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Abd Rahim NN, Ami M, Zainal Abidin Z. Parinaud Oculoglandular Syndrome Among Female Adults in Malaysia: A Case Series. Cureus 2024; 16:e67066. [PMID: 39286673 PMCID: PMC11403930 DOI: 10.7759/cureus.67066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Parinaud oculoglandular syndrome (POGS), is typically rare and often presented as a unilateral ocular inflammation accompanied by ipsilateral lymphadenopathy. POGS is an atypical manifestation of cat scratch disease (CSD) caused by Bartonella henselae (BH). Diagnosis of POGS poses a challenge due to its rarity and the array of potential etiologies including infections from fleas, ticks, and various microorganisms. This case series details three cases of CSD attributed to POGS, highlighting the diagnostic challenges faced in the absence of the gold standard diagnostic method, which is the polymerase chain reaction (PCR) DNA test for BH. The cases encompass a set of presentations including granulomatous inflammation and lymphadenopathy, managed effectively with antibiotics and non-pharmacological interventions such as flea control in domestic felines and hygiene measures post-feline inflicted injury. These cases highlight the necessity for heightened clinical suspicion, especially in patients with a history of feline contact, and appeal for further research to refine diagnostic criteria for more accurate and practical detection of CSD particularly for the atypical manifestations. This will be especially beneficial in areas where the more invasive lesion biopsy or gold standard PCR DNA test for BH are not available so accurate management can be instituted immediately in cases where there is multisystemic involvement.
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Affiliation(s)
- Nur Nadia Abd Rahim
- Otolaryngology - Head and Neck Surgery, KPJ Healthcare University, Nilai, MYS
| | - Mazita Ami
- Otolaryngology - Head and Neck Surgery, KPJ Healthcare University, Nilai, MYS
| | - Zurina Zainal Abidin
- Ophthalmology and Oculoplastic Surgery, KPJ Klang Specialist Hospital, Klang, MYS
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2
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Nainshtein-Baturov L, Achrak E, Grabie YY, Khan K. Fatal Cat Scratch Disease in Alcoholic Patient With Liver Cirrhosis: A Case Report. Cureus 2024; 16:e60609. [PMID: 38894778 PMCID: PMC11185286 DOI: 10.7759/cureus.60609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Cat-scratch disease (CSD), a human infection resulting from Bartonella species, commonly manifests as tender lymphadenopathy. Consequently, its inclusion in the differential diagnosis of fevers of unknown origin and lymphadenopathy syndromes is imperative. Typically, it manifests as self-limiting tender lymphadenopathy and does not lead to fatalities, though it may assume a more severe course in immunocompromised individuals. Diagnostic challenges often surround CSD due to its elusive nature in laboratory tests, necessitating a reliance on the clinical presentation for definitive diagnosis. This can manifest in delayed procedures and testing, which can prolong intervention and cause rapid progress of bacteria, potentially causing severe complications and death. In this case report of a 58-year-old Caucasian male, we delve into the clinical presentation and eventual fatality of CSD in a patient with liver cirrhosis, occurring in the United States. He sought care in the emergency department due to lethargy, fever, and swollen axilla following a cat scratch. Although the patient did not exhibit signs of sepsis upon admission, he rapidly progressed to sepsis and passed away within 24 hours. This case highlights the significance of timely and proactive management in individuals presenting with CSD, especially when complicated by underlying immunocompromised conditions. Early recognition, the administration of suitable antibiotics, and comprehensive supportive care are pivotal in averting fatal outcomes in such cases.
