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Background Only three other cases of rat bite fever caused by Streptobacillus notomytis in humans have been reported since this species was identified in 2015. Data specific to the differences in clinical features and geographic distribution between S. notomytis infection and S. moniliformis infection are scarce. All previous cases of human S. notomytis infection were reported from Japan. This is the first case of S. notomytis infection reported from outside of Japan. Case presentation A 72-year-old Thai woman was admitted to Siriraj Hospital (Bangkok, Thailand)—Thailand’s largest university-based national tertiary referral center—in August 2020 with fever, myalgia, and polyarthralgia for 3 days, and gradually decreased consciousness for the past 1 day. Physical examination and laboratory investigations revealed septic arthritis of both knee joints, meningitis, and hepatitis. She was initially misdiagnosed as rheumatoid arthritis in the elderly since the initial investigations were unable to detect a causative pathogen. However, S. notomytis infection was later confirmed by polymerase chain reaction amplification of a part of the 16S rRNA gene and sequencing from synovial fluid. Her clinical course was also complicated by spondylodiscitis and epidural abscess caused by S. notomytis, which was detected from tissue biopsy. Therefore, rat bite fever in this patient manifested as meningitis, septic polyarthritis, hepatitis, and spondylodiscitis. The patient was treated with intravenous ceftriaxone then switched to oral amoxicillin with complete recovery. Conclusions The clinical manifestations of S. notomytis infection are similar to those demonstrated in S. moniliformis infection. This case also showed that arthritis caused by S. notomytis mimics rheumatoid arthritis, and that meningitis and spondylodiscitis are potential coexisting complications that can be found in S. notomytis infection.

Rats can transmit Streptobacillus moniliformis, which may cause rat-bite fever (RBF), a rare and potentially lethal zoonosis. Fastidious in vitro growth and unspecific symptoms, including fever, arthralgia, and polymorphous skin lesions, complicate the diagnosis. Rat-bite fever follows exposure to contaminated bodily fluids of infected rodents; however, reports on Streptobacillus moniliformis-related infections are few so far. A female patient presented with painful hemorrhagic pustules and purpuric lesions on hands and feet. She developed fever and migratory polyarthralgia. Blood culture yielded growth with Streptobacillus moniliformis. The patient owned rats and handled contaminated rat feces and urine, making this the most likely etiology of infection. We report a case of RBF due to Streptobacillus moniliformis in a rat handling-patient. Difficulties in clinical and microbiological diagnosis highlight the need for a thorough and complete history-taking and a greater understanding of this rare infectious disease.

Rat bite fever is a systemic illness most commonly caused by Streptobacillus moniliformis that is classically characterized by fever, rash and migratory polyarthritis. Here, we highlight the highly variable clinical presentations of rat bite fever in children and the importance of maintaining a high degree of suspicion so appropriate treatment can be promptly initiated.

Rat bite fever is an acute illness caused by bacteria from rodents. In the United States, rat bite fever is considered rare; however, actual incidence is unknown because of lack of mandatory disease reporting requirements. Risk of development of rat bite fever after being bitten by a rat is approximately 10%. Early treatment is imperative as death is a potential complication. The following case study demonstrates the gravity of the syndrome.

Water needed for daily use is viable water that is clean and healthy. Due to limited access to clean water, people buy bottled water and refillable drinking water. It is necessary to do clinical research at the laboratory to determine whether the water condition is feasible or not for consumption. The purpose of this study was to determine whether or not there is E.coli bacteria in the refillable drinking water and bottled water. This study uses an experimental method. Samples were taken from 15 refillable drinking water depots in Kecamatan Rawalumbu Bekasi and 15 bottled water samples. The bacterias identification was made by planting the samples in Blood Agar media and EMB. The results showed four positive samples of E. coli bacteria (26.7%) in the refillable drinking water depot at Kecamatan Rawalumbu Bekasi and one positive sample of E. coli bacteria (6.7%) in bottled water. It was also found that other types of bacteria such as Coliform (6.7%), Pseudomonas sp. (40%), Klebsiella sp. (13.3%), Staphylococcus sp. (6.7%), and Streptobacillus Gram + (13.4%). Key words: Refillable Drinking Water, Bottled Water, Escherichia coli.

