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Otrock ZK, Eby CS. Zoonotic Bacterial Infections Triggering Cytokine Storm Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:285-291. [PMID: 39117822 DOI: 10.1007/978-3-031-59815-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Zoonotic infections can result in life-threatening complications that can manifest with hemophagocytic lymphohistiocytosis (HLH)/cytokine storm syndrome (CSS). Bacteria constitute the largest group of zoonotic infection-related HLH cases. The growing list of zoonotic bacterial infections associated with HLH/CSS include Brucella spp., Rickettsia spp., Ehrlichia, Coxiella burnetii, Mycobacterium spp., and Bartonella spp. Patients most commonly present with fever, cytopenias, hepatosplenomegaly, myalgias, and less frequently with rash, jaundice, and lymphadenopathy.
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Affiliation(s)
- Zaher K Otrock
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, USA.
| | - Charles S Eby
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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2
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Eloseily EM, Cron RQ. Bacteria-Associated Cytokine Storm Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:275-283. [PMID: 39117821 DOI: 10.1007/978-3-031-59815-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
While viruses are considered the most common infectious triggers for cytokine storm syndromes (CSS), a growing list of bacterial pathogens, particularly intracellular organisms, have been frequently reported to be associated with this syndrome. Both familial and sporadic cases of CSS are often precipitated by acute infections. It is also important to note that an underlying precipitating infection might not be clinically obvious as the CSS clinical picture can mimic an infectious process or an overwhelming septicemia. It is important to detect such an underlying treatable condition. In addition, infections can also be acquired during the course of CSS due to the concurrent immune suppression with treatment. Optimal CSS outcomes require treating bacterial infections when recognized.CSS should always be suspected in patients presenting with a sepsis-like or multi-organ dysfunction picture. There are many criteria proposed to diagnose CSS in general, with HLH-2004 being the most commonly used. Alternatively, criteria have been proposed for CSS occurring in specific underlying conditions such as systemic lupus erythematosus (SLE) or systemic juvenile idiopathic arthritis (sJIA). However, waiting for many of these criteria to be fulfilled could lead to significant delay in diagnosis, and the physician needs a high index of suspicion for CSS in critically ill febrile hospitalized patients in order to properly recognize the condition. Thus, there should be diagnostic equipoise between CSS and infections, including bacterial, in this population. In this chapter, we discuss the more common bacterial precipitants of CSS with many of the cases being discussed in the pediatric age group.
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Affiliation(s)
| | - Randy Q Cron
- University of Alabama at Birmingham, Department of Pediatrics, Birmingham, AL, USA.
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3
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Minezaki D, Endo M, Saito T, Tokumaru T, Iwao M, Arakawa M, Honda K, Mizukami K, Kodama M, Murakami K. A case of hepatosplenic cat scratch disease with hemophagocytic lymphohistiocytosis. Clin J Gastroenterol 2023; 16:871-876. [PMID: 37581719 DOI: 10.1007/s12328-023-01840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
Cat scratch disease (CSD) is associated with Bartonella henselae (B. henselae) infection caused by cat scratches or bites. It typically presents with lymphadenitis and fever. However, there are atypical cases such as hepatosplenic CSD, which presents with specific lesions in the liver and spleen. Hemophagocytic lymphohistiocytosis (HLH) is a rare and severe multisystem disorder triggered by infections, cancers, or autoimmune diseases. We experienced a rare case of hepatosplenic CSD with HLH in a non-immunocompromised adult. A 78-year-old woman complained of fever and fatigue. Laboratory tests revealed anemia and liver dysfunction; abdominal contrast-enhanced computed tomography (CT) revealed splenomegaly and nodular hypodense areas in the spleen. In addition, the levels of ferritin and serum soluble IL-2R were markedly elevated, so clinical diagnosis of HLH was made. Positron emission tomography/CT revealed diffuse fluorodeoxyglucose uptake in the liver and spleen suggesting malignant lymphoma, while the pathological findings from liver biopsy suggested infectious diseases. Although she had no cat bites and scratches, she had many cats; therefore, serum B. henselae antibody titers were measured. The B. henselae IgG and IgM titer were 1:128 and 1:20; thus, she was diagnosed with hepatosplenic CSD. Patients with hepatosplenic nodular lesions and contact with cats should be considered for this disease.
