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26-Year-Old Female with Rat Bite on Finger

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

A 26-year-old healthy doctoral candidate was doing research in the university laboratory when she was bitten on the finger by one of the rats she was handling. She comes to your office seeking guidance.

How would you treat this patient?

Choose one to reveal diagnosis and discussion

Prophylactic antibiotics to cover Pasteurella multocida & Capnocytophaga canimorsus
Prophylactic antibiotics to cover Streptobacillus moniliformis
Prophylactic antibiotics to cover Spirillum minus
Conservative wait & watch – symptoms usually occur 3-10 days after exposure
Give the patient a tetanus shot

Answer: Give a tetanus shot, then wait and watch

See the full case at Consultant360

In healthy individuals, it is acceptable to wait and watch for uncomplicated bites for up to 3 weeks before starting a penicillin-based antibiotic. Symptoms to look for include fever, vomiting, headache, muscle pain, joint pain, and rash. The organism to be covered is Streptobacillus moniliformis.

Differential Diagnosis: Spirillum minus organisms are seen in Asian rodent bites and Pasteurella multocida are seen with dog bites. Tetanus shots are recommended if not up to date.

Outcome of the case: The patient was given a penicillin-based antibiotic and had an uneventful complete recovery continuing her doctoral thesis work.
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