Streptobacillus felis is a fastidious microorganism and a novel member of the potentially zoonotic bacteria causing rat bite fever. Since its description, this is the second isolation of S. felis in a diseased member of the Felidae. Interestingly, the strain from this study was isolated from a zoo held, rusty-spotted cat (Prionailurus rubiginosus), with pneumonia, thereby indicating a possible broader host range in feline species. A recent preliminary sampling of domestic cats (Felis silvestris forma catus) revealed that this microorganism is common in the oropharynx, suggesting that S. felis is a member of their normal microbiota. Due to unawareness, fastidiousness, antibiotic sensitivity and lack of diagnostics the role of S. felis as a cat and human pathogen might be under-reported as with other Streptobacillus infections. More studies are necessary to elucidate the role of S. felis in domestic cats and other Felidae in order to better estimate its zoonotic potential.

Rat bite fever (RBF) is predominantly caused by Streptobacillus moniliformis. We report a human infection with Streptobacillus felis. Clinical presentation was consistent with RBF, but serologic testing was negative for S moniliformis. Eventually, S felis–specific sequences were detected in skin lesions of the patient and in the oropharynx of local cats.

From a phlegmon in a dog an aerobic and facultatively anaerobic, indole-, oxidase- and catalase-negative, non-motile bacterium was isolated in 2019 in Germany that stained Gram-negative and showed a pleomorphic, rod-shaped, non-spore-forming appearance. Based on the results of 16S rRNA gene sequence analyses, strain IHIT1603-19T was assigned to the genus Streptobacillus with sequence similarities of 98.6, 98.0, 97.9, 97.1 and 94.4 % to the type strains of Streptobacillus felis , Streptobacillus notomytis , Streptobacillus ratti , Streptobacillus moniliformis and Streptobacillus hongkongensis , respectively. Strain IHIT1603-19T could also clearly be differentiated from other Streptobacillus species by rpoB, groEL and recA gene, nucleotide and amino acid sequence analyses as well as by core genome phylogeny. Regarding DNA–DNA relatedness, strain IHIT1603-19T demonstrated an average nucleotide identity of 83.00 and 82.28 % compared to S. felis 131000547T and S. moniliformis DSM 12112T, respectively. Chemotaxonomic and physiological data of strain IHIT1603-19T were in congruence with other closely related members of the family Leptotrichiaceae , represented by highly similar enzyme profiles and fatty acid patterns. MALDI-TOF MS analysis also proved suitable in unequivocally discriminating strain IHIT1603-19T from all currently described taxa of the genus Streptobacillus . On the basis of these data, we propose the novel species Streptobacillus canis sp. nov. with the type strain IHIT1603-19T (=DSM 110501T=CCUG 74118T=CIP 111795T). The G+C content of the DNA of the type strain is 26.6 mol%, genome size is 1.60 Mbp.

Case presentation of a 66 year old female with penicillin hypersensitivity, who suffered late acute periprosthetic infection of her total knee replacement. After emergency surgery and admission to intensive care, the responsible organism was later identified as Streptobacillus moniliformis.This serves as the first documented case of Streptobacillus moniliformis prosthetic joint infection. As standard culture mediums provide an exceedingly low detection rate, 16S PCR should instead be used as the first line method of identification. As a result, its detection is largely dependent on clinicians recognising relevant factors within the patient's history, namely close contact with rodents. In a patient with penicillin hypersensitivity, carbapenems have demonstrated potential as an effective treatment strategy.