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Affiliation(s)
- Daisuke Minezaki
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Mizuki Endo
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
| | - Tomoko Saito
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tomoko Tokumaru
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Masao Iwao
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Mie Arakawa
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Koichi Honda
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Masaaki Kodama
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
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Hempel A, Manzoor F, Petrescu D. Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report. Trop Dis Travel Med Vaccines 2023; 9:14. [PMID: 37743475 PMCID: PMC10518968 DOI: 10.1186/s40794-023-00200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/28/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Bartonella henselae is a species of intracellular bacteria transmitted to humans through animal bites and scratches contaminated with the feces of arthropod vectors, and are most commonly associated with cat exposure although transmission from other mammals has been reported. Bartonella henselae infection has a spectrum of clinical manifestations and has rarely been reported as cause of hemophagocytic lymphohistiocytosis (HLH) in immunocompromised hosts. CASE PRESENTATION We present a report of Bartonella henselae infection progressing to HLH in an immunocompetent patient. The patient initially presented with regional lymphadenopathy but the diagnosis was not suspected as the patient reported no exposure to cats. On further history, he did report a scratch from a dog prior to development of symptoms. The patient was treated with methylprednisolone, intravenous immunoglobulin and anakinra for the HLH and three months of Doxycycline for Bartonella infection, with complete resolution of symptoms. CONCLUSIONS Although commonly associated with cat exposure, Bartonella henselae transmission can occur after exposure to other animals and vectors including dogs and clinicians need to maintain an index of suspicion for timely diagnosis. Bartonella henselae is associated with a spectrum of clinical manifestations which can include disseminated infection with severe complications such as hemophagocytic lymphohistiocytosis. Prompt initiation of Bartonella treatment is essential when thought to be the trigger for hemophagocytic lymphohistiocytosis although the optimal treatment regimen is unclear.
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Affiliation(s)
- Amanda Hempel
- Department of Medicine, University of Toronto, RM 13EN, 300 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Fizza Manzoor
- Department of Medicine, University of Toronto, RM 13EN, 300 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Dan Petrescu
- Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
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5
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Benevenuta C, Mussinatto I, Orsi C, Timeus FS. Secondary hemophagocytic lymphohistiocytosis in children (Review). Exp Ther Med 2023; 26:423. [PMID: 37602304 PMCID: PMC10433411 DOI: 10.3892/etm.2023.12122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/16/2023] [Indexed: 08/22/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening condition characterized by hyperinflammation in an uncontrolled and ineffective immune response. Despite great improvement in diagnosis and treatment, it still represents a challenge in clinical management, with poor prognosis in the absence of an aggressive therapeutic approach. The present literature review focuses on secondary HLH at pediatric age, which represents a heterogeneous group in terms of etiology and therapeutic approach. It summarizes the most recent evidence on epidemiology, pathophysiology, diagnosis, treatment and prognosis, and provides a detailed description and comparison of the major subtypes of secondary HLH. Finally, it addresses the open questions with a focus on diagnosis and new treatment insights.
