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Bite from toilet rat hospitalizes man in Canada
News
By Emily Cooke published 22 hours ago
Doctors believe the man was likely infected with bacteria in the rat's mouth.
In an unusual new medical case, a man in Canada was hospitalized with a severe bacterial infection after being bitten by a rat that was lurking in his toilet.
The 76-year-old visited the emergency department at a hospital in Montréal, Quebec, after encountering a rat in his toilet bowl. He was trying to remove the rodent when the critter bit two of his fingers. At the emergency department, doctors gave him basic wound care, as well as a tetanus booster.
However, about 18 days later, the man was back in the hospital having experienced fever, headaches and abdominal pain for several days. By this time, although his finger wounds had mostly healed, the man's blood pressure was low and his heart was beating very fast.
Initial blood tests showed that the patient's kidneys were damaged and that his blood had a low number of platelets — the fragments of cells that form clots to prevent or stop bleeding. Doctors admitted him to the intensive care unit (ICU) as he showed signs of multi-organ dysfunction and sepsis, a dangerous phenomenon in which an infection sends the immune system into overdrive.
To uncover the cause of the man's illness, doctors took and analyzed blood and urine samples. These revealed that he had an infectious disease called leptospirosis, according to a report of the case, published in January in the Canadian Medical Association Journal.
...
https://www.livescience.com/health/...te-from-toilet-rat-hospitalizes-man-in-canada
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Severe leptospirosis after a rat bite in an urban setting
Maxime Arbour, Marc Brosseau and Xavier Marchand-Senécal
CMAJ January 22, 2024 196 (2) E47-E50; DOI: https://doi.org/10.1503/cmaj.231218
KEY POINTS
...
The patient was admitted to the intensive care unit (ICU) for hypotension and multiorgan dysfunction secondary to sepsis of unclear origin. We initiated treatment with aggressive fluid resuscitation and intravenous piperacillin–tazobactam at 3.375 g every 6 hours. He did not require vasopressors as hypotension responded well to fluids. Oxygen saturation levels remained normal. Despite the favourable hemodynamic evolution, the acute kidney injury the patient had had on arrival deteriorated from a creatinine level of 162 μmol/L to 518 μmol/L. He did not meet any criteria for hemodialysis. He also developed severe thrombocytopenia (nadir 17 × 10[SUP]9[/SUP]/L). His liver enzyme levels remained normal.
Given the patient’s clinical presentation and history of rat bite, we suspected both leptospirosis and rat-bite fever. We collected and incubated blood culture bottles. We sent leptospirosis serologies and polymerase chain reaction (PCR) tests on urine to the National Microbiology Laboratory in Winnipeg, Manitoba.
Because of the patient’s accentuated thrombocytopenia and out-of-proportion acute kidney injury, he received steroids. He also received intravenous immunoglobulin (IVIG) in case there was an immune component to the severe thrombocytopenia.
The patient improved over the next few days, with normalization of creatinine level and platelet count, and was discharged from the ICU after 3 days. Steroid weaning began 3 days after treatment initiation. After 7 days of piperacillin–tazobactam, antibiotic treatment was completed with 500 mg oral amoxicillin administered 3 times daily for a total of 14 days.
Leptospirosis was later confirmed on multiple samples. A specific real-time PCR targeting the LipL32 gene was positive for Leptospira sp on the urine specimen. It was then confirmed as Leptospira interrogans through conventional PCR and sequencing. The negative blood culture bottles were sent out to Laboratoire de santé publique du Québec, where 16S rRNA PCR and sequencing identified Leptospira sp. Serology for Leptospira immunoglobulin M taken on day 2 of the patient’s hospital stay was negative. We did not perform serology on convalescent serum because a diagnosis had been confirmed, and the patient had received IVIG, which interferes with the test.
...
https://www.cmaj.ca/content/196/2/E47
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In French language:
Open Access
Cas grave de leptospirose après une morsure de rat en milieu urbain
Maxime Arbour, Marc Brosseau and Xavier Marchand-Senécal
CMAJ April 08, 2024 196 (13) E460-E464; DOI: https://doi.org/10.1503/cmaj.231218-f
...
https://www.cmaj.ca/content/196/13/E460
News
By Emily Cooke published 22 hours ago
Doctors believe the man was likely infected with bacteria in the rat's mouth.
In an unusual new medical case, a man in Canada was hospitalized with a severe bacterial infection after being bitten by a rat that was lurking in his toilet.
