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Beydon M, Rodriguez C, Karras A, Cez A, Rafat C, Jourde-Chiche N, Fain O, Philipponnet C, Puéchal X, Dossier A, Dupin N, Levy D, Aureau I, Guillevin L, Terrier B. Bartonella and Coxiella infections presenting as systemic vasculitis: case series and review of literature. Rheumatology (Oxford) 2021; 61:2609-2618. [PMID: 34500468 DOI: 10.1093/rheumatology/keab691] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Coxiella and Bartonella sp. display particular tropism for endothelial or endocardial tissues and an abnormal host response to infections with induced autoimmunity. We aimed, through a case series combined with a comprehensive literature review, to outline characteristics of Coxiella and Bartonella infections presenting as systemic vasculitis. METHODS We retrospectively included cases of definite Coxiella and Bartonella infections presenting with vasculitis features and performed a comprehensive literature review. RESULTS Six cases of Bartonella infections were added to 18 cases from literature review. Causative pathogens were mainly B. henselae. Bartonella infection mimicked anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis in 83% with PR3-ANCA and presented as cryoglobulinemic vasculitis in 8%. Glomerulonephritis was present in 92%, and 88% had endocarditis. Complement fractions were low in 82% and rheumatoid factor positive in 85%. Kidney biopsies showed cell proliferation, mostly crescentic, with pauci-immune glomerulonephritis in 29%. Outcome was favorable, with the use of antibiotics alone in one third. Five cases of Coxiella infections were added to 16 from literature review. Sixteen had small-vessel vasculitides, mainly cryoglobulinemia vasculitis in 75%. One patient had polyarteritis nodosa-like vasculitis and four large-vessel vasculitis. Outcome was good except for one death. A highly sensitive next generation sequencing analysis on 3 Coxiella and 2 Bartonella-related vasculitides biopsies did not find any bacterial DNA. CONCLUSION Coxiella and Bartonella are both able to induce vasculitis but display distinct vasculitis features. Bartonella mimics PR3-ANCA-associated vasculitis in the setting of endocarditis, whereas Coxiella may induce vasculitis involving all vessel sizes.
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Affiliation(s)
- Maxime Beydon
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Rodriguez
- Departement de Virologie, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Alexandre Karras
- Unité de Néphrologie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, F-75006, France
| | - Alexandre Cez
- Service de néphrologie et dialyse, Hôpital Tenon (AP-HP), Paris, France
| | - Cédric Rafat
- Service des urgences Néphrologiques et Transplantation rénale, Assistance Publique-Hôpital de Paris, Paris, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Centre de Néphrologie et de Transplantation Rénale, Hôpital de la Conception AP-HM, Marseille, France
| | - Olivier Fain
- Département de Médecine interne, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carole Philipponnet
- Département de néphrologie et de dialyse CHU Clermont Ferrand, Clermont Ferrand, France
| | - Xavier Puéchal
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Service de médecine interne, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Dupin
- Département de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dan Levy
- Service de rhumatologie, CHU Strasbourg, Strasbourg, France
| | - Inès Aureau
- Service de médecine interne, Centre Hospitalier de Pau, Pau, France
| | - Loïc Guillevin
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Terrier
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, F-75006, France
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Lantos PM, Maggi RG, Ferguson B, Varkey J, Park LP, Breitschwerdt EB, Woods CW. Detection of Bartonella species in the blood of veterinarians and veterinary technicians: a newly recognized occupational hazard? Vector Borne Zoonotic Dis 2015; 14:563-70. [PMID: 25072986 DOI: 10.1089/vbz.2013.1512] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bartonella species are important emerging pathogens in human and veterinary medicine. In the context of their daily activities, veterinary professionals have frequent animal contact and arthropod exposures. Detection of Bartonella spp. using traditional culture methods has been limited by poor sensitivity, making it difficult to determine the prevalence of infection in this population. We have developed a detection method combining enrichment culture and molecular amplification, which increases testing sensitivity. METHODS We performed a cross-sectional study to determine the prevalence of detectable Bartonella spp. in the blood of veterinary personnel and nonveterinary control subjects. Bartonella was detected by enrichment blood culture with conventional PCR followed by DNA sequencing. RESULTS were correlated with epidemiological variables and symptoms. RESULTS We detected DNA from at least one Bartonella species in 32 (28%) of the 114 veterinary subjects. After DNA sequencing, the Bartonella species could be determined for 27 of the 32 infected subjects, including B. henselae in 15 (56%), B. vinsonii subsp. berkhoffii in seven (26%), B. koehlerae in six (22%), and a B. volans-like sequence in one (4%). Seventy percent of Bartonella-positive subjects described headache compared with 40% of uninfected veterinarians (p=0.009). Irritability was also reported more commonly by infected subjects (68% vs. 43%, p=0.04). CONCLUSIONS Our study supports an emerging body of evidence that cryptic Bartonella bloodstream infection may be more frequent in humans than previously recognized and may induce symptoms. Longitudinal studies are needed to determine the natural course and clinical features of Bartonella infection.
