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CASE REPORT
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 51-53

Rat bite in the neonate: A case report and review of literature


1 Department of General Surgery, R G Kar Medical College, Kolkata, West Bengal, India
2 Department of Pediatric Medicine, R G Kar Medical College, Kolkata, West Bengal, India
3 Department of Pediatric Surgery, R G Kar Medical College, Kolkata, West Bengal, India

Date of Submission05-Jan-2022
Date of Acceptance02-Feb-2022
Date of Web Publication02-Sep-2022

Correspondence Address:
Dr. Pankaj Kumar Halder
Saroda Palli, Panchanon Tala, Baruipur, Kolkata - 700 144, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjmsr.mjmsr_1_22

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  Abstract 


Animal (dog, cat, and rodent) bite injuries in neonates are common in developing countries, especially when the mother leaves the baby at the side of the field in which she is working. A wide spectrum of rat-bite injuries is described in the literature. Disease following the bite of a rat has been known for many years and has been described as rat-bite fever. We report a case of a 17-day-old female neonate who presented with a severe rat-bite injury to the face, with consequent problems in management.

Keywords: Bite, fever, infection, injury, rat, shock


How to cite this article:
Shaikh A, Guhathakurata P, Chakraborty P, Halder PK. Rat bite in the neonate: A case report and review of literature. Muller J Med Sci Res 2022;13:51-3

How to cite this URL:
Shaikh A, Guhathakurata P, Chakraborty P, Halder PK. Rat bite in the neonate: A case report and review of literature. Muller J Med Sci Res [serial online] 2022 [cited 2022 Sep 29];13:51-3. Available from: https://www.mjmsr.net/text.asp?2022/13/1/51/355288




  Introduction Top


The exact incidence of animal bite is not obtained from the literature as all victims do not seek medical advice following an animal bite. Rat bites are mostly associated with poor living conditions in developing countries.[1] Sometimes, child neglect due to underlying social constraints makes a favorable condition for animal bites. The wild and domestic rat bite may have a variety of bite-related health consequences. However, an accurate understanding of bite-related infection risk is missing in the literature and thus, it is difficult for health professionals to evaluate the adequacy of existing guidelines for empirical therapy. The management recommends an immediate first aid and definitive wound debridement depending on the severity of the injury. Prophylactic antibiotics and rabies prophylaxis are not routinely advocated but tetanus prophylaxis is mandatory following a rat bite.[2] Here, we report a unique case of rat bite in the face without fever in a female newborn who was managed successfully in our institute.


  Case Report Top


A 17-day-old female neonate was brought to the emergency with a facial wound over the right cheek. She was a term and one of the twins being delivered by cesarean section, with a birth weight of 1.480 kg. Pregnancy and delivery were uncomplicated. The neonate was previously healthy and fully vaccinated to date. About 30 min prior to the incident, she was breastfed, wrapped in a shawl, and put in a zipped-up net that was placed on a bed on the floor. She was kept alone in the room while her mother was attending to the other twin in a separate room. The baby was brought to the emergency immediately after the incident by her father and grandmother with lacerated injuries over the right cheek. It was not actively bleeding. Later, she developed active convulsion. She was hemodynamically unstable with heart rate-188 beats/min and respiratory rate-78/min and prolonged capillary refill time. Pallor was present; hence, packed red blood cell was transfused in addition to intravenous (IV) bolus, followed by maintenance IV fluid along with dopamine (@10 mcg/kg/min). Injection tetanus toxoid was given. The anti-rabies vaccine was started as per schedule (zero doses given on admission). Investigations showed a Hb of 15.6 g% with a packed cell volume of 45%, white blood cell of 15,300, platelet of 282000 (N 70% L 25%), capillary blood glucose of 121 mg/dl, an axillary temperature of 101° F, and oxygen saturation of 94% room air. Other serum parameters were within normal limits. Antibiotic was started in the form of meropenem and linezolid according to the body weight. Fresh frozen plasma was transfused (22 ml over 45 min) in 2 consecutive days.