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Affiliation(s)
| | - Eleonora Achrak
- Department of Osteopathic Medicine, Touro College of Osteopathic Medicine, New York, USA
| | - Yisroel Y Grabie
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, New York, USA
| | - Kalim Khan
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, New York, USA
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3
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López-Rueda S, Valente-Acosta B, Murillo-Zolezzi A, Moreno-Sánchez F, Hoyo-Ulloa I, Baquera-Heredia JJ. A Man in His Forties with Recurrent Cat-Scratch Disease. Case Rep Infect Dis 2024; 2024:4411133. [PMID: 38444733 PMCID: PMC10914428 DOI: 10.1155/2024/4411133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Cat-scratch disease (CSD) is a self-limited zoonotic infection transmitted by felines caused by the Gram-negative bacillus Bartonella henselae. It usually presents with lymphadenopathy and constitutional symptoms that resolve within eight weeks, with, or without antibiotic treatment. The diagnosis is made by serology, molecular diagnosis in a biopsy, or a positive culture. The recurrence or reactivation of B. henselae has rarely been reported. We present the case of a 45-year-old man with a history of CSD two years before who presented to the clinic with groin lymphadenopathy. The patient had a history of close contact with felines though no known risk exposure was reported. The diagnosis was made with a positive serology suggestive of recent infection along with histopathological changes suggestive of CSD. Subsequently, azithromycin was administered with complete resolution of symptoms.
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Affiliation(s)
- Sara López-Rueda
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Benjamin Valente-Acosta
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Adrian Murillo-Zolezzi
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Francisco Moreno-Sánchez
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Irma Hoyo-Ulloa
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
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Ericson ME, Mozayeni BR, Radovsky L, Bemis LT. Bartonella- and Borrelia-Related Disease Presenting as a Neurological Condition Revealing the Need for Better Diagnostics. Microorganisms 2024; 12:209. [PMID: 38276194 PMCID: PMC10819350 DOI: 10.3390/microorganisms12010209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The diagnostic tests available to identify vector-borne pathogens have major limitations. Clinicians must consider an assortment of often diverse symptoms to decide what pathogen or pathogens to suspect and test for. Even then, there are limitations to the currently available indirect detection methods, such as serology, or direct detection methods such as molecular tests with or without culture enrichment. Bartonella spp., which are considered stealth pathogens, are particularly difficult to detect and diagnose. We present a case report of a patient who experienced a spider bite followed by myalgia, lymphadenopathy, and trouble sleeping. She did not test positive for Bartonella spp. through clinically available testing. Her symptoms progressed and she was told she needed a double hip replacement. Prior to the surgery, her blood was submitted for novel molecular testing, where Bartonella spp. was confirmed, and a spirochete was also detected. Additional testing using novel methods over a period of five years found Bartonella henselae and Borrelia burgdorferi in her blood. This patient's case is an example of why new diagnostic methods for vector-borne pathogens are urgently needed and why new knowledge of the variable manifestations of Bartonellosis need to be provided to the medical community to inform and heighten their index of suspicion.
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Affiliation(s)
| | | | | | - Lynne T. Bemis
- Department of Biomedical Sciences, Medical School Duluth Campus, University of Minnesota, Duluth, MN 55812, USA
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5
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Carujo A, Santos Silva A, Videira Santos F, Furtado MJ, Vasconcelos AL. Optic Neuritis and Vertebral Osteomyelitis: An Uncommon Presentation of Cat-Scratch Disease. Cureus 2024; 16:e52284. [PMID: 38357045 PMCID: PMC10865162 DOI: 10.7759/cureus.52284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
In cat-scratch disease (CSD), hematogenous spread may result in atypical presentations. Ocular manifestations develop in a minority of patients, with treatment being important in reducing long-term visual sequelae. Bone infection is rare. We present the case of a 52-year-old woman, with close contact with cats, reporting acute unilateral blurred vision and presenting papilledema, optic disc pallor, and peripapillary hemorrhage. Etiologic study of optic neuritis revealed an elevated positive Bartonella IgG; hence, treatment for CSD with doxycycline plus rifampin and corticosteroids was started. Concomitant lumbar pain of increasing intensity warranted magnetic resonance imaging, which revealed L3-L4 vertebral osteomyelitis with spondylodiscitis. Given the temporal link with CSD diagnosis and the significant clinical improvement since its treatment was started, an etiologic link was presumed and antibiotics were prolonged. This case stands out for the presence of distinct atypical CSD manifestations in the same patient. Further studies are needed to determine the optimal treatment for rare manifestations, particularly bone infection.
