[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-406411-105":59,"doc-detail-406411-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","rat-bite-fever-presenting-as-localized-cellulitis-the-first-documented-presumptive-case-from-nepal-and-a-call-for-clinical-awareness","Rat bite fever presenting as localized cellulitis - The first documented presumptive case from Nepal and a call for clinical awareness","","Rat bite fever (RBF) is a rare but potentially fatal zoonotic infection caused by Streptobacillus moniliformis or Spirillum minus, often leading to atypical presentations that complicate diagnosis. This article reports a 35-year-old female from Far-Western Nepal who developed fever and progressive localized swelling of the right hand eight days after a rat bite, without rash, polyarthritis, or lymphadenopathy. Despite a negative blood culture, the case was diagnosed presumptively as S. minus RBF using epidemiological context, incubation timing, and clinical features. Treated with intravenous ampicillin, doxycycline, and timely surgical debridement, she fully recovered.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/rat-bite-fever-presenting-as-localized-cellulitis-the-first-documented-presumptive-case-from-nepal-and-a-call-for-clinical-awareness/406411/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/rat-bite-fever-presenting-as-localized-cellulitis-the-first-documented-presumptive-case-from-nepal-and-a-call-for-clinical-awareness/406411.png","ImageObject",300,407,{"name":92,"@type":93},"Cipher","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What organism causes rat bite fever and how does it typically present?","Question",{"text":113,"@type":114},"Rat bite fever is caused by Streptobacillus moniliformis or Spirillum minus. In Asia, Spirillum minus is often implicated and may show atypical features that hinder recognition.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why was the diagnosis considered despite a negative blood culture?",{"text":118,"@type":114},"Blood cultures were negative, but the presumptive diagnosis relied on epidemiological context, the incubation period after the rat bite, and the clinical presentation of localized swelling with fever.",{"name":120,"@type":111,"acceptedAnswer":121},"What treatment approach was used and what was the outcome?",{"text":122,"@type":114},"The patient received intravenous ampicillin and doxycycline, along with surgical wound debridement, followed by an oral antibiotic course and wound care instructions. She recovered fully with significant clinical improvement on follow-up.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},406411,1790766203,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":39,"preview_page_count":4},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","IDCases 43 (2026) e02440  \nContents lists available at ScienceDirect  \nIDCases  \njournal [homepage:](homepage: www.elsevier.com/locate/idcases)[ www.elsevier.com/locate/idcases](homepage: www.elsevier.com/locate/idcases)  \n| Case report\u003Cbr>Rat bite fever presenting as localized cellulitis: The first documented presumptive case from Nepal and a call for clinical awareness\u003Cbr>Suman Chaudharya,*, Shankar Adhikari b, Kaushal Sharmac\u003Cbr>a Department of Internal Medicine, Dhangadhi Sanjeevani Hospital, Dhangadhi, Kailali, Nepal b Department of Surgery, Dhangadhi Sanjeevani Hospital, Dhangadhi, Kailali, Nepal c Department of Emergency Medicine, Dhangadhi Sanjeevani Hospital, Dhangadhi, Kailali, Nepal |  |  |\n| --- | --- | --- |\n| A R T I C L E I N F O |  | A B S T R A C T |\n| Keywords:\u003Cbr>Cellulitis Diagnostic challenge Nepal\u003Cbr>Rat bite fever Spirillum minus Zoonotic infection |  | Background: Rat bite fever (RBF) is a rare but potentially fatal zoonotic disease caused by Streptobacillus moniliformis or Spirillum minus. In Asia, it is often caused by Spirillum minus and may present with atypical clinical features that complicate diagnosis.\u003Cbr>Case presentation: A 35-year-old female from Far-Western Nepal developed fever and progressive localized swelling of the right hand eight days after a rat bite. Classic systemic features like rash, polyarthritis, and lymphadenopathy were absent. Laboratory tests showed neutrophilia, thrombocytopenia, and elevated CRP, while blood culture was negative. Despite negative microbiological result, a presumptive diagnosis of S. minus RBF was made based on epidemiological context, incubation period, and clinical presentation. She was treated with a combination of intravenous ampicillin, doxycycline and surgical wound debridement. She completed a course of oral antibiotics and recovered fully.\u003Cbr>Conclusion: This case represents the first documented presumptive case of Spirillum minus RBF in Nepal, which presented atypically. It underscores the importance of clinical suspicion over microbiological confirmation in diagnosing RBF and emphasizes considering RBF in the differential diagnosis of febrile patients with cellulitis and a history of rodent exposure. Early initiation of empiric antibiotic therapy and timely surgical intervention can prevent serious complications. This case highlights RBF as an under-recognized zoonotic disease in Nepal and the need for greater clinical awareness and strengthened public health measures focused on rodent control. |\n\nIntroduction  \nRat bite fever (RBF) is an uncommon zoonotic infection caused by Streptobacillus moniliformis or Spirillum minus [1,2]. S. moniliformis is prevalent in the Americas and Europe, whereas S. minus, also known as Sodoku, is more common in Asia [3]. Transmission occurs primarily through rodent bites, scratches, or contact with rodent secretions [4].  \nAlthough the global incidence is low, untreated RBF can carry a mortality rate of up to 13 %[5]. The clinical features of S. minus infections differ from S. moniliformis in terms of incubation period, rash frequency, arthritis, and regional lymphadenopathy [3]. The diagnosis ofS. minus is challenging as the bacteria is fastidious, it cannot be grownon standard artificial media. Moreover, atypical presentations, particularly with only localized lesions, are often under-recognized, leading to delayed diagnosis [6].  \nIn Nepal, no cases have been formally reported in the medical  \nliterature, however, national news reports have highlighted suspected outbreaks, suggesting it is an emerging public health concern [7]. Wereport the first documented case of presumptive S. minus RBF from Nepal, which presented as localized cellulitis without systemic features such as rash, arthritis, or lymphadenopathy.  \nCase presentation  \nPatient Profile: A 35-year-old female farmer from Kailali District, Far-Western Nepal.  \nTimeline of Illness:  \nDay 0: Sustained a rat bite on the palmar aspect of the right hand while","cbCainrOHBOxKNni","https://ap.wps.com/l/cbCainrOHBOxKNni","pdf",758053,"English","# Background\n## Case presentation\n## Conclusion","[{\"question\":\"What organism causes rat bite fever and how does it typically present?\",\"answer\":\"Rat bite fever is caused by Streptobacillus moniliformis or Spirillum minus. In Asia, Spirillum minus is often implicated and may show atypical features that hinder recognition.\"},{\"question\":\"Why was the diagnosis considered despite a negative blood culture?\",\"answer\":\"Blood cultures were negative, but the presumptive diagnosis relied on epidemiological context, the incubation period after the rat bite, and the clinical presentation of localized swelling with fever.\"},{\"question\":\"What treatment approach was used and what was the outcome?\",\"answer\":\"The patient received intravenous ampicillin and doxycycline, along with surgical wound debridement, followed by an oral antibiotic course and wound care instructions. She recovered fully with significant clinical improvement on follow-up.\"}]","Rat bite fever presenting as localized cellulitis - The first documented presumptive case from Nepal and a call for clinical awareness | PDF",1790565530]