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Streptobacillary Rat Bite Fever (Table 27.9)

1. Streptobacillary rat bite fever is characterized by relapsing fevers, head and muscle aches, and vomiting, following a rat bite. A rash and joint pains often develop.

2. It is usually caused by Streptobacillus moniliformis, a highly pleomorphic Gram-negative rod that characteristically produces cell wall deficient variants called L-forms.

3. Those in rat-infested dwellings and those who handle laboratory rats are at greatest risk of contracting the disease.

Human Bites (Table 27.10)

1. Human bites, injuries from objects that have been in a person's mouth, and those from striking a person in the teeth often result in severe infections, with pain, massive swelling and foul-smelling pus.

2. The infections are usually caused by members of the normal mouth flora acting synergistically, including anaerobic streptococci, fusiforms, spirochetes, and Bacteroides sp., often with Staphylococcus aureus.

3. The crushing nature of bite wounds causes death of tissue and conditions suitable for growth of anaerobes; prompt cleansing and application of an antiseptic are advised.

27.5 Fungal Wound Infections

1. Fungal wound infections are unusual in economically developed countries, except for Candida albicans infections of burns and other wounds in individuals receiving antibacterial therapy.

2. Madura foot occurs in many impoverished areas of the world where people do not wear shoes.

"Rose Gardener's Disease" (Sporotrichosis) (Table 27.11)

1. Rose gardener's disease, also called sporotrichosis, is a chronic fungal disease mainly of people who work with wood or vegetation.

2. The usual case is characterized by painless ulcerating nodules that develop one after the other along the course of a lymphatic vessel. (Figure 27.16)

3. The causative organism is the dimorphic fungus, Sporothrix schenckii (Figure 27.17), usually introduced into wounds caused by thorns or splinters.

4. The fungus is distributed worldwide in tropical and temperate climates; people at risk include farmers, carpenters, gardeners, and greenhouse workers.

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