Description of wound and management

A lacerated wound over the right cheek with irregular margins, which became 3 cm in length ×1 cm in largest width ×0.8 depth approximately after freshening the wound margin. Multiple abrasions (2–3 mm each) were also noted around the major wound. Underlying subcutaneous tissue, facial muscles, and blood vessels were visible (one pulsatile artery noted which was secured with muscle apposition). No other major wound was noted elsewhere in the body. The wound was cleansed, margin freshened and primary closure was done with 6–0 Vicryl [Figure 1]. Stitches were removed on the 6th postoperative day. The child was eventually managed with fluids, antibiotics, and inotrope support in neonatal intensive care unit and was kept in observation for about 20 days. Meropenem and linezolid were continued for 14 days. No further convulsion was noted. Anti-rabies vaccines schedule: day 0, day 3, day 7, day 14, and day 28. She had an uneventful recovery following surgery and had no further complications. Gradually, breastfeeding was started. Neuromedicine consultation was also taken which ruled out any neurological complications.
Figure 1: Intra-operative pictures of surgical management of rat-bite wound over the right cheek in a 17- day old female neonate

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  Discussion Top


Most animal bites are caused by domestic dogs and cats. House rat bite is infrequently reported in the literature and mostly from developing countries. The majority of the victims are females and <5 years of age. Maximum bites are inflicted on the face and hands and occur between midnight and early morning.[3] Most of the wounds are usually wedged, clean, and without subcutaneous bleeding. Our baby had a lacerated and infected wound requiring debridement and stitching. A wide spectrum of injuries is described that includes lacerations, multiple bites, strangling marks on the throat, bruises, bleeding, avulsion of the scalp, and shock.[4]

Streptobacillus moniliformis and Spirillum minus, transmitted by either rat bites or after ingestion of sullied substance or water, may cause a rare bacterial zoonotic disease which is portrayed by fever, arthralgia, and skin rash.[5] In a typical case of rat-bite fever (RBF), symptoms begin approximately 3 days to 3 weeks sustaining a rodent bite. It is generally assumed that rats are the natural host and asymptomatic carriers of S. moniliformis. Besides, S. minus has been isolated from the oropharynx, blood, and exudate from infected eyes of up to 25% of wild rats.[6] Diagnosis of the RBF is difficult because the disease is uncommon and can be confused with Rocky Mountain spotted fever or (less commonly) meningococcemia. Living or spending time in areas of rodent infestations has become a greater risk, especially for a child <5 years living in poverty. Store workers and laboratory technicians working with rats are also at high risk.[7] Dustbin, gutters, garbage bins, and railway platforms are frequently used as dumping grounds for deserting unwanted newborns, especially females. In our case, the injury was unusual. The neonate had a very big, atypical wound over her face. Penicillin is the drug of choice for both forms of rat-bite fever. Doxycycline, gentamicin, or streptomycin represent effective alternatives for penicillin-allergic patients.[8]


  Conclusion Top


Child abuse and neglect, though common in India are rarely highlighted due to underlying social constraints. Low socioeconomic status, poor hygiene, and a rat-infested environment are the social risk factors contributing to the fatal outcome of these attacks. Preventive measures by all strata in society and health education are required to improve the outcome of rat bites. It is significantly important to acknowledge and be aware of the diagnosis in any case of rat bite when classical symptoms such as fever or rash are missing.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Skarentzos K Sr., Papadopulos N, Deftereos SP, Thomaidis S, Kambouri K. Serious rodent bites to an 8-month-old infant due to child neglect. Cureus 2021;13:e18493.  Back to cited text no. 1
    
2.
Sethi SK, Saha A, Karela M, Dubey NK. Infantile trauma due to a rat bite. J Emerg Trauma Shock 2011;4:409-10.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kothari PR, Sarda D, Kumar R. Rat Bite. Bombay Hosp J 2008;50:505-6.  Back to cited text no. 3
    
4.
Elliott SP. Rat bite fever and Streptobacillus moniliformis. Clin Microbiol Rev 2007;20:13-22.  Back to cited text no. 4
    
5.
Hayakawa Y, Suzuki J, Suzuki M, Sugiura W, Ohkusu K. A case study of rat bite fever caused by Streptobacillus moniliformis. Jpn J Infect Dis 2017;70:323-5.  Back to cited text no. 5
    
6.
Kowalik-Mikolajewska B, Aniszewska M, Pluta M, Marczynska M. Fever in an 8-month-old infant following a rat bite. Pediat Therapeut 2015;5:250-2.  Back to cited text no. 6
    
7.
Walker JW, Reyes LB. Rat bite fever: A case report and review of the literature. Pediatr Emerg Care 2019;35:e28-9.  Back to cited text no. 7
    
8.
Donoso A, León J, Rojas G, Ramírez M, Oberpaur B. Hypovolaemic shock by rat bites. A paradigmatic case of social deprivation. Emerg Med J 2004;21:640-1.  Back to cited text no. 8
    


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