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Affiliation(s)
- Paul M Lantos
- 1 Departments of Internal Medicine and Pediatrics, Duke University School of Medicine , Durham, North Carolina
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Chaudhry A, Chaudhry M, Papadimitriou J, Drachenberg C. Bartonella henselaeinfection-associated vasculitis and crescentic glomerulonephritis leading to renal allograft loss. Transpl Infect Dis 2015; 17:411-7. [DOI: 10.1111/tid.12376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/14/2015] [Accepted: 02/16/2015] [Indexed: 01/28/2023]
Affiliation(s)
- A.R. Chaudhry
- Department of General Surgery; Sinai Hospital of Baltimore; Baltimore Maryland USA
| | - M.R. Chaudhry
- Department of Pathology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - J.C. Papadimitriou
- Department of Pathology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - C.B. Drachenberg
- Department of Pathology; University of Maryland School of Medicine; Baltimore Maryland USA
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Abstract
PURPOSE OF REVIEW In recent years, many investigators have focused on potential associations between infections and vascular inflammation. We review the principal pathogenic mechanisms that have been implicated for possible roles in the vascular inflammation initiated by infectious agents. We also summarize the most important literature related to this topic. RECENT FINDINGS A novel theory known as autoantigen complementarity suggests that an infectious agent could trigger antineutrophil cytoplasmic antibody-associated vasculitis. Several recent studies investigating the presence of parvovirus B19 and herpesviruses in temporal arteries with giant cell arteritis have yielded contradictory results. A recent study has identified higher frequency of a novel human virus, the 'New Haven coronavirus', in respiratory secretions of children with Kawasaki disease. Many case reports have suggested potential relationships between human pathogens and vasculitis. SUMMARY There remains considerable interest in the possibilities of primary vasculitic syndromes caused in some fashion by infection. With the exception of a few well sustained associations - for example hepatitis B or C with known vasculitic syndromes - most of the purported links between microbial agents and primary vasculitides remain speculative.
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Affiliation(s)
- Alicia Rodríguez-Pla
- Division of Molecular and Clinical Rheumatology, The Johns Hopkins School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
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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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Robinson JL, Spady DW, Prasad E, McColl D, Artsob H. Bartonella seropositivity in children with Henoch-Schonlein purpura. BMC Infect Dis 2005; 5:21. [PMID: 15807903 PMCID: PMC1274276 DOI: 10.1186/1471-2334-5-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Accepted: 04/05/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An association between Henoch-Schonlein purpura (HSP) and seropositivity for Bartonella henselae (BH) has been described. The objective of this study was to see if such an association exists in northern Alberta. METHODS Immunofluorescent antibody testing utilizing an antigen prepared from B. henselae was undertaken on sera from six children with current HSP, 22 children with remote HSP, and 28 controls that were matched for age. Blood from the six children with current HSP was analysed by polymerase chain reaction (PCR) assay with primers derived from the citrate synthase (gltA) gene for the detection of Bartonella DNA. RESULTS The seropositivity rate for BH was 61% in cases versus 21% in controls (p < 0.03). The PCR assay was negative in all six current cases. CONCLUSION There is an increased seropositivity rate for BH in children with HSP. However, it is not clear if infection with B. henselae or a related Bartonella species can result in HSP, or if the increased seropositivity is from non-specific or cross-reacting antibodies.