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Affiliation(s)
- António Carujo
- Infectious Diseases Department, Santo António University Hospital, Porto, PRT
| | - André Santos Silva
- Infectious Diseases Department, Santo António University Hospital, Porto, PRT
- Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, PRT
| | | | - Maria João Furtado
- Ophthalmology Department, Santo António University Hospital, Porto, PRT
- Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, PRT
| | - António Ludgero Vasconcelos
- Infectious Diseases Department, Santo António University Hospital, Porto, PRT
- Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, PRT
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6
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Berce V, Rataj N, Dorič M, Zorko A, Kolarič T. Association between the Clinical, Laboratory and Ultrasound Characteristics and the Etiology of Peripheral Lymphadenopathy in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1589. [PMID: 37892252 PMCID: PMC10604910 DOI: 10.3390/children10101589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Peripheral lymphadenopathy affects most children at least once in a lifetime and represents a major reason for concern. Therefore, we aimed to identify the most common causes of peripheral lymphadenopathy in hospitalized children and to determine the clinical, laboratory and ultrasound characteristics that enable fast, easy and accurate etiological diagnosis. We performed a cross-sectional study including 139 children who were hospitalized because of peripheral lymphadenopathy. Ultrasound of lymph nodes was performed in 113 (81.3%) patients. Lymphadenopathy was generalized in nine (6.5%) patients. Malignant etiology was established in only three (2.2%) patients. Bacterial lymphadenitis, infectious mononucleosis (IM) and cat scratch disease (CSD) were diagnosed in 66 (47.5%), 31 (22.3%) and 29 (20.9%) patients, respectively. Bacterial lymphadenitis was significantly associated with neutrophilia (p < 0.01), and increased C-reactive protein levels (p < 0.01). IM was associated with pharyngitis (p < 0.01), leukocytosis without neutrophilia (p = 0.03) and increased blood liver enzyme levels (p < 0.01). CSD was associated with recent contact with a cat (p < 0.01), absence of a fever (p < 0.01) and normal white blood cell count (p < 0.01). Thorough history and clinical examination in combination with a few basic laboratory tests enable fast and accurate differentiation between the most common etiologies of lymphadenopathy in children to avoid unnecessary procedures and hospitalizations.
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Affiliation(s)
- Vojko Berce
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.R.); (M.D.); (A.Z.)
| | - Nina Rataj
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.R.); (M.D.); (A.Z.)
| | - Maja Dorič
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.R.); (M.D.); (A.Z.)
| | - Aleksandra Zorko
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.R.); (M.D.); (A.Z.)
| | - Tjaša Kolarič
- Community Health Center Velenje, Vodnikova cesta 1, 3320 Velenje, Slovenia;
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7
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Alias NNA, Omar S, Ahmad NI, Watanabe M, Tay ST, Aziz NA, Mustaffa-Kamal F. Profiling Bartonella infection and its associated risk factors in shelter cats in Malaysia. J Vet Sci 2023; 24:e38. [PMID: 37271506 DOI: 10.4142/jvs.22277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Poor disease management and irregular vector control could predispose sheltered animals to disease such as feline Bartonella infection, a vector-borne zoonotic disease primarily caused by Bartonella henselae. OBJECTIVES This study investigated the status of Bartonella infection in cats from eight (n = 8) shelters by molecular and serological approaches, profiling the CD4:CD8 ratio and the risk factors associated with Bartonella infection in shelter cats. METHODS Bartonella deoxyribonucleic acid (DNA) was detected through polymerase chain reaction (PCR) targeting 16S-23S rRNA internal transcribed spacer gene, followed by DNA sequencing. Bartonella IgM and IgG antibody titre, CD4 and CD8 profiles were detected using indirect immunofluorescence assay and flow cytometric analysis, respectively. RESULTS B. henselae was detected through PCR and sequencing in 1.0% (1/101) oral swab and 2.0% (1/50) cat fleas, while another 3/50 cat fleas carried B. clarridgeiae. Only 18/101 cats were seronegative against B. henselae, whereas 30.7% (31/101) cats were positive for both IgM and IgG, 8% (18/101) cats had IgM, and 33.7% (34/101) cats had IgG antibody only. None of the eight shelters sampled had Bartonella antibody-free cats. Although abnormal CD4:CD8 ratio was observed in 48/83 seropositive cats, flea infestation was the only significant risk factor observed in this study. CONCLUSIONS The present study provides the first comparison on the Bartonella spp. antigen, antibody status and CD4:CD8 ratio among shelter cats. The high B. henselae seropositivity among shelter cats presumably due to significant flea infestation triggers an alarm of whether the infection could go undetectable and its potential transmission to humans.
