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Secamilli EN, Drummond MR, Serrano JYM, Stelini RF, Cintra ML, Velho PENF. Is Bartonella sp. infection relevant in hematological malignancies in HIV-negative patients? A literature review. Leuk Res Rep 2023; 21:100402. [PMID: 38192503 PMCID: PMC10772291 DOI: 10.1016/j.lrr.2023.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/22/2023] [Accepted: 11/23/2023] [Indexed: 01/10/2024] Open
Abstract
Bartonelloses are diseases caused by Bartonella sp., transmitted to humans by blood sucking arthropod vectors. Clinical presentations include bacillary angiomatosis, cat scratch disease and atypical forms. We performed a review of cases of bartonelloses and hematological malignancies published in HIV-negative patients. Terms used were Bartonella or Bacillary Angiomatosis and Leukemia, Lymphoma, Multiple Myeloma, or Cancer. Fifteen cases met our criteria. Clinical presentations included bacillary angiomatosis, chronic fever, chronic lymphadenopathy, osteomyelitis, neuroretinitis, chronic anemia and hepatosplenic peliosis. Fourteen patients were asymptomatic after antibiotic therapy, and one died before antibiotic treatment. Clinicians should be suspicious of Bartonella sp. infections in immunocompromised patients.
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Affiliation(s)
- Elisa Nunes Secamilli
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marina Rovani Drummond
- Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Juliana Yumi Massuda Serrano
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Rafael Fantelli Stelini
- Department of Pathology, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Maria Leticia Cintra
- Department of Pathology, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
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2
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Fohle E, Smith BA, Guerrero DM. A Rare Case of Spontaneous Splenic Rupture Secondary to Tularemia Following a Cat Bite. Cureus 2021; 13:e13218. [PMID: 33717752 PMCID: PMC7945001 DOI: 10.7759/cureus.13218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 11/25/2022] Open
Abstract
Spontaneous splenic rupture is a rare but potentially life-threatening condition. More common infectious causes include infectious mononucleosis, cytomegalovirus (CMV), human immunodeficiency virus (HIV), and malaria. We present a case of a 42-year-old male who was admitted with persistent fevers, myalgia, and a recent ulcerative lesion on the base of his left thumb after a cat bite. He developed abdominal and back pains, left axillary lymphadenopathy, and near syncope. Abdominal computed tomography (CT) scan showed splenomegaly with subcapsular splenic rupture and large hematoma requiring emergent splenic embolization. Infectious work-up revealed tularemia as a cause which was successfully treated with oral doxycycline. Though not a common cat zoonoses, tularemia should be considered in a patient with splenomegaly or spontaneous splenic rupture in the setting of cat bite.
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Affiliation(s)
- Emmanuel Fohle
- Internal Medicine, University of North Dakota, Fargo, USA
- Internal Medicine, Sanford Health, Fargo, USA
| | - Bradley A Smith
- Internal Medicine, University of North Dakota, Fargo, USA
- Infectious Diseases, Sanford Health, Fargo, USA
| | - Dubert M Guerrero
- Internal Medicine, University of North Dakota, Fargo, USA
- Infectious Diseases, Sanford Health, Fargo, USA
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3
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Agarwal A, Joy D, Das P, Dash NR, Srivastava DN, Madhusudhan KS. Hemorrhage and Rupture of an Unusual Benign Liver Lesion in Pregnancy: A Case Report. J Clin Exp Hepatol 2021; 11:260-263. [PMID: 33746452 PMCID: PMC7953012 DOI: 10.1016/j.jceh.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022] Open
Abstract
Liver rupture in pregnancy is an acute condition with significant risk to the mother and fetus. It is known to occur with tumors such as hepatic adenoma, infective causes such as abscess, granulomatous diseases, and parasitic infections, and rarely spontaneously. Most of these conditions have overlapping clinicoradiological findings, almost always requiring histopathological confirmation. We report a case of a ruptured hepatic lesion, with an unusual diagnosis of Bartonella henselae infection causing cat-scratch disease, in a 24-year-old pregnant lady.
