal nasopharyngeal flora in rats. It is the cause of two similar illnesses: rat bite fever and Haverhill fever. Clinicians should consider these infections in the work-up of unexplained fever or sepsis, certainly in the presence of known exposure to rats. Treatment consists of antibiotics.

To investigate the percentage of ticks infected with Borrelia burgdorferi on the Dutch North Sea island of Ameland, and the risk of developing Lyme disease following tick bite on the island.Prospective, observational.Ticks were collected from patients who visited a general practitioner and were tested for the DNA of B. burgdorferi. After 6 months the patients were interviewed by phone using a standardised questionnaire.From 2004-2006, 216 ticks were collected from 167 persons. Most ticks were removed within 24 hours. In 44 ticks (20.4%) B. burgdorferi DNA was detected. Follow up information was available on 146 persons, 41 (28.1%) of whom had been bitten by a Borrelia-positive tick. None of the persons developed a typical erythema migrans. From the 13 persons (9%) reporting a non-specific redness of the skin (diameter less than 5 cm) at the site of the tick bite, 5 had been bitten by a positive tick and 8 by a negative tick. One patient bitten by a positive tick reported systemic symptoms related to Lyme borreliosis, namely fatigue, perspiration and joint ache, without local redness.The probability of developing Lyme borreliosis was low even though a relatively large percentage of the ticks collected were positive for B. burgdorferi. This is probably connected to the fact that in the majority of cases the tick had been removed within 24 hours.

A healthy 54-year-old man presented at the emergency department with signs of sepsis. Four days prior he was bitten and scratched by his dog. Microscopy of the blood smear showed intracellular Gram-negative rods. Despite maximal treatment the patient died a day and a half after admission due to septic shock with multi-organ failure and disseminated intravascular coagulopathy. After extended incubation of the spleen culture a Gram-negative rod was isolated and identified as Capnocytophaga canimorsus based on 16s RNA analysis. This is a commensal microorganism found in the oropharynx of dogs and cats. Infection occurs 2-3 days after contamination. The clinical presentation is heterogeneous, and contamination can sometimes proceed to fulminant infection. The lethality of infection is 30%. A risk factor is often present, such assplenectomy, alcohol abuse or immunosuppression. Immediate antibiotic treatment may influence the course of infection. Antibiotic prophylaxis has also been proposed for high-risk patients with dog bites.

A 16-year-old boy suffered from progressive paralysis and retching when attempting to drink, due to rabies.

In a 28-year-old male American tourist who presented in the hospital with fever, cold shivers, headache, nausea, myalgia and arthralgia, Rocky Mountain spotted fever was suspected, partly because he came from an endemic region (the state of Georgia). The patient was treated with doxycycline, 100 mg b.i.d.; 9 days after the first appearance of the symptoms, the diagnosis was confirmed by the report of a positive antibody titre against Rickettsia rickettsii. The patient did not have exanthema. He was discharged in good general condition after two weeks of treatment. Rocky Mountain spotted fever, caused by the Gram-negative bacterium R. rickettsii, is a serious rickettsiosis. The disease is seen only sporadically in the Netherlands because the ticks in the Netherlands do not carry the bacterium. The travel history is still not a standard component of the anamnesis and is therefore often forgotten. This can lead to under-diagnosis and delayed treatment of diseases that were formerly limited to the continent. The early recognition and treatment of Rocky Mountain spotted fever is important since delayed treatment is associated with a clear increase in both morbidity and mortality.

A 34-year-old man sought medical advice for a dog bite on his left lower leg. The wound progressed after split skin transplantation. It was proved to be pyoderma gangrenosum associated with colitis ulcerosa and responded well to oral prednisone therapy.

To obtain detailed information about the current geographical distribution and incidence of tick bites and Lyme borreliosis in the Netherlands and to identify regional differences in the ecological risk factors that might be involved.Retrospective questionnaire study.All Dutch general practitioner's (GP) practices.In April 2002, all GPs in the Netherlands were asked to complete a short questionnaire on the number of cases of tick bites and erythema migrans seen in 2001 and the size of their practice. Associations with possible risk factors were determined at the municipal level. Results were compared with the results of a similar study done in 1995.The response of the GPs was 64.5% (4730/7330). Together, all GPs reported seeing approximately 61,000 patients in 2001 with tick bites and 12,000 patients with erythema migrans. The incidence of erythema migrans was estimated at 73 per 100,000 inhabitants. There were obvious risk areas. At the municipal level, tick bites and erythema migrans were positively associated with the area covered by forest, sandy soil, the number of roe deer and tourism. There was a negative association with the degree of urbanisation. Increases in tourism in areas with many ticks, new forests in urban regions and an increased number of horses were positively associated with the increase in tick bites and erythema migrans since 1994.The number of patients with tick bites and erythema migrans seen by GPs in the Netherlands had doubled between 1994 and 2001. This increase may be attributed partly to changes in ecological risk factors and human behaviour. The number of cases of Lyme borreliosis may be reduced by giving prophylactic information annually about ticks and ways to remove them, plus additional education of patients about the recognition of erythema migrans.