Streptobacillus (S.) moniliformis is the most important pathogen causing rat bite fever (RBF) worldwide. This zoonotic pathogen is understudied mainly due to difficulties in culturing S. moniliformis as a fastidious microorganism. Therefore, advances in molecular detection techniques are highly needed, especially with regard to the widespread availability of real-time quantitative (q) PCR in laboratories. In this study, we aimed to develop a qPCR for the identification of Streptobacillus species and quantification of S. moniliformis in clinical samples, especially those derived from tissue samples of animal origin. We optimized a previously described PCR protocol in order to develop a qPCR, which can detect different Streptobacillus species with high specificity and is simultaneously able to quantitate S. moniliformis in different clinical matrices. The qPCR exhibited a limit of detection (LOD) of 21 copies/reaction representing ~4-5 streptobacilli, while the limit of quantification (LOQ) was 2.1 × 10

Almost all major classes of bacteria are surrounded by a peptidoglycan cell wall, which is a crucial target for antibiotics. It is now understood that many bacteria can tolerate loss of the cell wall provided that they are in an isotonic environment. Furthermore, in some cases the cells can continue to proliferate in a state known as the L-form. L-form proliferation occurs by an unusual blebbing or tubulation mechanism that is completely independent of the normally essential division machine or cell wall synthetic enzymes, and is resistant to cell wall-active antibiotics. However, the growth is limited by reactive oxygen species generated by the respiratory chain pathway. In this work, we examined the walled to L-form transition in a pathogenic Gram-negative bacterium, Streptobacillus moniliformis, which naturally lacks the respiratory chain pathway, under aerobic conditions. L-form-like cells often emerged spontaneously, but proliferation was not observed unless the cells were treated with cell wall-active antibiotics. Time-lapse imaging revealed that cell division of S. moniliformis L-forms involves unusual membrane dynamics with an apparent imbalance between outer membrane and cytoplasmic volume growth. The results suggest that outer membrane expansion may be an important general factor for L-form proliferation of diderm bacteria., This work investigates general factors involved in a process of the walled to L-form switching using a Gram-negative bacterium, Streptobacillus moniliformis, which was the first organism in which the L-form state was reported.

Context Rat bite fever is a rare disease with a challenging differential diagnosis. The zoonosis has a potentially lethal course in a vulnerable population (children and low socioeconomic class) and a commonly available standard therapy (penicillin). This case report review outlines common epidemiological and clinical factors to improve clinical awareness and timely response to therapeutic actions. Methods A systematic literature review was conducted in the PubMed database looking for English language European case reports of rat bite fever from 2000 to 2021. Results In 17 out of 20 selected cases, the condition of the index patient was identified as an infectious syndrome. Thanks to the almost omnisensitive susceptibility pattern of Streptobacillus moniliformis, timely antibiotic administration prevented an unfavorable outcome in all these cases. However, in the three remaining cases, the initial diagnoses were arthritis (on autoimmune basis and gout) and viral syndrome. Due to delayed antibiotic administration, one case suffered persistent harm, while the other two cases encountered prolonged illness. Conclusion and recommendations Rat bite fever is a diagnosis that can be easily missed from both a clinical and a microbiological point of view. As such, rat bite fever becomes part of the differential diagnosis whenever a patient presents with a fever syndrome after being in contact with rodents. In the case of persistent fever, blood culture sampling should be performed even in the absence of a systemic inflammatory response. A bacterial 16S ribosomal RNA PCR on blood or joint aspiration (cultures) is an even more sensitive diagnostic test. Since most transmissions occurred in a domestic setting, keeping rats as pets cannot be recommended.

Rat-bite fever is an over-looked, global zoonotic disease that has a mortality rate of up to 13%, if untreated. Historically, this rat-borne disease has been attributed to one of two causative agents, Streptobacillus moniliformis or Spirillum minus. Given the confirmed presence of multiple invasive Rattus host species, high rat densities in urban, informal human settlements and increasing reports of rat bites in South Africa, we undertook a retrospective assessment of Streptobacillus in rats sampled from 16 urban sites, in Gauteng, the smallest but most populous Province in South Africa. Using a multi-gene PCR-sequencing approach, we confirmed Streptobacillus presence in 50.9% of oral swabs from three rat species and the presence of two Streptobacillus species, viz. S. moniliformis and S. notomytis. The two members of the cryptic Rattus rattus species complex (R. rattus and R. tanezumi), which are morphologically indistinguishable from each other, had markedly different colonization rates. Whereas 48.6% of rats from this species complex were Streptobacillus-positive, only 32.3% of Rattus tanezumi were positive compared to 61.5% R. rattus. Rattus norvegicus had an intermediate prevalence of 55.6%. Phylogenetic analysis of four gene regions (16S rRNA, gyrB, groEL, recA) identified two discrete lineages; S. moniliformis occurred exclusively in R. norvegicus, and S. notomytis was restricted to the two members of the R. rattus species complex; this represents the first report of Streptobacillus in R. tanezumi. These results highlight a largely overlooked zoonotic threat posed by invasive rats and confirm the presence of two discrete and potentially host-specific Streptobacillus lineages in South Africa.