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Key Words
- ALFP, Acute liver failure in pregnancy
- CSD, Cat-scratch disease
- CT, Computed tomography
- FNH, Focal nodular hyperplasia
- HCC, Hepatocellular carcinoma
- HELLP, Hemolysis, elevated liver enzymes, and low platelet
- IFA, Immunofluorescent assay
- Ig-G, Immunoglobulin-G
- MRI, Magnetic resonance imaging
- PCR, Polymerase chain reaction
- USG, Ultrasonography
- cat-scratch disease
- hemorrhagic liver lesion
- liver rupture in pregnancy
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Affiliation(s)
- Ayushi Agarwal
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Danny Joy
- Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Prasenjit Das
- Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nihar R. Dash
- Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Deep N. Srivastava
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Kumble S. Madhusudhan
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
- Address for correspondence: Kumble S. Madhusudhan, Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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4
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Hepatosplenic bartonellosis in immunocompetent adults: a case series and literature review. Eur J Clin Microbiol Infect Dis 2020; 39:1789-1792. [PMID: 32306144 DOI: 10.1007/s10096-020-03906-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/07/2020] [Indexed: 10/23/2022]
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5
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Hyams C, Jenkins MH, Daly R, Heys IC, Maskell NA. Going with the flow: diagnosing a lymphocyte-rich pleural effusion. Thorax 2020; 75:354-356. [PMID: 32005757 DOI: 10.1136/thoraxjnl-2019-214293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Catherine Hyams
- Academic Respiratory Unit, Department of Clinical Sciences, University of Bristol, Bristol, UK
| | - Megan H Jenkins
- Department of Infectious Diseases, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Richard Daly
- Department of Histopathology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Izak C Heys
- Department of Infectious Diseases, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Nicholas A Maskell
- Academic Respiratory Unit, Department of Clinical Sciences, University of Bristol, Bristol, UK.,North Bristol Lung Centre, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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6
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Friedenberg SG, Balakrishnan N, Guillaumin J, Cooper ES, Lewis K, Russell DS, Breitschwerdt EB. Splenic vasculitis, thrombosis, and infarction in a febrile dog infected withBartonella henselae. J Vet Emerg Crit Care (San Antonio) 2015; 25:789-94. [DOI: 10.1111/vec.12367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 03/04/2014] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Steven G. Friedenberg
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Nandhakumar Balakrishnan
- the Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University; Raleigh NC 27607
| | - Julien Guillaumin
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Edward S. Cooper
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Kristin Lewis
- the Department of Veterinary Biosciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Duncan S. Russell
- the Department of Veterinary Biosciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Edward B. Breitschwerdt
- the Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University; Raleigh NC 27607
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García JC, Núñez MJ, Castro B, Fernández JM, Portillo A, Oteo JA. Hepatosplenic cat scratch disease in immunocompetent adults: report of 3 cases and review of the literature. Medicine (Baltimore) 2014; 93:267-279. [PMID: 25398062 PMCID: PMC4602414 DOI: 10.1097/md.0000000000000089] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cat-scratch disease (CSD) is the most frequent presentation of Bartonella henselae infection. It has a worldwide distribution and is associated with a previous history of scratch or bite from a cat or dog. CSD affects children and teenagers more often (80%) than adults, and it usually has a self-limiting clinical course. Atypical clinical course or systemic symptoms are described in 5%-20% of patients. Among them, hepatosplenic (HS) forms (abscess) have been described. The majority of published cases have affected children or immunosuppressed patients. Few cases of HS forms of CSD in immunocompetent adult hosts have been reported, and data about the management of this condition are scarce. Herein, we present 3 new cases of HS forms of CSD in immunocompetent adults and review 33 other cases retrieved from the literature. We propose an approach to clinical diagnosis and treatment with oral azithromycin.
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Affiliation(s)
- Juan C García
- Servicio de Medicina Interna (JCG, MJN), Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Galicia; Servicio de Medicina Interna (BC, JMF), Hospital Comarcal del Salnés, Vilagarcía de Arousa, Pontevedra, Galicia; Servicio de Medicina Interna (AL), Complejo Hospitalario Universitario de Ourense, Ourense, Galicia; Departamento de Enfermedades Infecciosas (AP, JAO), Hospital San Pedro-CIBIR, Logroño, La Rioja, Spain
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8
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Abstract
Spontaneous hemoperitoneum is a rare, but life-threatening condition usually caused by nontraumatic rupture of the liver, spleen, or abdominal vasculature with underlying pathology. Management revolves around angioembolization or surgical intervention. This article provides a brief overview of the diagnosis and treatment of this disorder.