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Affiliation(s)
- Joan L Robinson
- Department of Pediatrics and Stollery Children's Hospital, University of Alberta, Edmonton AB, Canada
| | - Donald W Spady
- Department of Pediatrics and Stollery Children's Hospital, University of Alberta, Edmonton AB, Canada
| | - Errol Prasad
- Dynacare Kasper Medical Laboratories, Edmonton, AB, Canada
| | - Dorothy McColl
- Bacterial and Rickettsial Zoonosis Section, National Microbiology Laboratory, Canadian Science Centre for Human and Animal Health, Winnipeg, MB, Canada
| | - Harvey Artsob
- Bacterial and Rickettsial Zoonosis Section, National Microbiology Laboratory, Canadian Science Centre for Human and Animal Health, Winnipeg, MB, Canada
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Chomel BB, Boulouis HJ, Breitschwerdt EB. Cat scratch disease and other zoonotic Bartonella infections. J Am Vet Med Assoc 2004; 224:1270-9. [PMID: 15112775 DOI: 10.2460/javma.2004.224.1270] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bruno B Chomel
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Breitschwerdt EB, Blann KR, Stebbins ME, Muñana KR, Davidson MG, Jackson HA, Willard MD. Clinicopathological Abnormalities and Treatment Response in 24 Dogs Seroreactive to Bartonella vinsonii (berkhoffii) Antigens. J Am Anim Hosp Assoc 2004; 40:92-101. [PMID: 15007043 DOI: 10.5326/0400092] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bartonella vinsonii (B. vinsonii) subspecies berkhoffii is a recently recognized cause of endocarditis, myocarditis, and granulomatous disease in dogs. In an effort to elucidate other potential disease manifestations, the case records of 24 dogs that were seroreactive to B. vinsonii (berkhoffii) antigens were studied retrospectively. Diagnoses included immune-mediated hemolytic anemia, neutrophilic or granulomatous meningoencephalitis, neutrophilic polyarthritis, cutaneous vasculitis, and uveitis. Repeated B. vinsonii (berkhoffii) antibody titers became negative after treatment. This study indicates that a diverse spectrum of disease manifestations and clinicopathological abnormalities can be detected in dogs that are seroreactive to B. vinsonii (berkhoffii) antigens.
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Affiliation(s)
- Edward B Breitschwerdt
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27606, USA
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Chomel BB, Kasten RW, Sykes JE, Boulouis HJ, Breitschwerdt EB. Clinical impact of persistent Bartonella bacteremia in humans and animals. Ann N Y Acad Sci 2003; 990:267-78. [PMID: 12860639 DOI: 10.1111/j.1749-6632.2003.tb07376.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bartonella spp. are emerging vector-borne pathogens that cause persistent, often asymptomatic bacteremia in their natural hosts. As our knowledge progresses, it appears that chronic infection may actually predispose the host to mild, insidious nonspecific manifestations or induce, in selected instances, severe diseases. Persistent asymptomatic bacteremia is most common in animals that serve as the main reservoir for the specific Bartonella. In humans, these organisms are B. bacilliformis and B. quintana. Other Bartonella species, for which humans are not the natural reservoir, tend to cause persistent bacteremia only in immunodeficient individuals. In some of these individuals, endothelial cell proliferation may create lesions such as bacillary angiomatosis or bacillary peliosis. In cats, bacteremia of variable level and continuity may last for years. Some strains of B. henselae may induce clinical manifestations, including fever, mild neurological signs, reproductive disorders, whereas others do not induce clinically obvious disease. Reproductive disorders have also been reported in mice experimentally infected with B. birtlesii. Finally, canids constitute the most interesting naturally occurring animal model for the human disease. Like immunocompetent people, healthy dogs only occasionally demonstrate long-term bacteremia when infected with Bartonella spp. However, some dogs develop severe clinical manifestations, such as endocarditis, and the pathologic spectrum associated with Bartonella spp. infection in domestic dogs is rapidly expanding and resembles the infrequently reported clinical entities observed in humans. In coyotes, persistent bacteremia is more common than in domestic dogs. It will be of interest to determine if coyotes develop clinical or pathological indications of infection.