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Affiliation(s)
- Chiara Benevenuta
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
| | - Ilaria Mussinatto
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
| | - Cecilia Orsi
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
| | - Fabio S. Timeus
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
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Steed D, Collins J, Farris AB, Guarner J, Yarar D, Friedman-Moraco R, Doane T, Pouch S, Marshall Lyon G, Woodworth MH. Haemophagocytic lymphohistiocytosis associated with bartonella peliosis hepatis following kidney transplantation in a patient with HIV. THE LANCET. INFECTIOUS DISEASES 2022; 22:e303-e309. [PMID: 35500593 PMCID: PMC9942922 DOI: 10.1016/s1473-3099(22)00276-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/28/2021] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
Bacillary peliosis hepatis is a well recognised manifestation of disseminated Bartonella henselae infection that can occur in immunocompromised individuals. Haemophagocytic lymphohistiocytosis is an immune-mediated condition with features that can overlap with a severe primary infection such as disseminated Bartonella spp infection. We report a case of bacillary peliosis hepatis and secondary haemophagocytic lymphohistiocytosis due to disseminated Bartonella spp infection in a kidney-transplant recipient with well controlled HIV. The patient reported 2 weeks of fever and abdominal pain and was found to have hepatomegaly. He recalled exposure to a sick dog but reported no cat exposures. Laboratory evaluation was notable for pancytopenia and cholestatic injury. The patient met more than five of eight clinical criteria for haemophagocytic lymphohistiocytosis. Pathology review of a bone marrow core biopsy identified haemophagocytosis. A transjugular liver biopsy was done, and histopathology review identified peliosis hepatis. Warthin-Starry staining of the bone marrow showed pleiomorphic coccobacillary organisms. The B henselae IgG titre was 1:512, and Bartonella-specific DNA targets were detected by peripheral blood PCR. Treatment with doxycycline, increased prednisone, and pausing the mycophenolate component of his transplant immunosuppression regimen resulted in an excellent clinical response. Secondary haemophagocytic lymphohistiocytosis can be difficult to distinguish from severe systemic infection. A high index of suspicion can support the diagnosis of systemic Bartonella spp infection in those who present with haemophagocytic lymphohistiocytosis, especially in patients with hepatomegaly, immunosuppression, and germane animal exposures.
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Affiliation(s)
- Danielle Steed
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Alton B Farris
- Department of Medicine, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeannette Guarner
- Department of Medicine, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dilek Yarar
- Kidney Specialists of Kentucky, Bowling Green, KY, USA
| | | | - Tristan Doane
- Department of Medicine, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - G Marshall Lyon
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael H Woodworth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
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7
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Singh NS, Pagano AL, Hays AJ, Kats A, Dahl SM, Warady BA, Beins NT, Yin DE. Ehrlichia-induced hemophagocytic lymphohistiocytosis in a pediatric kidney transplant recipient. Pediatr Transplant 2022; 26:e14134. [PMID: 34595809 DOI: 10.1111/petr.14134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Kidney transplant patients are susceptible to a variety of infections in the post-transplant period due to the use of immunosuppressant medications. Ehrlichiosis is a rare infection in solid organ transplant recipients with signs and symptoms that mimic rejection and other viral infections. Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory syndrome that can be triggered by infections. METHODS We describe a pediatric kidney transplant recipient who experienced secondary HLH due to ehrlichiosis within the initial post-transplant month. RESULT Our patient improved after treatment with doxycycline, corticosteroids, and intravenous immunoglobulin (IVIG). CONCLUSION Clinicians should consider infections such as ehrlichiosis as a potential cause of illness in febrile solid organ transplant recipients in immediate post-transplant period, especially when accompanied by a compatible exposure history.
