Bartonella (Rochalimaea) quintana causing fever and bacteremia in an immunocompromised patient with non-Hodgkin's lymphoma

A 48-yr-old man with stage IV non-Hodgkin's lymphoma, became neutropenic following chemotherapy and developed a fever. His blood cultures were processed to enhance the yield of fastidious bacteria. A slow-growing, capnophilic Gram-negative rod was isolated. The febrile episode was treated with cefotaxime, imipenem and vancomycin and resolved. The bacterial isolate was identified as Bartonella (Rochalimaea) quintana by 16S-rDNA gene sequencing. The isolate showed 99.8% sequence homology with the type strain. This is the first isolation of Bartonella (Rochalimaea) quintana from a bacteremic patient in Australia. This bacterium is a fastidious Gram-negative rod requiring prolonged culture for its isolation. Patients with culture-negative pyrexia, especially immunocompromised patients, may need to be investigated for infection with this agent.

Hansenula anomala infection after bone marrow transplantation

Hansenula anomala is a yeast which has seldom been reported as a human pathogen. A case of fungaemia with this organism is described in a 22-year-old patient with chronic myeloid leukaemia undergoing a second HLA-matched sibling transplant. A Hickman catheter was in situ and hyperalimentation commenced on day -1. Fever developed on day +10 and H. anomala was isolated from blood cultures. The patient was receiving cyclosporin and methotrexate as prophylaxis against graft-versus-host disease and was severely neutropenic. Treatment with amphotericin B was commenced and the patient's Hickman catheter was removed. Fever resolved and subsequent blood cultures were negative. Amphotericin was continued to a cumulative dose of 680 mg and oral fluconazole 400 mg/day was given for a further week. H. anomala infection has been reported in premature babies and in immunosuppressed individuals but has not been previously observed in patients undergoing bone marrow transplantation. Clinical features of previously reported cases of infection with H. anomala are reviewed.