Rat-bite fever caused by Streptobacillus moniliformis is a rare infection that may be fatal. An adolescent male presented with multiorgan failure, negative blood cultures and Gram-negative rods in blood smear. S. moniliformis was identified by 16S ribosomal RNA gene sequencing from the blood. He developed systemic hyperinflammatory syndrome resembling hemophagocytic lymphohistiocytosis, for which immune-globulins and steroids were added to the antibiotic regimen and he rapidly recovered.

The reclassification of Streptobacillus hongkongensis as Pseudostreptobacillus hongkongensis gen. nov., comb. nov. is proposed because of the separate phylogenetic position on the basis of the 16S rRNA gene sequence phylogeny, the combined analysis of the three protein-coding housekeeping genes groEL, gyrB and recA and a core genome sequence phylogeny to all other Streptobacillus species that is supported by phenotypic differences. The species Pseudostreptobacillus hongkongensis is the type species of the genus. The type strain is HKU33T, JCM 18691T, NCTC 13659T, DSM 26322T.

Rat-bite fever (RBF) is characterized by fever, rash and arthritis, mainly caused by Streptobacillus moniliformis. We present a case of inflammatory erosive polyarthritis with sepsis caused by Streptobacillus notomytis, a novel species isolated from S. moniliformis. A 67-year-old man presented with fever, purpura and peripheral arthritis. After blood cultures were performed, loxoprofen administration was initiated. Arthritis partially improved, but left first metatarsophalangeal (MTP) arthritis persisted. A gram-negative rod was detected in the blood culture, and meropenem administration was started that improved arthritis. Ultrasonography and computed tomography revealed bone erosion in the left first MTP joint, leading to the diagnosis of septic arthritis. 16S rRNA gene sequence analysis revealed that this strain was S. notomytis. Further questioning revealed the patient may have had contact with rats. It is essential to consider Streptobacillus infection in the differential diagnosis of erosive polyarthritis.

Infectious diseases contribute to the vulnerable status of marine mammals, including respiratory illnesses. This study aimed to capture exhaled breath condensate (blow) for microbial identification from wild Indo-Pacific bottlenose dolphins Tursiops aduncus. Individual dolphins were sampled by holding a funnel connected to a 50 ml centrifuge tube over the blowhole of the animal near shore in Shark Bay (SB), Western Australia. Four individuals were sampled on 2 occasions along with seawater samples. Comparative blow and pool water samples were collected from 4 individual common bottlenose dolphins Tursiops truncatus housed in the National Aquarium (NA), Baltimore, Maryland, USA. Bacteria were identified using the V4 region of the 16S rRNA gene from extracted DNA. We identified bacteria independent of seawater in SB dolphins, which included the classes Alphaproteobacteria (26.1%) and Gammaproteobacteria (25.8%); the phyla Bacteroidetes (15.6%) and Fusobacteria (7.2%); and the genera Pseudomonas (11.5%), Pedomicrobium (4.5%), Streptobacillus (3.7%), Phenylobacterium (2.2%) and Sphingomonas (2.1%). There were broad similarities in phyla between SB and NA dolphins yet there were differences between lower taxonomic groups. A number of operational taxonomic units (OTUs) were shared between dolphin individuals, which may be a result of their genetic lineage (siblings or parentage), shared living and social interactions. A number of genera were observed in SB dolphins which have species known to be infectious in marine mammals such as Pseudomonas, Mycoplasma and Streptococcus. This study successfully characterised bacteria from DNA captured in blow from wild dolphins. The ability to capture these communities from individuals in the wild provides a novel health indicator.