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Affiliation(s)
- Nisha S Singh
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Alexa L Pagano
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Kansas, USA
| | - Allyson J Hays
- Department of Pediatric Hematology and Oncology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Alexander Kats
- Division of Pathology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Steven M Dahl
- Divisions of Infectious Diseases and Clinical Pharmacology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Nathan T Beins
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Dwight E Yin
- Divisions of Infectious Diseases and Clinical Pharmacology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
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Valdés Francí E, Perez Flores I, Candel FJ, Moreno de la Higuera MA, Romero NC, Rodríguez Cubillo B, Lucena Valverde R, Sánchez Fructuoso AI. Hemophagocytic syndrome triggered by donor-transmitted toxoplasmosis as a complication in same-donor recipients of renal transplantation: Case report and review of the literature. Transpl Infect Dis 2021; 23:e13732. [PMID: 34533259 DOI: 10.1111/tid.13732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/16/2021] [Accepted: 09/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hemophagocytic syndrome (HPS) is an infrequent complication of transplantation caused by an inflammatory response with a benign proliferation of macrophages and defective lytic capability of T lymphocytes and NK cells that can lead to multiorgan failure. Transplant patients are particularly exposed as a result of the increased risk of both infections and malignancies derived from immunosuppressive drugs. There is no consensus for therapy or immunosuppression; mortality is high. We report a case and present a review of all cases of HPS occurring in solid organ transplant recipients. CASE REPORT: We report two cases of infection by Toxoplasma gondii transmitted by the kidney allograft. One of the recipients was seronegative before transplantation and developed disseminated primary toxoplasmosis. An immune reaction compatible with an HPS ensued. Both were treated with Trimethoprim/sulfamethoxazole, immunosuppression was tapered, and after a 2-week period a complete response was obtained. CONCLUSION HPS presents therapeutic challenges in the context of transplantation. If HPS is suspected, the search of a very likely underlying infection should be central to the management.
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Affiliation(s)
- Elena Valdés Francí
- Nephrology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Isabel Perez Flores
- Nephrology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Francisco Javier Candel
- Department of Clinical Microbiology and Infectious Diseases, Clínico San Carlos University Hospital, Madrid, Spain
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9
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Lopez SMC, Davis A, Zinn M, Feingold B, Green M, Michaels MG. Bartonella henselae infection in the pediatric solid organ transplant recipient. Pediatr Transplant 2021; 25:e13823. [PMID: 32841466 DOI: 10.1111/petr.13823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 12/19/2022]
Abstract
Bartonella henselae infection can cause a wide spectrum of diseases in both the immunocompetent and immunocompromised host with BA a severe form relegated to immunocompromised hosts, including solid organ transplant population. There are established criteria for diagnosis of Bartonella infection based on clinical presentation, serologic testing, imaging studies and, when indicated, tissue sampling for histopathological evaluation, particularly for BA. However, treatment recommendations for BA are inconclusive. Furthermore, there are no studies in the pediatric solid organ transplant population for antimicrobial therapy during BA secondary to Bartonella henselae infection. A case of BA following heart transplant is presented along with a literature review of clinical presentation; diagnosis and therapy for BA in the pediatric solid organ transplant population.
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Affiliation(s)
- Santiago Manuel Cayetano Lopez
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.,Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD, USA.,Division of Infectious Disease, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Davis
- Division of Pathology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew Zinn
- Division of Cardiology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian Feingold
- Division of Cardiology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Green
- Division of Infectious Disease, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.,Pediatrics/Surgery and Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marian G Michaels
- Division of Infectious Disease, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.,Pediatrics/Surgery and Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA, USA
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10
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Ud Din MA, Hussain SA, Said B, Zafar A. Anaplastic Large Cell Lymphoma Presenting as Haemophagocytic Lymphohistiocytosis with Underlying Coxiella burnetii and Bartonella henselae Seropositivity. Eur J Case Rep Intern Med 2020; 7:001850. [PMID: 33194860 DOI: 10.12890/2020_001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/05/2022] Open
Abstract
A 44-year-old woman with no significant medical history presented with a 3-week history of high-grade fevers, fatigue and shortness of breath. Laboratory investigation was significant for lymphopenia and thrombocytopenia which progressively worsened during her hospital stay, along with new-onset anaemia, and elevated ferritin, transaminase and triglycerides. A computerized tomography (CT) scan of the abdomen revealed retroperitoneal lymphadenopathy. A bone marrow biopsy confirmed the diagnosis of haemophagocytic lymphohistiocytosis (HLH). Extensive infectious work-up revealed high IgG titres for Bartonella henselae and Coxiella burnetii. Interestingly, the left supraclavicular node was negative for both microbes by polymerase chain reaction (PCR), but the biopsy revealed anaplastic large T-cell lymphoma. LEARNING POINTS Haemophagocytic lymphohistiocytosis (HLH) is an important differential diagnosis to consider for fever of unknown origin in adults, especially in the setting of pancytopenia and hyperferritinaemia.Q fever resulting from Coxiella burnetii can cause HLH and is also postulated to increase the risk of lymphoma.Bartonella henselae infection can also trigger HLH, but the risk of lymphoma following infection by B. henselae is unknown.
