Most people acquire rat bite fever through contact with urine, oral (mouth) or conjunctival (eye or nose) secretions from an infected animal (usually rats, but rarely other animals such as squirrels, weasels and gerbils). This most commonly occurs via a bite, yet some cases may occur without an actual bite.

In rat bite fever due to Streptobacillus moniliformis, fever, chills, headache and muscle pain usually occur within 10 days of exposure, followed within 3 days by a diffuse rash primarily in the extremities. One or several large joints may become swollen, red and painful. If untreated, several complications including infection of the heart valves may occur.

In the form of rat-bite fever caused by Spirillum minus (Sodoku), a particular skin rash characterized by red or purple plaques is frequently seen, and the previously healed wound at the site of the bite may reactivate and open. Joint involvement is rare.

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