A 54-year-old man presented with fever and an eschar, probably caused by African tick-bite fever, contracted during a holiday in South Africa. He recovered rapidly after treatment with doxycyclin.

A 63-year-old healthy man developed acute meningitis. A Gram-stain of the cerebrospinal fluid showed Gram-negative rods, which grew slowly. They were identified by 16S ribosomal RNA sequence-analysis as Capnocytophaga canimorsus, an oral commensal found in various animal species including dogs. Upon further questioning, the patient mentioned a superficial dog bite. Using fluorescence-in situ-hybridisation with specific DNA probes, C. canimorsus cells were detected in a gingiva swab from his dog. The strains isolated from the patient and his dog were identical. The patient made a quick recovery following therapy with cefotaxime. Infections with C. canimorsus are associated with immune suppression (especially splenectomy or alcohol abuse), yet 40% of the patients have no predisposing conditions. Documented infections concern mainly sepsis or meningitis, with a mortality of approximately 30%. Due to its fastidious growth, C. canimorsus may be missed in standard culture methods. Therefore, in each case of unexplained sepsis or meningitis contact with animals should be enquired about.

A 50-year-old fisherman was stung in his right hand by a Great Weever fish (Trachinus draco). The crew did not have sufficient medical knowledge to adequately treat him on board. Severe pain, oedema of the hand, fever, vomiting and syncope occurred. Treatment with antibiotics, on board, after disembarkation and later in hospital for six days reduced the severity of the symptoms. However, two years after the accident, the patient still suffered from a dysfunction of the right hand as well as extreme fatigue and intermittent joint complaints. The symptoms mostly commonly arising from a Weever fish sting are: severe pain, local erythema and oedema. Systemic symptoms may sometimes occur: headache, syncope, bradycardia, fever and hypotension. The symptoms of continuous joint pain and severe fatigue following a Weever sting have not been previously described. The Weever fish venom contains a mixture of biogenous amines, of which some are known: 5-hydroxytryptamine, epinephrine, norepinephrine and histamine. The venom's composition has yet to be fully elucidated. In the event of a Weever fish sting, the first aid which should be given is: clean the wound and immerse the affected part of the body for at least 30 minutes in water which is as hot as the victim can tolerate (40-45 degrees C). Persons at risk from Weever fish stings are bathers, especially from the Lesser Weever fish (Echiichthys vipera), and sea fishermen. General practitioners and first aiders in coastal areas as well as sea fishermen should be informed about the first aid to be given in the event of a Weever sting.

Practising veterinarians and their assistants run the risk of being bitten by their patients, mostly cats and dogs, and many have experienced that bites and bite-wound infections can have unpleasant consequences. In recent years, more insight has been gained into a 'new' bacterial infection of bite wounds that not only has severe local effects but also potentially fatal systemic consequences. The bacterium involved is Capnocytophaga canimorsus. All bite wounds should be treated adequately, but this is especially so when wounds are infected with C. canimorsus. In this article, dog and cat bites are briefly described and then an overview is given of current knowledge of C. canimorsus and appropriate prophylactic measures.

A 43-year-old woman presented with a generalized febrile illness, an exanthema with mixed maculopapulous and pustulous eruptions on the lower halves of the extremities, elbows, knees, palms and soles. There was also severe arthralgia and asymmetric arthritis. The diagnosis was rat bite fever. The disease became manifest eight days after she was bitten by a pet rat. Rat bite fever can easily be missed, even after adequate anamnesis and physical examination, while the differential diagnostic considerations are numerous. Our patient was cured completely after intravenous administration of penicillin G. Antimicrobial therapy was completed by an oral course of doxycycline.