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Affiliation(s)
- Nurul Najwa Ainaa Alias
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Sharina Omar
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Nur Indah Ahmad
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Malaika Watanabe
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Sun Tee Tay
- Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nor Azlina Aziz
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Farina Mustaffa-Kamal
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
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Mullins K, Canal E, Ouch P, Prasetyo D, Tagoe J, Attram N, Yeboah C, Kumordjie S, Fox A, Letizia AG, Rachlin A, Nguyen HM, Robinson MT, Vongsouvath M, Davong V, Maxay M, Simons MP, Caranci A, Newton PN, Richards AL, Farris CM. Bartonella Species in Cambodia, Ghana, Laos, and Peru: Results from Vector and Serosurveys. Vector Borne Zoonotic Dis 2023; 23:9-17. [PMID: 36633562 PMCID: PMC7614129 DOI: 10.1089/vbz.2021.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Bartonella species are fastidious gram-negative vector-borne bacteria with a wide range of mammalian reservoirs. While it is understood that some species of Bartonella are human pathogens, the extent of human exposure to Bartonella species (both pathogenic and nonpathogenic) is yet to be fully understood. Materials and Methods: To this end, residual sera from participants enrolled in undifferentiated fever studies in Cambodia, Ghana, Laos, and Peru were screened for the presence of IgG antibodies against Bartonella quintana and Bartonella henselae, using the FOCUS diagnostics Dual Spot- Bartonella IgG Immunofluorescence assay. Forty-eight patients with suspected or confirmed Bartonella bacilliformis exposure or infection in Peru were screened to assess cross-reactivity of the FOCUS assay for IgG against other Bartonella species. Results: Ten of 13 patients with confirmed B. bacilliformis infection were Bartonella-specific IgG positive, and overall, 36/48 of the samples were positive. In addition, 79/206, 44/200, 101/180, and 57/100 of the samples from Peru, Laos, Cambodia, and Ghana, respectively, were Bartonella-specific IgG positive. Furthermore, ectoparasite pools from Cambodia, Laos, and Peru were tested using quantitative real-time PCR (qPCR) for the presence of Bartonella DNA. Of the sand fly pools collected in Peru, 0/196 were qPCR positive; 15/140 flea pools collected in Cambodia were qPCR positive; while 0/105 ticks, 0/22 fleas, and 0/3 louse pools collected in Laos tested positive for Bartonella DNA. Conclusion: Evidence of Bartonella in fleas from Cambodia supports the possibility that humans are exposed to Bartonella through this traditional vector. However, Bartonella species were not found in fleas, ticks, or lice from Laos, or sand flies from Peru. This could account for the lower positive serology among the population in Laos and the strictly localized nature of B. bacilliformis infections in Peru. Human exposure to the Bartonella species and Bartonella as a human pathogen warrants further investigation.