Background Rat bite fever (RBF) is a rare systemic febrile illness transmitted by rats. Streptobacillus moniliformis is a pleomorphic Gram-negative bacillus which is the usual etiologic organism for rat bite fever in the United States. Case presentation Here we present a case of rat bite fever complicated by vertebral osteomyelitis and discitis. The patient revealed an exposure history of being bitten by pet rats. The patient’s symptoms dramatically improved with a six-week course of cephalexin therapy. Conclusions It is important to obtain a thorough zoonotic exposure history and maintain rat bite fever in the differential when considering potential causes of discitis and osteomyelitis.

Streptobacillus moniliformis is a pleomorphic, fastidious gram-negative bacillus that colonizes rodent respiratory tracts and causes rat-bite fever in humans. Rat-bite fever is associated with septic arthritis, usually monoarticular or pauciarticular. We report a rare case of polyarticular septic arthritis caused by S. moniliformis; the disease was initially misdiagnosed as inflammatory arthritis.

Rat bite fever and Haverhill fever are often difficult to diagnose in a clinical setting. This difficulty results in part from clinicians and laboratory professionals not being able to reliably recover the causative agent Streptobacillus moniliformis using culture-based methods. After utilizing an automated continuous-monitoring blood culture bottle system, we showed that the organism can be reliably cultured when a blood volume inoculum of 10 mL is used. Further, we showed that when the above recommendation is followed, sodium polyanethole sulfonate (up to a concentration of 0.05% w/v) in commercially purchased blood culture bottle formulations seems to be inactivated, allowing for the growth and detection of S. moniliformis. Herein, we offer data and methods used to overcome these clinical limitations. This is a comprehensive study of the historical collection of S. moniliformis isolates maintained by our facility and believed to be the largest of its kind to date.

The microbial communities living on and in vertebrate hosts have myriad effects on their hosts, potentially including fitness and speciation. Microbiomes are influenced by both intrinsic (from the host) and extrinsic (from the environment) factors, but the relative contributions of each are unknown for most non-model species. Abiotic environmental factors can influence the microbiome directly but it is less clear how abiotic gradients shape microbiome communities in the wild. Here, we captured eight wild Anna’s hummingbirds from three different elevations along their elevational distribution in California and moved them directly to a middle (“Within Range”) elevation. After some time at this elevation, the birds were moved in captivity to an “Above Range” elevation, and two birds were later moved back to the Within Range elevation. Fecal and food samples were collected longitudinally and the V4 region of the 16S rRNA gene analyzed. The most abundant phyla in all samples were Fusobacteria, Firmicutes, Actinobacteria, and Proteobacteria. Individual Bird ID explained the greatest amount of microbiome variation at 27.5%, signifying some amount of stability in the Anna’s hummingbird fecal microbiome. Sample elevation explained 19.6% (p = 0.001) of the variation using weighted UniFrac, but only 2.0% (p = 0.047) using unweighted UniFrac, implying a change in abundance of bacterial lineages in the microbiome but not in the presence or absence of the microbes. Additionally, Fusobacteria were 7.0x more abundant in the Above Range elevation samples while Firmicutes were 0.3x lower. A thorough understanding of how the environment can shape the microbiome may assist in conservation efforts and a general understanding of host-microbiome relationships in an era of rapid and global environmental change.

Rat-bite fever (RBF) is characterized by fever, rash and arthritis, mainly caused by

Fever in combination with a rash is a presentation regularly seen in medicine. The causes clinicians must consider include infections, medications, autoimmune diseases.A previously healthy young woman presented with a 3 to 4 day history of fever, headache and a maculopapular rash that also affected her palms. She was in a stable condition and was admitted for observation and further investigations without initiating antibiotic treatment. During the next two days her condition improved spontaneously, and her symptoms were initially interpreted as a viral infection. On day 3, blood cultures taken on the day of admission came back positive for Streptobacillus moniliformis, the causative agent of rat-bite fever. A more detailed patient history was taken, and the patient reported that she had several pet rats and one of them had given her some superficial scratches a few days before she fell ill.Rats and other rodents are often colonised by Streptobacillus moniliformis in their oropharynx. Many people keep such animals as pets, and it is important to be aware of this disease as a differential diagnosis when a patient presents with fever and rash. Untreated, the disease might have a fatal course and the treatment of choice, penicillin, is usually easily available.