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Affiliation(s)
- George Kasotakis
- Section of Trauma & Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, 840 Harrison Avenue, Dowling 2 South, #2414, Boston, MA 02118, USA.
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Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
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Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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10
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Rostad CA, McElroy AK, Hilinski JA, Thompson MP, Drew CP, Denison AM, Zaki SR, Mahle WT, Rogers J, Abramowsky CR, Shehata B. Bartonella henselae-mediated disease in solid organ transplant recipients: two pediatric cases and a literature review. Transpl Infect Dis 2012; 14:E71-81. [PMID: 22862881 DOI: 10.1111/j.1399-3062.2012.00774.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/15/2012] [Accepted: 03/19/2012] [Indexed: 01/27/2023]
Abstract
Bartonella henselae, the etiologic agent of cat-scratch disease, causes a well-defined, self-limited syndrome of fever and regional lymphadenopathy in immunocompetent hosts. In immunocompromised hosts, however, B. henselae can cause severe disseminated disease and pathologic vasoproliferation known as bacillary angiomatosis (BA) or bacillary peliosis. BA was first recognized in patients infected with human immunodeficiency virus. It has become more frequently recognized in solid organ transplant (SOT) recipients, but reports of pediatric cases remain rare. Our review of the literature revealed only one previously reported case of BA in a pediatric SOT recipient. We herein present 2 pediatric cases, one of which is the first reported case of BA in a pediatric cardiac transplant recipient, to our knowledge. In addition, we review and summarize the literature pertaining to all cases of B. henselae-mediated disease in SOT recipients.
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Affiliation(s)
- C A Rostad
- Department of Pediatrics, Emory University, Atlanta, Georgia 30322, USA
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11
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Varanat M, Maggi RG, Linder KE, Breitschwerdt EB. Molecular prevalence of Bartonella, Babesia, and hemotropic Mycoplasma sp. in dogs with splenic disease. J Vet Intern Med 2011; 25:1284-91. [PMID: 22092618 DOI: 10.1111/j.1939-1676.2011.00811.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/02/2011] [Accepted: 08/24/2011] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Among diseases that cause splenomegaly in dogs, lymphoid nodular hyperplasia (LNH), splenic hemangiosarcoma (HSA), and fibrohistiocytic nodules (FHN) are common diagnoses. The spleen plays an important role in the immunologic control or elimination of vector-transmitted, blood-borne pathogens, including Bartonella sp., Babesia sp., and hemotropic Mycoplasma sp. OBJECTIVE To compare the prevalence of Bartonella sp., Babesia sp., and hemotropic Mycoplasma sp. DNA in spleens from dogs with LNH, HSA, and FHN. MATERIALS AND METHODS Paraffin-embedded, surgically obtained biopsy tissues from LNH (N = 50), HSA (N = 50), and FHN (N = 37) were collected from the anatomic pathology archives. Spleens from specific pathogen-free (SPF) dogs (N = 8) were used as controls. Bartonella sp., Babesia sp., and Mycoplasma sp. DNA was amplified by PCR, followed by DNA sequencing. RESULTS Bartonella sp. DNA was more prevalent in FHN (29.7%) and HSA (26%) as compared to LNH (10%) (P = .019, .0373, respectively) or control spleens (0.0%). The prevalence of Babesia sp. and hemotropic Mycoplasma sp. DNA was significantly lower than Bartonella sp. DNA in HSA (P = .0005, .006, respectively) and FHN (P = .003, .0004, respectively). There was no statistically significant difference in DNA prevalence among the 3 genera in the LNH group. CONCLUSIONS The higher prevalence of Bartonella sp. in FHN and HSA warrants future investigations to determine if this bacterium plays a role in the development of these splenic diseases.
