OUR FINAL DIAGNOSIS

Murine typhus or rat-bite fever

Murine Typhus

- The patient shows common symptoms like high fever, severe muscle pain (myalgia) and dull red rash, which are also seen in the people infected with murine typhus.

- Since the disease occurs commonly in elderly and the patient is 85 years old, it is highly possible that the patient contracted murine typhus.

- His house is infested with rodents and rats, and he has the habit of feeding stray dogs and cats. Thus these made him widely exposed to the bacteria, as the main transmitters of the disease are fleas, rats and stray cats.

- Murine typhus may result in mild kidney failure which causes excessive urination at night, which explains why his mattress was soiled with urine.

Rat-bite Fever

- The patient shows common symptoms such as moderate fever, chills, a diffuse red rash, which are also seen in the people infected with Rat-bite fever. [1]

- It is caused by a bacterium (S.Moniliformis) which is transmitted from rodent to human via the rodent's urine or mucous secretions. [1]

- It can also be caused by the scratches and bites by rats. This is highly possible as his house is infested with cockroaches and fleas as well as rats.

- It is mostly found in Asia like Singapore and Japan.

References:
http://en.wikipedia.org/wiki/Main_Page > Rat-bite_fever (1)