To date, there is a lack of research into the vaginal and sperm microbiome and its bearing on artificial insemination (AI) success in the ovine species. Using hypervariable regions V3&ndash, V4 of the 16S rRNA, we describe, for the first time, the combined effect of the ovine microbiome of both females (50 ewes belonging to five herds) and males (five AI rams from an AI center) on AI outcome. Differences in microbiota abundance between pregnant and non-pregnant ewes and between ewes carrying progesterone-releasing intravaginal devices (PRID) with or without antibiotic were tested at different taxonomic levels. The antibiotic treatment applied with the PRID only altered Streptobacillus genus abundance, which was significantly lower in ewes carrying PRID with antibiotic. Mageebacillus, Histophilus, Actinobacilllus and Sneathia genera were significantly less abundant in pregnant ewes. In addition, these genera were more abundant in two farms with higher AI failure. Species of these genera such as Actinobacillus seminis and Histophilus somni have been associated with reproductive disorders in the ovine species. These genera were not present in the sperm samples of AI rams, but were found in the foreskin samples of rams belonging to herd 2 (with high AI failure rate) indicating that their presence in ewes&rsquo, vagina could be due to prior transmission by natural mating with rams reared in the herd.

BackgroundHeavy tobacco smoking, a hallmark feature of lung cancer, is drastically predominant in Middle Eastern populations. The precise links between nicotine dependence and the functional contribution of the oral microbiota remain unknown in these populations.MethodsWe evaluated the composition and functional capabilities of oral microbiota with relation to cigarette smoking in 105 adults through shotgun metagenomics using buccal swabs.ResultsThe oral microbiota composition in our study subjects was dominated by the phylaFirmicutes,Proteobacteria,Actinobacteria, andBacteroidetes, in addition to the generaPrevotellaandVeillonella,similar to previously described westernized cohorts. Furthermore, the smoker's oral microbiota represented a significant abundance ofVeillonella dispar,Leptotrichiaspp. andPrevotella pleuritidiswhen compared to non-smokers. Within the smoking groups, differential relative abundance testing unveiled relative abundance ofStreptobacillus hongkongensis,Fusobacterium massiliense,Prevotella biviain high nicotine dependent compared to low nicotine dependent profiles based on Fagerström Test for Nicotine Dependence. Functional profiling showed marked differences between smokers and non-smokers. Smokers exhibited an enrichment of Tricarballylate utilization and Lactate racemization when compared to the non-smokers. According to their nicotine dependence, enrichment of Xanthosine utilization, p-Aminobenzoyl-Glutamate utilization, and multidrug efflux pump inCampylobacter jejunibiosynthesis modules were detected in the high nicotine dependent group.ConclusionsThese compositional and functional differences may provide critical insight on how variations in the oral microbiota could predispose to respiratory illnesses and smoke cessation relapse in cigarette smokers. In particular, the observed enrichment ofFusobacteriumandPrevotellain the oral microbiota possibly suggests an intriguing linkage to gut and lung cancers.