The 76-year-old visited the emergency department at a hospital in Montréal, Quebec, after encountering a rat in his toilet bowl. He was trying to remove the rodent when the critter bit two of his fingers. At the emergency department, doctors gave him basic wound care, as well as a tetanus booster.
However, about 18 days later, the man was back in the hospital having experienced fever, headaches and abdominal pain for several days. By this time, although his finger wounds had mostly healed, the man's blood pressure was low and his heart was beating very fast.
Initial blood tests showed that the patient's kidneys were damaged and that his blood had a low number of platelets — the fragments of cells that form clots to prevent or stop bleeding. Doctors admitted him to the intensive care unit (ICU) as he showed signs of multi-organ dysfunction and sepsis, a dangerous phenomenon in which an infection sends the immune system into overdrive.
To uncover the cause of the man's illness, doctors took and analyzed blood and urine samples. These revealed that he had an infectious disease called leptospirosis, according to a report of the case, published in January in the Canadian Medical Association Journal.
...
https://www.livescience.com/health/...te-from-toilet-rat-hospitalizes-man-in-canada
--------------------------------------
Severe leptospirosis after a rat bite in an urban setting
Maxime Arbour, Marc Brosseau and Xavier Marchand-Senécal
CMAJ January 22, 2024 196 (2) E47-E50; DOI: https://doi.org/10.1503/cmaj.231218
KEY POINTS
- Differential diagnosis of acute undifferentiated febrile illness after a rat bite includes leptospirosis (Leptospira interrogans) and rat-bite fever (Streptobacillus moniliformis or Spirillum minus).
- Diagnosis of leptospirosis can be difficult, as this pathogen cannot be isolated from conventional cultures, and other laboratory investigations are therefore necessary to confirm the diagnosis.
- While test results are pending, penicillins are the antibiotics of choice to treat severe leptospirosis and rat-bite fever, and corticosteroids might also be considered.
- Although antibiotic preventive therapy after a rat bite remains an unresolved issue, rat bites could warrant antibiotic prophylaxis because they regularly result in rat-bite fever, and they create puncture wounds that have a higher risk of infection.
...
The patient was admitted to the intensive care unit (ICU) for hypotension and multiorgan dysfunction secondary to sepsis of unclear origin. We initiated treatment with aggressive fluid resuscitation and intravenous piperacillin–tazobactam at 3.375 g every 6 hours. He did not require vasopressors as hypotension responded well to fluids. Oxygen saturation levels remained normal. Despite the favourable hemodynamic evolution, the acute kidney injury the patient had had on arrival deteriorated from a creatinine level of 162 μmol/L to 518 μmol/L. He did not meet any criteria for hemodialysis. He also developed severe thrombocytopenia (nadir 17 × 10[SUP]9[/SUP]/L). His liver enzyme levels remained normal.
Given the patient’s clinical presentation and history of rat bite, we suspected both leptospirosis and rat-bite fever. We collected and incubated blood culture bottles. We sent leptospirosis serologies and polymerase chain reaction (PCR) tests on urine to the National Microbiology Laboratory in Winnipeg, Manitoba.
Because of the patient’s accentuated thrombocytopenia and out-of-proportion acute kidney injury, he received steroids. He also received intravenous immunoglobulin (IVIG) in case there was an immune component to the severe thrombocytopenia.
The patient improved over the next few days, with normalization of creatinine level and platelet count, and was discharged from the ICU after 3 days. Steroid weaning began 3 days after treatment initiation. After 7 days of piperacillin–tazobactam, antibiotic treatment was completed with 500 mg oral amoxicillin administered 3 times daily for a total of 14 days.
Leptospirosis was later confirmed on multiple samples. A specific real-time PCR targeting the LipL32 gene was positive for Leptospira sp on the urine specimen. It was then confirmed as Leptospira interrogans through conventional PCR and sequencing. The negative blood culture bottles were sent out to Laboratoire de santé publique du Québec, where 16S rRNA PCR and sequencing identified Leptospira sp. Serology for Leptospira immunoglobulin M taken on day 2 of the patient’s hospital stay was negative. We did not perform serology on convalescent serum because a diagnosis had been confirmed, and the patient had received IVIG, which interferes with the test.
...
https://www.cmaj.ca/content/196/2/E47
--------------------------
In French language:
Open Access
Cas grave de leptospirose après une morsure de rat en milieu urbain
Maxime Arbour, Marc Brosseau and Xavier Marchand-Senécal
CMAJ April 08, 2024 196 (13) E460-E464; DOI: https://doi.org/10.1503/cmaj.231218-f
...
https://www.cmaj.ca/content/196/13/E460
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