The National Poisons Information Centre of the National Institute of Public Health and the Environment in the Netherlands in the past 2 years received dozens of requests for information about intoxication due to stings of the weever, Echiichtis vipera. The venomous apparatus of the weever consists of gill cover spines and 5 to 8 dorsal fin spines. The fish buries itself in the sandy or muddy bottom of the sea to wait for prey. The mixture of toxins that enters the skin upon contact with the spines causes a heavy local reaction, characterized mostly by pain, which untreated persists for 24 hours. An erythematous oedema may develop locally, spread over the entire extremity and persist for days. Systemic reactions are rare. Since the toxin mixture is heat labile, treatment is essentially simple: clean the wound and immerse the affected limb as soon as possible in warm water (45 degrees C) for 30 to 90 minutes. This makes the pain disappear.

To determine, on the basis of published research on dog bites, risk groups and localisations, risk factors for wound infection, effectiveness of prophylactic antibiotics and indications and contraindications for primary closure of the bite wounds.Literature study.Search in Medline (1975-October 1994) on "dog" and "bite(s)" and selection using methodological inclusion and exclusion criteria.Incidence of dog bites is highest in younger children and in hands/arms. The infection rate amounts to 3-17%. Risk factors for wound infection include hand/arms, puncture wounds, delay of presentation and possibly older age. The effectiveness of prophylactic antibiotics appears to be limited. There is no evidence that the infection rate after primary closure of wounds is higher. Cleaning and debridement are important.More attention should be paid to prevention of dog bites, especially in children. Most important is adequate cleaning of the wounds. Antibiotics should be given on indication only, such as hand wounds, puncture deep wounds and immune compromised patients. Primary closure is not contraindicated.

After a fight between two Pyrenean Mountain Dogs, the resulting lameness in one of the dogs was found to be due to a remaining point of canine tooth.

Annually 50,000 to 100,000 animal bites are seen by physicians in the Netherlands. Infections of these bite wounds frequently occur. Pasteurella multocida is one of the main causes of these infections and many serious complications may occur. We present 3 patients with disturbances in wound healing after animal bites or scratches due to infection with P. multocida. In view of the high infection ratio after cat bites we advise giving amoxicillin/clavulanic acid (Augmentin) for 5 days as prophylaxis. According to the literature prophylaxis for dog bites is not necessary. However, fatal complications after dog bites due to infections with Capnocytophaga canimorsus (DF-2) support those who prefer to give antibiotics after these bites also.

Although much is known of the causes and prevention of tail-biting, this continues to be a common vice in pigs. The animals seek diversion by chewing on the tails of their fellows as they feel uncomfortable. This may result in inflammation of the tail. Prevention should be directed towards improvement of the conditions which cause the animal to feel uncomfortable. As this will often not be possible or only in part, efforts are made to prevent tail-biting by docking the tails. When tail-docking is performed according to the rule in one- to three-day-old animals, tail-biting obviously will no longer be possible. However, this does not mean removing the causes of tail-biting. This procedure is therefore undesirable from the point of view of welfare of the animals. Inflammation of the tail may result in metastasis to the spinal column and/or lungs. This is frequently associated with bacteraemia. Moreover, the resulting abscess formation will be highly objectionable from the point of view of hygiene.

Infection with Pasteurella multocida caused by bites has been known for several decades. Cats are an important factor in Pasteurella multocida infection. Considerable numbers of victims are 'rescued' from the mouths of cats and submitted to bird reception centres for treatment. A number of bird shelters sent birds in this condition to the present authors for closer examination. The majority of birds caught by cats die. The mortality rates in shelters were reported to be 30, 90, 99 and one hundred per cent. Of the birds rescued alive from the mouths of cats, approximately 40 per cent died from the direct effects of the bites, and approximately 60 per cent died from Pasteurella multocida infection.

Thirty patients with deep infections of the hand presented between 1982 and 1986 in our Department of Traumatology. Twenty infections were caused by neglected cut- or stab-wounds or animal bite injuries. Mostly Staphylococci or Streptococci were isolated from the wound culture. Only twelve patients could be operated upon ambulatory basis. Postoperative treatment was necessary for more than two months in half of the patients. The patients had a moderate or severe diminution of hand function. All cut- or stab-wounds and human or animal bite injuries of the fingers and hand must be considered as infected wounds. In patients with deep hand infections, surgical debridement and exploration should be performed urgently. Postoperative daily cleaning of the wound, washing out of the infected tendon sheath and passive mobilization of the fingers should be done. The active mobilization starts when infection is regressed and is continued for several weeks. Nevertheless we have to accept a significant loss of hand function in many patients.