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Affiliation(s)
| | - Syed Ather Hussain
- Department of Internal Medicine, Rochester General Hospital, New York, USA
| | - Bassil Said
- Department of Internal Medicine, Rochester General Hospital, New York, USA
| | - Aneeqa Zafar
- Department of Hospitalist Medicine, El Camino Hospital, Mountain View, California, USA
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11
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Yang T, Mei Q, Zhang L, Chen Z, Zhu C, Fang X, Geng S, Pan A. Hemophagocytic lymphohistiocytosis is associated with Bartonella henselae infection in a patient with multiple susceptibility genes. Ann Clin Microbiol Antimicrob 2020; 19:28. [PMID: 32517705 PMCID: PMC7281694 DOI: 10.1186/s12941-020-00370-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/30/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Adult-onset hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening condition, which is often triggered by certain types of infection, cancer and numerous autoimmune diseases; however, of the numerous infectious triggers associated with HLH, the consequences of Bartonella henselae infection have been rarely reported. CASE PRESENTATION A 48-year-old female presented with a 20-day history of intermittent fever accompanied by systemic rash, fatigue, anorexia and weight loss later she developed shock and unconsciousness. Blood tests showed a reduction of leukocyte, anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed hemophagocytic activity. Metagenomic next-generation sequencing (mNGS) analysis of the lymph node detected the presence of B. henselae. Whole exome sequencing revealed two gene variants, STXBP2 and IRF5, in this adult patient with secondary HLH. Then, she received minocycline and rifampin combination anti-infective therapy. Intravenous immunoglobulin for 5 days followed by a high dose of methylprednisolone were also administered. The patient was successfully discharged from the intensive care unit and remained in good condition after 2 months of follow-up. CONCLUSIONS mNGS served crucial roles in obtaining an etiological diagnosis, which suggested that screening for B. henselae should be considered in patients with HLH, especially those with a cat at home. In addition, the genetic defects were discovered to not only be present in primary HLH, but also in secondary HLH, even in the elderly.
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Affiliation(s)
- Tianjun Yang
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China
| | - Qing Mei
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China
| | - Lei Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China
| | - Zhendong Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China
| | - Chunyan Zhu
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China
| | - Xiaowei Fang
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China
| | - Shike Geng
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China.,Department of Intensive Care Unit, Affiliated Provincial Hospital of Anhui Medical University, 17 Lujiang Road, Hefei, Anhui, China
| | - Aijun Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, China. .,Department of Intensive Care Unit, Affiliated Provincial Hospital of Anhui Medical University, 17 Lujiang Road, Hefei, Anhui, China.
