A Fatal Case of Rat-bite Fever due to Streptobacillus moniliformis *

In 1916 Blake' reported the first recorded fatal case of rat-bite fever shown to be due to Streptobacillus moniliformis. The organism isolated from the blood of this case was at that time called Streptothrix muris ratti after Schottmuller7 who had given this name in 1914 to a similar organism recovered repeatedly from the blood of a case of rat-bite fever. It has subsequently been identified with Streptobacillus moniliformis, described in 1925 by Levaditi, Nicolau, and Poincloux3 from a spontaneous human infection without rat bite, and with Haverhillia multiformis recovered by Parker and Hudson4 from cases of Haverhill fever (Erythema arthriticum epdemzicm), described by Place, Sutton, and Willner' in 1926 and further by Place and Sutton' in 1934. The former name, Streptobacillus moniliformis, is now generally accepted, although Brown and Nunemaker2 in a recent comprehensive review of rat-bite fever are inclined to accept the name Actinomzyces muris as suggested by Topley and Wilson.9 Relatively little is known concerning the pathological anatomy of infections caused by Streptobocillus moniliformis, since a fatal outcome is very unusual and has been recorded only twice" ' in cases following rat bite, not at all in Haverhill fever,5 and only once8 in an apparently spontaneous infection without history of rat bite caused by a pleomorphic streptobacillus. In Blake's' case of rat-bite fever, a woman of 67 who died on the sixteenth day of the disease, the principal findings at autopsy were acute ulcerative endocarditis with infarcts of spleen and kidney, subacute myocarditis, and subacute interstitial hepatitis and nephritis. The myocardium showed focal necrosis and disappearance of muscle fibers with interstitial infiltration by mononuclear