Rare case of rat bite fever

Nurses General Nursing


Man fights rare case of rat bite fever




Jeffrey Banks had trouble breathing. His heart raced. And he coughed up blood. When the 24-year-old walked into Santa Barbara Cottage Hospital's emergency room, physicians suspected pneumonia. It was something much worse. A scratch he said he got in mid-July while handling a rat cage at the pet store where he worked had turned life-threatening. Bacteria from the rodent's saliva had entered his bloodstream and had reached his heart, doctors say. One of his heart valves was destroyed, and he needed open-heart surgery to replace it. Also, a growth had formed on his heart.

Today, the Santa Barbara High School graduate lies heavily sedated at Cedars-Sinai Medical Center in Los Angeles, recovering from two open-heart surgeries to replace or repair his heart valves. He breathes through a ventilator and he's undergoing dialysis. His kidneys shut down a few days ago. He's in serious condition, according to a spokeswoman at Cedars-Sinai.

"This is incredibly unusual," said Dr. Stephen Hosea, the infectious disease specialist for Santa Barbara Cottage Hospital who helped treat Mr. Banks before he was transferred to Cedars-Sinai. "The majority of people who have a rat bite don't get an infection on the heart valve. The chances of this happening are incredibly small."

Rat bite fever is an infectious disease that is transmitted through saliva after a bite, or, on occasion, exposure to a substance contaminated by rats, according to the National Library of Medicine. About 10 percent of rat bites result in some form of rat bite fever, says the Web site of the Kirksville (Mo.) College of Osteopathic Medicine.

The bacteria is present in the saliva of all rats, but rat bite fever symptoms vary with each victim. Usually they include fever, chills, headache, muscle aches, weakness and sore throat. Symptoms usually subside within a week, but can reoccur over the next several months. Ultimately, the symptoms disappear. But in Mr. Banks' case, the bacteria found its way to his heart, severely complicating matters. Doctors don't know why.

Physicians performed the first open-heart surgery July 28 at Cottage Hospital. They replaced one of his four heart valves with an artificial valve and drained an abscess, a collection of pus, from his heart. He was recovering and released from the hospital on Aug. 4. But a day later he was back again. He had a fever and was coughing up blood.

He stayed at Cottage for three days before he was transferred by helicopter to Cedars-Sinai. Surgeons there removed the artificial valve that Cottage Hospital surgeons had installed and replaced it with a tissue valve.hey also repaired a second valve that had been damaged by the bacteria. Mr. Banks' family is hoping the bacteria doesn't return and cause further problems. For now, Mr. Banks is in an induced coma-like state because he is heavily sedated.

On Monday he slept with a chilled blanket to lower his temperature, which has been as high as 104 degrees in recent days. How this could happen to an energetic, health-conscious young man is something his family and friends are still trying to understand. Mr. Banks was in good shape and often rode his bicycle from his home in downtown Santa Barbara to the Montecito Pet Shop, where he worked for the last few months.

A manager at the shop refused to comment.

Mr. Banks' family said he was enjoying one of the happiest periods of his life before he got sick. "He really liked the pet store," his mother, Valerie Banks, said from her hotel near Cedars-Sinai. "I think he just really liked being around animals."

Since high school, Mr. Banks worked several different jobs, including Cantwell's Market, a couple of coffee shops and the family catering business. Occasionally, he played guitar in a band with friends.

At Santa Barbara High School, he was a photographer for the school newspaper. His mother said her son was interested in photography, art and drawing.

She remembered how, one Christmas, her son painted a picture of a star with a moon and the sun on a piece of cardboard and gave it to her as a gift because he was low on cash that year.

Seeing her youngest son endure this situation has been difficult.

"I couldn't believe that a 24-year-old would have heart problems," Valerie Banks said. "He's never had a heart problem."

His brother, Jason Banks, said the family is optimistic that Jeffrey will recover. "We are just taking it in stride," he said. "Day by day. Just as long as he gets a little better every single day."

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