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Affiliation(s)
- M Varanat
- Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
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12
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Cherry NA, Liebisch G, Liebisch A, Breitschwerdt EB, Jones SL, Ulrich R, Allmers E, Wolf P, Hewicker-Trautwein M. Identification of Bartonella henselae in a horse from Germany. Vet Microbiol 2011; 150:414-5. [PMID: 21388754 DOI: 10.1016/j.vetmic.2011.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/10/2011] [Indexed: 11/17/2022]
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13
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Pachirat O, Kosoy M, Bai Y, Prathani S, Puapairoj A, Zeidner N, Peruski LF, Baggett H, Watt G, Maloney SA. The first reported case of Bartonella endocarditis in Thailand. Infect Dis Rep 2011; 3:e9. [PMID: 24470907 PMCID: PMC3892604 DOI: 10.4081/idr.2011.e9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/27/2011] [Accepted: 05/27/2011] [Indexed: 12/31/2022] Open
Abstract
Bartonella species have been shown to cause acute, undifferentiated fever in Thailand. A study to identify causes of endocarditis that were blood culture-negative using routine methods led to the first reported case in Thailand of Bartonella endocarditis A 57 year-old male with underlying rheumatic heart disease presented with severe congestive heart failure and suspected infective endocarditis. The patient underwent aortic and mitral valve replacement. Routine hospital blood cultures were negative but B. henselae was identified by serology, PCR, immunohistochemistry and specific culture techniques.
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Affiliation(s)
| | - Michael Kosoy
- Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado USA
| | - Ying Bai
- Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado USA
| | - Sompop Prathani
- Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Nordin Zeidner
- Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado USA
| | - Leonard F Peruski
- International Emerging Infections Program (IEIP), Thailand MOPH-US CDC Collaboration, GDD RegionalCenter, US CDC SE Asia Regional Office, Nonthaburi, Thailand
| | - Henry Baggett
- International Emerging Infections Program (IEIP), Thailand MOPH-US CDC Collaboration, GDD RegionalCenter, US CDC SE Asia Regional Office, Nonthaburi, Thailand
| | - George Watt
- International Emerging Infections Program (IEIP), Thailand MOPH-US CDC Collaboration, GDD RegionalCenter, US CDC SE Asia Regional Office, Nonthaburi, Thailand
| | - Susan A Maloney
- International Emerging Infections Program (IEIP), Thailand MOPH-US CDC Collaboration, GDD RegionalCenter, US CDC SE Asia Regional Office, Nonthaburi, Thailand
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14
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Systemic Bartonella henselae Infection in Immunocompetent Adult Presenting as Fever of Unknown Origin. Case Rep Med 2011; 2011:183937. [PMID: 21629850 PMCID: PMC3099194 DOI: 10.1155/2011/183937] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 03/07/2011] [Indexed: 12/01/2022] Open
Abstract
Systemic clinical presentations of infection caused by Bartonella henselae are rare in immunocompetent adults. We report four cases with hepatic and/or splenic involvement, presenting as fever of unknown origin. We discuss diagnosis and treatment of this infection.
Bartonella henselae serology allows an easy diagnosis of hepatosplenic involvement in cat scratch disease, a clinical picture that appears to be underrecognized.
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Schiffmann A, Pers YM, Lukas C, Combe B, Morel J. Mesenteric and splenic cat-scratch disease during etanercept therapy. Rheumatology (Oxford) 2009; 48:1461-2. [DOI: 10.1093/rheumatology/kep241] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Schmulewitz L, Moumile K, Patey-Mariaud de Serre N, Poirée S, Gouin E, Mechaï F, Cocard V, Mamzer-Bruneel MF, Abachin E, Berche P, Lortholary O, Lecuit M. Splenic rupture and malignant Mediterranean spotted fever. Emerg Infect Dis 2008; 14:995-7. [PMID: 18507929 PMCID: PMC2600289 DOI: 10.3201/eid1406.071295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Laura Schmulewitz
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Kaoutar Moumile
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Sylvain Poirée
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Frédéric Mechaï
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Véronique Cocard
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Eric Abachin
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Patrick Berche
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Paris, France
| | - Marc Lecuit
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Paris, France
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Babesiosis, Significance of Spleen Function Illustrated by Postsplenectomy Course in 3 Cases. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e31809fe523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Florin TA, Zaoutis TE, Zaoutis LB. Beyond cat scratch disease: widening spectrum of Bartonella henselae infection. Pediatrics 2008; 121:e1413-25. [PMID: 18443019 DOI: 10.1542/peds.2007-1897] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bartonella henselae was discovered a quarter of a century ago as the causative agent of cat scratch disease, a clinical entity described in the literature for more than half a century. As diagnostic techniques improve, our knowledge of the spectrum of clinical disease resulting from infection with Bartonella is expanding. This review summarizes current knowledge regarding the microbiology, clinical manifestations, diagnostic techniques, and treatment of B. henselae infection.