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Affiliation(s)
- Bruno B Chomel
- Department of Population Health and Reproduction, University of California, Davis 95616, USA.
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Barouky R, Badet F, Rousset H. Les formes atypiques de la maladie des griffes du chat. Revue de la littérature. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(02)00456-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ayoub EM, McBride J, Schmiederer M, Anderson B. Role of Bartonella henselae in the etiology of Henoch-Schönlein purpura. Pediatr Infect Dis J 2002; 21:28-31. [PMID: 11791094 DOI: 10.1097/00006454-200201000-00006] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The etiology of Henoch-Schönlein purpura (HSP) has been ascribed to a variety of infectious and noninfectious agents. Because we encountered a patient with HSP who had evidence of Bartonella henselae infection and a prior report of a patient with systemic cat-scratch disease presenting as leukoclastic vasculitis, we investigated the association of B. henselae infection with HSP. METHODS We determined the antibody titers to B. henselae on the sera of 18 patients with HSP and on 57 controls. All patients presented with the characteristic leukoclastic rash of HSP. About one-half of the patients had joint or abdominal symptoms, and four had hematuria at presentation. An indirect immunofluorescent assay was used to determine serum antibody titers to B. henselae. Sera that were reactive at a dilution of 1/64 were considered positive. RESULTS Eight of the 57 (14%) control sera and 12 of the 18 (67%) patient sera were positive for B. henselae antibody (P < 0.0001). CONCLUSION The results of this study indicate a significant association of antecedent B. henselae infection with HSP. The frequency of this association (67%) exceeds that of previously ascribed etiologic agents for this disease, such as the group A Streptococcus.
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Affiliation(s)
- Elia M Ayoub
- Department of Pediatrics, University of Florida, Gainesville 32610, USA.
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Gurfield AN, Boulouis HJ, Chomel BB, Kasten RW, Heller R, Bouillin C, Gandoin C, Thibault D, Chang CC, Barrat F, Piemont Y. Epidemiology of Bartonella infection in domestic cats in France. Vet Microbiol 2001; 80:185-98. [PMID: 11295338 DOI: 10.1016/s0378-1135(01)00304-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Blood samples were collected between February and June 1996 from a convenience sample of 436 domestic French cats living in Paris and its environs and were tested for Bartonella bacteremia and seropositivity. Seventy-two cats (16.5%) were Bartonella bacteremic, of which 36 cats (50%) were infected with Bartonella henselae type II (B.h. II) only, 15 cats (21%) were infected with Bartonella clarridgeiae (B.c.) only, and 11 cats (15%) were infected with B. henselae type I (B.h. I) only. Eight cats (11%) were co-infected with B. henselae and B. clarridgeiae (B.h. II/B.c.: five cats; B.h. I/B.c.: three cats). Two cats (2.8%) were concurrently bacteremic with B. henselae types I and II. Risk factors associated with bacteremia included ownership for <6months (prevalence ratio (PR)=1.80; 95% confidence interval (CI)=1.13-2.85), adoption from the pound or found as a stray (PR=1.67, 95% CI=1.05-2.65), and cohabitation with one or more cats (PR=1.60, 95% CI=1.01-2.53). Bartonella antibodies to either B. henselae or B. clarridgeiae were detected in 179 cats (41.1%). Risk factors associated with seroposivity paralleled those for bacteremia, except for lack of association with time of ownership. Prevalence ratios of bacteremic or seropositive cats increased with the number of cats per household (p=0.02). The lack of antibodies to B. henselae or B. clarridgeiae was highly predictive of the absence of bacteremia (predictive value of a negative test=97.3%). Multiple logistic regression analysis indicated that bacteremia, after adjustment for age and flea infestation, and positive serology, after adjustment for age, were associated with origin of adoption and number of cats in the household. Flea infestation was associated with positive serology.