Background Rat bite fever is a systemic febrile illness caused by infection with the Gram-negative bacillus Streptobacillus moniliformis following a bite, scratch, or contact with excrement. Only 26 cases of native valve endocarditis have been reported to date. We could find no other reports of severe Streptobacillus endocarditis requiring valve replacement in a young, pregnant patient. Case presentation A pregnant patient sought care for right leg pain, fevers, left upper quadrant pain, generalized weakness, fatigue, and inability to bear weight on her right leg. She had a syncopal episode 9 months earlier, resulting in a mandibular fracture and internal fixation hardware. Her pregnancy was complicated by hyperemesis and weight loss. Her pets included a rescued wild bird, a cat, and four rats. Her parents rescued stray cats, and she recalled multiple cat bites and scratches since childhood. She denied injection drug use. Ultrasound indicated a right popliteal artery thrombus. Transesophageal echocardiogram revealed a 2 cm × 0.7 cm vegetation. Angiography demonstrated multiple splenic infarcts and bilateral renal infarcts. She underwent mitral valve repair. The mitral valve Gram stain demonstrated 2+ Gram-negative rods, rare Gram-positive rods, and moderate white blood cells. Propionibacterium spp. was isolated from the mitral valve tissue on Columbia agar incubated anaerobically. Anaerobic and aerobic cultures of the valve tissue on all other broths and agars remained negative at 14 days. Hematoxylin and eosin stains showed a fibro-inflammatory vegetation. Aggregates of rod-shaped bacteria were identified on Warthin Starry/Steiner stain. Bartonella titers were positive for B. henselae IgG 1:256, IgM Streptobacillus sp. (genus level) and most closely related to Streptobacillus moniliformis. Conclusion This case demonstrates diagnostic and therapeutic challenges associated with a relatively uncommon cause of endocarditis. The diagnosis of rat bite fever was delayed due to symptoms of a concomitant pregnancy. Other confounders included possible alternative sources or co-infections with another zoonosis from multiple pets, and an odontogenic source due to presence of exposed jaw hardware.

The reclassification of

A 71-year-old man was admitted with confusion having been discovered on the floor of his unkempt home. Social services would later confirm that the home was infested by rats. An infection of unclear origin was suspected, and he was immediately started on broad spectrum antibiotics. He subsequently developed a swollen left knee. Two knee aspirates showed a raised white cell count but no microbiological or cytological diagnosis. Finally, samples sent for 16S rDNA PCR identified Streptobacillus monilliformis. Fastidious organisms and early treatment with antibiotics can limit microbiological diagnosis through standard laboratory analysis. Newer techniques such as sequence-based testing can overcome these limitations; however, they are not widely available and require the clinician to have a high index of suspicion. Crucially, the patient continued to be treated for his clinical sepsis despite initial laboratory results being negative and conflicting specialist opinions.

Objective: An insufficient mineralization (hypomineralization) in the teeth during the maturation stage of amelogenesis cause defects in 3–44% of children. Here, we describe for the first time the microbiota associated with these defects and compared it to healthy teeth within the same subjects. Methods: Supragingival dental plaque was sampled from healthy and affected teeth from 25 children with molar–incisor hypomineralization (MIH). Total DNA was extracted and the 16S rRNA gene was sequenced by Illumina sequencing in order to describe the bacterial composition. Results: We detected a higher bacterial diversity in MIH samples, suggesting better bacterial adhesion or higher number of niches in those surfaces. We found the genera Catonella, Fusobacterium, Campylobacter, Tannerella, Centipeda, Streptobacillus, Alloprevotella and Selenomonas associated with hypomineralized teeth, whereas Rothia and Lautropia were associated with healthy sites. Conclusion: The higher protein content of MIH-affected teeth could favour colonization by proteolytic microorganisms. The over-representation of bacteria associated with endodontic infections and periodontal pathologies suggests that, in addition to promote caries development, MIH could increase the risk of other oral diseases.

We herein report the case of a 61-year-old Japanese cirrhotic patient who developed rat bite fever (RBF) and whose first presentation was serious clinical features mimicking those of Henoch-Schönlein purpura (HSP). In addition to the critical clinical conditions, since the histopathology from purpuric skin eruptions was not inconsistent with that of HSP, therapy with prednisolone was promptly started in order to prevent his death. However, initial blood culture on admission yielded a small and slow-growing bacterial growth, which was gradually revealed by further subculture to be a peculiar bacterium, Streptobacillus moniliformis, leading to a definitive diagnosis of RBF. After the immediate cessation of prednisolone, the patient was treated with a more appropriate antibiotic and consequently made a full recovery. An immunocompromised condition with seriously decompensated liver cirrhosis together with moderately severe chronic kidney disease (CKD) in this patient probably exacerbated the severity of the disease.