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12
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Mantis J, Ali Y, Junejo SZ. Cat-Scratch Disease in an AIDS Patient Presenting with Generalized Lymphadenopathy: An Unusual Presentation with Delayed Diagnosis. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:906-911. [PMID: 30068900 PMCID: PMC6083936 DOI: 10.12659/ajcr.909325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Female, 44 Final Diagnosis: Cat-scratch disease Symptoms: Lymfadenopathy Medication: — Clinical Procedure: Lymph node biopsy Specialty: Infectious Diseases
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Affiliation(s)
- Jazila Mantis
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,NYC Health + Hospital/Queens, Jamaica, NY, USA
| | - Yasir Ali
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,NYC Health + Hospital/Queens, Jamaica, NY, USA
| | - Shoaib Zahoor Junejo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,NYC Health + Hospital/Queens, Jamaica, NY, USA
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13
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Núñez Cuadros E, Cabrera del Moral A, Jiménez Hinojosa JM, Leiva Gea I, Conejo Muñoz L. Haemophagocytic syndrome secondary to endocarditis due to Bartonella henselae. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Núñez Cuadros E, Cabrera del Moral A, Jiménez Hinojosa JM, Leiva Gea I, Conejo Muñoz L. Síndrome hemofagocítico secundario a endocarditis por Bartonella henselae. An Pediatr (Barc) 2018; 89:119-120. [DOI: 10.1016/j.anpedi.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/22/2017] [Accepted: 11/03/2017] [Indexed: 11/27/2022] Open
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15
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Shamekhi Amiri F. Bartonellosis in Chronic Kidney Disease: An Unrecognized and Unsuspected Diagnosis. Ther Apher Dial 2017; 21:430-440. [PMID: 28884961 DOI: 10.1111/1744-9987.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 11/27/2022]
Abstract
Systemic cat scratch disease or bartonellosis is a clinical entity caused by Bartonella henselae, which manifests with necrotizing granulomas in visceral organs. The cat flea, Ctenocephalides felis, is the vector responsible for horizontal transmission of the disease from cat to cat, and its bite can also infect humans. In immunocompromised patients including chronic kidney disease and renal transplant recipients, it can cause persistent and disseminated cat scratch disease. The aim of this paper is to perform a systematic review of the studies that have addressed the diagnostic methods of cat scratch disease in chronic kidney disease and renal transplant recipients. This review was searched via electronic PubMed and Google scholar databases. Few qualitative full-text original articles in chronic kidney disease and kidney transplant were extracted. At this paper, 19 articles identified including six articles in chronic kidney disease and 13 articles in renal transplant recipients. Of these six identified case reports in chronic kidney disease, serology via immunofluorescence antibody test was led to diagnosis of cat scratch disease in five patients and a one patient showed nonreactive serologic test. Polymerase chain reaction usage to detect deoxyribonucleic acid in tissue biopsy and bone marrow biopsy was led to diagnosis. Cat scratch disease diagnosis in 13 renal transplant recipients was attained more by combining serology and polymerase chain reaction to detect deoxyribonucleic acid in tissue specimens. These selected studies demonstrate that serology and polymerase chain reaction via deoxyribonucleic acid extraction of tissue specimens yield the best outcome in diagnostic field of bartonellosis.
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Affiliation(s)
- Fateme Shamekhi Amiri
- Division of Nephrology, Imam Khomeini Hospital, Faculty of Medicine, National Tehran University of Medical Sciences, Tehran, Iran
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16
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Anandh U, Johari S, Vaswani B. Hemophagocytic lymphohistiocytosis secondary to hemodialysis catheter-related blood stream infection. Indian J Nephrol 2017; 27:133-135. [PMID: 28356667 PMCID: PMC5358155 DOI: 10.4103/0971-4065.180604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 57-year-old man on dialysis presented with fever due to Pseudomonas septicemia. Workup revealed very high triglycerides and serum ferritin levels. A bone marrow examination showed hemophagocytosis. A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made and steroids were started. He was put on automated peritoneal dialysis. Patients' condition continued to deteriorate and he succumbed to his illness. This case illustrates the development of HLH secondary to infections which are increasingly being recognized in the literature. Often this diagnosis is missed as it becomes difficult to differentiate between sepsis and HLH. The presence of high ferritin, hypertriglyceridemia, and hemophagocytosis in the bone marrow confirms the diagnosis.
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Affiliation(s)
- U Anandh
- Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - S Johari
- Department of Laboratory Medicine, Yashoda Hospitals, Secunderabad, Telangana, India
| | - B Vaswani
- Department of Clinical Hematology and Oncology, Yashoda Hospitals, Secunderabad, Telangana, India
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17
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Filippone EJ, Singh P, Frank AM, Gupta A, Farber JL. Rapidly Fatal Hemophagocytic Lymphohistiocytosis Developing Within Six Days Following Deceased-Donor Renal Transplantation: Case Report. Transplant Proc 2016; 48:3123-3127. [PMID: 27932162 DOI: 10.1016/j.transproceed.2016.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/30/2016] [Indexed: 12/12/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an often fatal hyperinflammatory syndrome that may complicate malignancy, infection, rheumatic disease, or immunosuppression. HLH after kidney transplantation is most often triggered by infection, usually Herpes viruses such as cytomegalovirus and Epstein-Barr virus (EBV). It usually occurs early after transplantation. We present a case of HLH triggered by reactivation of EBV that pursued a rapidly fatal course within 6 days of receiving a deceased-donor kidney transplant. This case serves to remind transplant clinicians to consider HLH when cytopenias and hyperinflammation are atypical for the usual post-transplantation course. We discuss pitfalls in diagnosis and suggestions for treatment in this setting.