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Affiliation(s)
- Todd A Florin
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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19
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Kuwayama D, Briones R. Spontaneous Splenic Rupture Caused byBabesia microtiInfection. Clin Infect Dis 2008; 46:e92-5. [DOI: 10.1086/587175] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Ridder-Schröter R, Marx A, Beer M, Tappe D, Kreth HW, Girschick HJ. Abscess-forming lymphadenopathy and osteomyelitis in children with Bartonella henselae infection. J Med Microbiol 2008; 57:519-524. [DOI: 10.1099/jmm.0.47438-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bartonella henselae is the agent of cat-scratch disease (CSD), a chronic lymphadenopathy among children and adolescents. A systemic infection is very rare and most of these cases are found in patients with immunodeficiency. Here, cases involving four children of 6–12 years of age are reported. Three of the children had an abscess-forming lymphadenopathy and surrounding myositis in the clavicular region of the upper arm. The diagnosis was made serologically and, in one case, using eubacterial universal PCR. One child was treated with erythromycin for 10 days, the second received cefotaxime and flucloxacillin for 14 days and the third child was not treated with antibiotics. The fourth child had a different course: a significantly elevated signal intensity affecting the complete humerus was found in magnetic resonance imaging, consistent with osteomyelitis. A lymph node abscess was also found in the axilla. Diagnosis was established by indirect fluorescence assay and lymph node biopsy. Antibiotic therapy using clarithromycin, clindamycin and rifampicin was gradually successful. Immunodeficiency was excluded. All described lesions healed without residues. In immunocompetent patients, infection affects skin and draining lymph nodes; however, prolonged fever of unknown origin as in the fourth patient indicated a systemic complication of CSD.
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Affiliation(s)
| | - Aleander Marx
- Institute of Pathology, University of Würzburg, 97080 Würzburg, Germany
| | - Meinrad Beer
- Department of Radiology, Section of Pediatric Radiology, University of Würzburg, 97080 Würzburg, Germany
| | - Dennis Tappe
- Institute of Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany
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Eyzaguirre E, Haque AK. Application of immunohistochemistry to infections. Arch Pathol Lab Med 2008; 132:424-31. [PMID: 18318584 DOI: 10.5858/2008-132-424-aoiti] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Pathologists play an important role in the diagnosis or exclusion of infectious diseases. Traditionally, the diagnosis of infectious diseases rely on serologic assays and cultures. Serologic results may be difficult to interpret in the setting of immunosuppression, fresh tissue is not always available for culture, and culture of fastidious pathogens can be difficult and may take weeks or months to yield a result. Although some microorganisms or their cytopathic effects may be readily identifiable on routine and/or histochemical stains, often these changes are not specific or are sparse in the sample evaluated. In these cases, additional immunohistochemical stains are often needed to establish the diagnosis of infection. OBJECTIVE To review the current value and limitations of the use of immunohistochemistry in the diagnosis of infectious diseases in formalin-fixed tissue samples. DATA SOURCES Literature in Medline and the authors' own experience. CONCLUSIONS Immunohistochemistry has proven to be a useful tool in the diagnosis of infectious diseases in tissue samples. Immunohistochemistry is especially useful in the identification of microorganisms that are present in low numbers, stain poorly, are fastidious to grow, are noncultivable, or exhibit an atypical morphology. Finally, it is important to remember that there may be widespread occurrence of common antigens among bacteria and pathogenic fungi and both monoclonal and polyclonal antibodies must be tested for possible cross-reactivity with other organisms.
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Affiliation(s)
- Eduardo Eyzaguirre
- Division of Surgical Pathology, Department of Pathology, The University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77555-0588, USA.
