title: A case of septic arthritis from rat-bite fever in Hawai'i.
abstract: BACKGROUND
  Infection associated with a rat bite has been known for centuries. Streptobacillus moniliformis is a zoonotic organism identified in the 20th century as the causative agent of most cases of rat bite fever outside of mainland Asia. There are no previously published cases of this pathogen in Hawai'i.
  
  
  METHODS
  The authors present a case of Streptobacillus moniliformis causing septic polyarthritis in a 59-year-old Hawaiian man with a history of alcohol abuse and recurrent exposure to rodents in his apartment. Blood cultures from the patient were negative. The organism was isolated after three days only in thioglycolate broth from a synovial fluid culture. 16S rRNA sequencing of extracted and purified DNA confirmed the organism as Streptobacillus moniliformis.
  
  
  CONCLUSIONS
  Diagnosis of infection from Streptobacillus moniliformis is difficult to make because of the fastidious nature of the organism's growth, as well as inhibitors present in standard blood culture bottles. The use of bacterial 16S rRNA sequencing may aid in an earlier diagnosis for this disease. More research is required to identify host and virulence risk factors for involvement of specific organ systems.
authors.affiliation: University of Hawai'i John A Burns School of Medicine, Honolulu, HI, USA. Jdworkin@hotmail.com
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dworkin
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bankowski
authors.forename: Stella M
authors.initials: SM
authors.lastname: Wenceslao
authors.forename: Royden
authors.initials: R
authors.lastname: Young
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D004269:DNA, Bacterial / Q000737:chemistry; D004275:DNA, Ribosomal / Q000737:chemistry; D004318:Doxycycline / Q000627:therapeutic use; D005839:Gentamicins / Q000627:therapeutic use; D006254:Hawaii; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D011906:Rat-Bite Fever / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D051381:Rats; D017422:Sequence Analysis, DNA; D013288:Streptobacillus / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D013582:Synovial Fluid / Q000382:microbiology; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D005839:Gentamicins; D010406:Penicillins; D012336:RNA, Ribosomal, 16S; D004318:Doxycycline
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