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Affiliation(s)
- A N Gurfield
- UMR 956 INRA/AFSSA/ENVA, Ecole Nationale Vétérinaire d'Alfort, 94704 Maisons-Alfort, France
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Landau M, Kletter Y, Avidor B, Ephrat G, Ephros M, Brenner S, Giladi M. Unusual eruption as a presenting symptom of cat scratch disease. J Am Acad Dermatol 1999; 41:833-6. [PMID: 10534662 DOI: 10.1016/s0190-9622(99)70337-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cat scratch disease (CSD) is a common infectious cause of subacute regional lymphadenopathy. Bartonella henselae is the principal etiologic agent. About 10% of CSD patients experience atypical manifestations, including rashes. The most common cutaneous manifestation of CSD is a papule at the inoculation site. We report a case of CSD presenting with an eruption on the upper trunk, reminiscent of Sweet's syndrome, accompanied by lymphadenopathy, arthralgia, and fever. Response to systemic corticosteroids was remarkable. Histopathologic findings refuted the diagnosis of Sweet's syndrome. Identification of anti-B henselae antibodies and B henselae DNA in the affected lymph node confirmed the diagnosis of CSD. This is a first report of extensive papuloedematous eruption as a cutaneous manifestation of CSD. Accurate diagnosis is possible due to the availability of serological tests and DNA amplification techniques.
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Affiliation(s)
- M Landau
- Department of Dermatology, Tel Aviv-Elias Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Israel.
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Abstract
OBJECTIVE To present a perspective on the current state of knowledge of cat scratch disease (CSD), including the evidence for Bartonella henselae as the etiological agent, epidemiological and clinical characteristics of the disease, available diagnostic tests and current therapeutic options. DATA SOURCES MEDLINE search of the literature published from 1966 to 1995 using 'cat scratch disease', 'Bartonella henselae', 'Rochalimaea henselae' as key words and bibliographies of selected papers. DATA EXTRACTION Selected studies reporting data on etiology, epidemiology, clinical characteristics, diagnosis and therapy of CSD were evaluated. DATA SYNTHESIS AND CONCLUSIONS Evidence accumulated to date supports B henselae as the etiological agent of CSD. The most significant risk factors for CSD are being licked on the face, scratched or bitten by a kitten and owning a kitten with fleas. Available serological tests can confirm classic CSD and identify B henselae as the cause of more atypical presentations, such as fever of unknown origin, granulomatous hepatitis, encephalitis and osteomyelitis. Symptomatic management is appropriate for isolated lymphadenopathy caused by CSD in healthy individuals; however, antibiotic therapy may be indicated for patients with more severe manifestations of the disease and immunocompromised hosts. Further study of CSD, in particular the epidemiology and therapy, is warranted. A better understanding of the pathogenesis of B henselae infection will have important implications in both immunocompetent and immunocompromised individuals.
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Affiliation(s)
- M A Opavsky
- Winner of the Canadian Infectious Disease Society/Canadian Journal of Infectious Diseases Review Article Award; portions of this review have also been submitted as part of a Canadian Paediatric Society statement on cat scratch disease, The Hospital for Sick Children, Toronto, Ontario
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