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An 8 year old boy comes in with 2 days of fever, chills, myalgias, headache, and a few episodes of non-bloody, non-bilious vomiting. He also has a faint maculopapular rash beginning on his legs. It is influenza season. He has no past medical history. He was bitten 4 days ago by the class pet rat that the teacher bought from a commercial pet store the week before. He went hiking 3 days ago and to Disneyland 2 days ago. He has no drug allergies and takes no medications.
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January 23, 2020 at 10:59 am
C) Penicillin
Rat bite fever is caused by streptobacillus moniliformis or minus, and presents with sudden onset fever, chills, myalgias, vomiting, headache, followed by a maculopapular or petechial rash predominantly on extremities including palms and soles, and polyarthritis in 50%. It is transmitted by bites or scratches exposed to oral secretions from infected rats. The incubation period is usually less than 7 days, but can be up to 3 weeks. There have been reports of infected rats sold by commercial pet stores. Due to the high case fatality rate of 7-13%, prophylactic penicillin should be considered for even asymptomatic patients who have been bitten by a rat. Symptomatic patients should receive IM or IV penicillin for 7-10 days.