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Affiliation(s)
- E J Filippone
- Division of Nephrology, Department of Medicine, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - P Singh
- Division of Nephrology, Department of Medicine, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - A M Frank
- Department of Surgery, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - A Gupta
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - J L Farber
- Department of Pathology, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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18
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Le Joncour A, Bidegain F, Ziol M, Nebbad B, Galicier L, Oksenhendler E, Mechai F, Boutboul D, Bouchaud O. Reply to Rokx et al. Clin Infect Dis 2016; 63:428. [PMID: 27161782 DOI: 10.1093/cid/ciw304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandre Le Joncour
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP and EA3518, Université Paris Diderot
| | - F Bidegain
- Department of Infectious Diseases, Hôpital Avicenne, AP-HP, Bobigny
| | - M Ziol
- Department of Pathology, Hôpital Jean Verdier, AP-HP, Bondy
| | - B Nebbad
- Department of Microbiology, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - L Galicier
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP and EA3518, Université Paris Diderot
| | - E Oksenhendler
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP and EA3518, Université Paris Diderot
| | - F Mechai
- Department of Infectious Diseases, Hôpital Avicenne, AP-HP, Bobigny
| | - D Boutboul
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP and EA3518, Université Paris Diderot
| | - O Bouchaud
- Department of Infectious Diseases, Hôpital Avicenne, AP-HP, Bobigny
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19
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Filippone EJ, Farber JL. Hemophagocytic lymphohistiocytosis: an update for nephrologists. Int Urol Nephrol 2016; 48:1291-1304. [DOI: 10.1007/s11255-016-1294-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/11/2016] [Indexed: 12/11/2022]
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20
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Le Joncour A, Bidegain F, Ziol M, Galicier L, Oksenhendler E, Mechai F, Boutboul D, Bouchaud O. Hemophagocytic Lymphohistiocytosis Associated With Bartonella henselae Infection in an HIV-Infected Patient. Clin Infect Dis 2015; 62:804-6. [PMID: 26646679 DOI: 10.1093/cid/civ999] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/24/2015] [Indexed: 12/20/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome that often occurs in immunocompromised patients. We report the first case of HLH due to Bartonella henselae infection in a patient with human immunodeficiency virus infection. Early recognition of HLH and B. henselae through liver biopsy and serological tests led to the patient's recovery.
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Affiliation(s)
- Alexandre Le Joncour
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP, and EA3518, Université Paris Diderot
| | | | - Marianne Ziol
- Department of Pathology, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Lionel Galicier
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP, and EA3518, Université Paris Diderot
| | - Eric Oksenhendler
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP, and EA3518, Université Paris Diderot
| | - Frederic Mechai
- Department of Infectious Diseases, Hôpital Avicenne, AP-HP, Bobigny
| | - David Boutboul
- Department of Clinical Immunology, Hôpital Saint Louis, AP-HP, and EA3518, Université Paris Diderot
| | - Olivier Bouchaud
- Department of Infectious Diseases, Hôpital Avicenne, AP-HP, Bobigny
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21
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Pultorak E, Linder K, Maggi R, Balakrishnan N, Breitschwerdt E. Prevalence of Bartonella spp. in Canine Cutaneous Histiocytoma. J Comp Pathol 2015; 153:14-21. [DOI: 10.1016/j.jcpa.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
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22
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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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