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22
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Isolation and characterization of Bartonella bacilliformis from an expatriate Ecuadorian. J Clin Microbiol 2007; 46:627-37. [PMID: 18094131 DOI: 10.1128/jcm.01207-07] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Carrion's disease is typically biphasic with acute febrile illness characterized by bacteremia and severe hemolytic anemia (Oroya fever), followed by benign, chronic cutaneous lesions (verruga peruana). The causative agent, Bartonella bacilliformis, is endemic in specific regions of Peru and Ecuador. We describe atypical infection in an expatriate patient who presented with acute splenomegaly and anemia 3 years after visiting Ecuador. Initial serology and PCR of the patient's blood and serum were negative for Bartonella henselae, Bartonella quintana, and B. bacilliformis. Histology of splenic biopsy was suggestive of bacillary angiomatosis, but immunohistochemistry ruled out B. henselae and B. quintana. Bacilli (isolate EC-01) were subsequently cultured from the patient's blood and analyzed using multilocus sequence typing, protein gel electrophoresis with Western blotting, and an immunofluorescence assay (IFA) against a panel of sera from patients with Oroya fever in Peru. The EC-01 nucleotide sequences (gltA and internal transcribed spacer) and protein band banding pattern were most similar to a subset of B. bacilliformis isolates from the region of Caraz, Ancash, in Peru, where B. bacilliformis is endemic. By IFA, the patient's serum reacted strongly to two out of the three Peruvian B. bacilliformis isolates tested, and EC-01 antigen reacted with 13/20 Oroya fever sera. Bacilliary angiomatosis-like lesions were also detected in the spleen of the patient, who was inapparently infected with B. bacilliformis and who presumably acquired infection in a region of Ecuador where B. bacilliformis was not thought to be endemic. This study suggests that the range of B. bacilliformis may be expanding from areas of endemicity in Ecuador and that infection may present as atypical clinical disease.
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Lucey BC, Varghese JC, Anderson SW, Soto JA. Spontaneous hemoperitoneum: a bloody mess. Emerg Radiol 2007; 14:65-75. [PMID: 17342463 DOI: 10.1007/s10140-007-0594-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 02/16/2007] [Indexed: 01/13/2023]
Abstract
Spontaneous hemoperitoneum may be a life-threatening occurrence. It most frequently presents with acute abdominal pain. Computed tomography (CT) is the most commonly used modality in the initial work up of these patients, but sonography and magnetic resonance imaging (MRI) play a role in the diagnosis. The etiology is varied, yet may be broadly classified into gynecologic, hepatic, splenic, vascular, and coagulopathic causes. This review will describe the common imaging findings of spontaneous hemoperitoneum, as it presents through the emergency room, and will detail the underlying causes and significance of spontaneous hemoperitoneum.
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Affiliation(s)
- Brian C Lucey
- Department of Radiology, Boston VA Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA.
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Morales SC, Breitschwerdt EB, Washabau RJ, Matise I, Maggi RG, Duncan AW. Detection ofBartonella henselaeDNA in two dogs with pyogranulomatous lymphadenitis. J Am Vet Med Assoc 2007; 230:681-5. [PMID: 17331050 DOI: 10.2460/javma.230.5.681] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 1 dog evaluated because of inappetence and lameness of the left hind limb of 1 day's duration and 1 dog evaluated because of inappetence, fever, and lymphadenopathy of 2 weeks' duration. CLINICAL FINDINGS Histologic examination of excisional biopsy specimens from lymph nodes revealed pyogranulomatous lymphadenitis in both dogs. Quantitative real-time PCR assays detected Bartonella henselae DNA in blood samples and affected lymph node specimens from both dogs. Antibodies against B. henselae were not detected via immunofluorescent antibody testing during active disease in either dog. TREATMENT AND OUTCOME 1 dog recovered after 6 weeks of treatment with doxycycline (5 mg/kg [2.3 mg/lb], p.o., q 12 h), whereas the other dog recovered after receiving a combination of azithromycin (14.5 mg/kg [6.6 mg/lb], p.o., q 24 h for 21 days), doxycycline (17.3 mg/kg [7.9 mg/lb], p.o., q 24 h for 4 weeks), and immunosuppressive corticosteroid (prednisone [3 mg/kg {1.4 mg/lb}, p.o., q 24 h], tapered by decreasing the daily dose by 25% every 2 weeks) treatment. CLINICAL RELEVANCE B. henselae is implicated as a possible cause or a cofactor in the development of pyogranulomatous lymphadenitis in dogs. In dogs with pyogranulomatous lymphadenitis, immunofluorescent assays may not detect antibodies against B. henselae. Molecular testing, including PCR assay of affected tissues, may provide an alternative diagnostic method for detection of B. henselae DNA in pyogranulomatous lymph nodes.