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Affiliation(s)
- Kristin Mullins
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | | | - Pidor Ouch
- Naval Medical Research Unit-2, Phnom Penh, Cambodia
| | | | - Janice Tagoe
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Naiki Attram
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Clara Yeboah
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | | | - Anne Fox
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | | | - Audrey Rachlin
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Hung Manh Nguyen
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Matthew T Robinson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Center for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Microbiology Laboratory, Mahosot Hospital, Qua Fa Ngum, Vientiane, Lao PDR
| | - Viengmon Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Microbiology Laboratory, Mahosot Hospital, Qua Fa Ngum, Vientiane, Lao PDR
| | - Mayfong Maxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Center for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Mark P Simons
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Angela Caranci
- Northwest Mosquito and Vector Control District, Corona, California, USA
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Center for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Allen L Richards
- Naval Medical Research Center, Silver Spring, Maryland, USA
- Uniformed Services University, Bethesda, Maryland, USA
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Limitations of Serological Diagnosis of Typical Cat Scratch Disease and Recommendations for the Diagnostic Procedure. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4222511. [PMID: 36915870 PMCID: PMC10008113 DOI: 10.1155/2023/4222511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/22/2023] [Accepted: 02/11/2023] [Indexed: 03/07/2023]
Abstract
Introduction Cat scratch disease (CSD) is the most common cause of bacterial infectious lymphadenopathy, especially in children, but its diagnosis still remains challenging. Serological assays are widely applied due to their simplicity and the non-invasive sampling. However, these techniques present several limitations, including not well-defined antigen preparation, assay conditions and cutoff titers, severe cross-reactions with other species and organisms, and the notably ranging seroprevalence in the normal population. The objective of this study is to review the literature in order to determine the best diagnostic procedure for the diagnosis of CSD. Methods Databases including PubMed, Medline, Google Scholar, and Google were searched to determine the best diagnostic procedure for the diagnosis of CSD. A total of 437 papers were identified and screened, and after exclusion of papers that did not fulfill the including criteria, 63 papers were used. Results It was revealed that sensitivities of serological assays varied from 10% to 100%. Indeed, more than half of the studies reported a sensitivity lower than 70%, while 71% of them had a sensitivity lower than 80%. Moreover, specificities of serological assays ranged from 15% to 100%, with 25 assays reporting a specificity lower than 90%. Conclusion It is considered that molecular assays should be the gold standard technique for CSD confirmation, and physicians are reinforced to proceed to lymph node biopsy in suspicious CSD cases.
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Abu‐Rumeileh S, Beltrami G, Di Maurizio M, Indolfi G, Trapani S. Bartonella henselae vertebral osteomyelitis in a pediatric patient: A case report. Clin Case Rep 2022; 10:e6117. [PMID: 36276906 PMCID: PMC9582676 DOI: 10.1002/ccr3.6117] [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: 02/03/2022] [Revised: 05/14/2022] [Accepted: 07/02/2022] [Indexed: 11/09/2022] Open
Abstract
Bartonella henselae is an unusual and rarely suspected osteomyelitis etiologic agent. We present a case of low back-pain in a 10-year-old female which lead to a challenging diagnostic work-up due to subtle imaging findings. The diagnosis was Bartonella henselae vertebral osteomyelitis mimicking bone tumor.