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Affiliation(s)
- Sofia C Morales
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108, USA
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Abstract
Spontaneous hemoperitoneum is an uncommon cause of acute abdominal pain. When it occurs, it may be catastrophic. There are a myriad of causes for spontaneous hemoperitoneum and an underlying cause should always be looked for if the patient survives the initial event. This article describes the imaging findings of spontaneous hemoperitoneum and discusses the relative merits of multiple imaging modalities used for the diagnosis of the hemoperitoneum and an underlying cause. In addition, we outline the etiology of spontaneous hemoperitoneum, which includes hepatic, splenic, gynecologic, and vascular causes, and bleeding disorders.
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Affiliation(s)
- Brian C Lucey
- Division of Body Imaging, Department of Radiology, Boston University Medical Center, Boston, MA 02118, USA.
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Lin YY, Hsiao CH, Hsu YH, Lee CC, Tsai HJ, Pan MJ. Immunohistochemical Study of Lymph Nodes in Patients with Cat Scratch Disease. J Formos Med Assoc 2006; 105:911-7. [PMID: 17098692 DOI: 10.1016/s0929-6646(09)60176-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE Bartonella henselaeis the causative agent of cat scratch disease (CSD), manifesting as fever and acute regional lymphadenopathy. Although serologic testing is the reference method for diagnosis, successful use of immunohistochemical (IHC) stain of regional lymph nodes for the diagnosis of CSD has been reported. To determine the characterization and diagnostic potential of IHC in lymphadenopathy of CSD, lymph nodes were excised from patients with suspected CSD for further evaluation. METHODS Polyclonal antibody-based IHC studies were performed for the detection of B. henselae. Between January 2001 and December 2004, the reference laboratory of the Center for Disease Control, Taiwan, received a total of 377 sera from 352 reported suspected CSD cases. Twenty-three formalin-fixed paraffin-embedded lymph nodes from 16 patients and two skin biopsies from two patients suspected of having CSD were included in this study. Nine of them were serologically confirmed to have CSD and the others were seronegative but suspected to have CSD by the attending physicians. Seven lymph node specimens were obtained from tuberculosis patients for comparison. RESULTS We demonstrated that the microorganisms existed in the cytoplasm of histiocytes within the granulomatous lesions in nine lymph nodes and one skin biopsy. Among the nine lymph nodes with IHC (+) stains, three were seronegative. On the other hand, three cases were IHC (+) and six cases were IHC (-) among nine seronegative patients. In addition, two seronegative patients with skin biopsy showed one IHC (+) and one IHC (-). CONCLUSION IHC can contribute to the etiologic diagnosis of B. henselaelymphadenopathy when serology and molecular techniques are not available.
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Affiliation(s)
- Ying-You Lin
- Graduate Institute of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
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Massei F, Gori L, Macchia P, Maggiore G. The Expanded Spectrum of Bartonellosis in Children. Infect Dis Clin North Am 2005; 19:691-711. [PMID: 16102656 DOI: 10.1016/j.idc.2005.06.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bartonella spp cause various clinical syndromes immunocompetent and immunocompromised hosts. Domestic cats are the natural reservoir, and vectors of B henselae. B henselae infection usually occurs early in childhood, is generally asymptomatic, and in most cases revolves spontaneously. It may, however, produce a wide spectrum of clinical symptoms, the most frequent feature being cat-scratch disease. Disseminated atypical B. henselae infection may follow cat-scratch disease alter a symptom-free period or may present de novo mimicking a wide range of clinical disorders. A careful clinical history researching an intimate contact with a kitten associated with a specific serology and an abdominal ultrasound for typical hepatosplenic involvement may follow a rapid and accurate diagnosis.
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Affiliation(s)
- Francesco Massei
- Department of Procreative Medicine and Child Development, Division of Pediatrics, University of Pisa Hospital, Italy.
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