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Affiliation(s)
- Sarah Abu‐Rumeileh
- Postgraduate School of PediatricsUniversity of Florence and Meyer Children's University HospitalFlorenceItaly
| | - Giovanni Beltrami
- Division of Pediatric Oncological OrthopedicsMeyer Children's University HospitalFlorenceItaly
| | | | - Giuseppe Indolfi
- Department of NEUROFARBAUniversity of Florence and Meyer Children's University HospitalFlorenceItaly
| | - Sandra Trapani
- Department of Health SciencesUniversity of Florence and Meyer Children's University HospitalFlorenceItaly
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11
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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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12
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Drummond MR, dos Santos LS, Fávaro RS, Stucchi RSB, Boin IDFSF, Velho PENF. Cryptogenic hepatitis patients have a higher Bartonella sp.-DNA detection in blood and skin samples than patients with non-viral hepatitis of known cause. PLoS Negl Trop Dis 2022; 16:e0010603. [PMID: 35849566 PMCID: PMC9292087 DOI: 10.1371/journal.pntd.0010603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to assess the prevalence of Bartonella sp.-DNA detection in blood and skin samples from patients with non-viral end-stage liver disease awaiting liver transplantation. Methodology/Principal findings Blood samples and healthy skin fragments from 50 patients were tested using microbiological and molecular methods. Fifteen patients had cryptogenic hepatitis (CH) and 35 had alcoholic, drug-induced or autoimmune liver disease. DNA was extracted from whole blood and liquid culture samples, isolates, and skin fragments. Thirteen of the 50 patients (26%) had Bartonella henselae DNA detection in their blood (9/50) and/or skin (5/50) samples. Colonies were isolated in 3/50 (6%) and infection was detected in 7/50 (14%) of the 50 patients. B. henselae-DNA detection was more prevalent in patients with CH than in other patients (p = 0.040). Of 39 patients followed-up for at least two years, a higher mortality rate was observed among patients with CH infected with B. henselae (p = 0.039). Conclusions/Significance Further studies assessing the role of B. henselae infection in the pathogenesis of hepatitis patients must be urgently conducted. One in four patients with end-stage liver disease awaiting liver transplantation for hepatitis of non-viral origin had documented B. henselae-DNA detection and cryptogenic hepatitis patients have a higher bacterium molecular detection than patients with non-viral hepatitis of known cause.
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Affiliation(s)
- Marina Rovani Drummond
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Luciene Silva dos Santos
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | | | | | | | - Paulo Eduardo Neves Ferreira Velho
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
- Division of Dermatology, Department of Medicine, UNICAMP, Campinas, São Paulo, Brazil
- * E-mail:
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13
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Goaz S, Rasis M, Binsky Ehrenreich I, Shapira L, Halutz O, Graidy-Varon M, Leibovitch C, Maisler N, Glikman D, Ephros M, Giladi M. Molecular Diagnosis of Cat Scratch Disease: a 25-Year Retrospective Comparative Analysis of Various Clinical Specimens and Different PCR Assays. Microbiol Spectr 2022; 10:e0259621. [PMID: 35262411 PMCID: PMC9045166 DOI: 10.1128/spectrum.02596-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 02/07/2023] Open
Abstract
Cat-scratch disease (CSD), caused primarily by Bartonella henselae, is a common etiology of infectious regional lymphadenopathy. Lymphadenopathy is preceded by a primary inoculation lesion and may progress to suppuration. Laboratory diagnosis of CSD is hampered by the limitations of available confirmatory tests. PCR, in general, is highly sensitive and specific; however, clinical sensitivity in CSD varies greatly between studies. We aimed to identify clinical specimens and PCR assays best suited for CSD diagnosis using a national CSD registry and a uniform case definition. Different clinical specimens and PCR assays, including conventional and real-time PCR, were evaluated. PCR was positive in 335/390 (86%) CSD patients and 425/482 (88%) PCR tests. The highest PCR sensitivity was achieved in lymph node pus aspirates (96%; n = 278 tests) followed by primary lesions (88%; n = 50), lymph node fine needle aspirations (85%; n = 46), lymph node biopsy specimens (73%; n = 91) and paraffin-embedded lymph nodes (59%; n = 17), (P < 0.001). Sensitivity was similar in all types of PCR assays studied. PCR negative predictive value of pus aspirate and lymph node biopsy specimen patient groups was 82% and 72%, respectively. Specificity was 100% based on 125 non-CSD patients with negative PCR. In conclusion, the specimen type rather than the PCR assay type has a major impact on CSD molecular diagnosis. We assume that the inadequate sensitivity of the biopsy specimens was due to sampling errors or the presence of inhibitory factors. Primary lesions should be sampled more frequently for CSD diagnosis. Physicians should be aware of the low PCR negative predictive value of lymph node biopsy specimens. IMPORTANCE Polymerase chain reaction (PCR) for the detection of Bartonella henselae is an important tool for the diagnosis of cat scratch disease (CSD); however, clinical sensitivity varies greatly between studies. The current study shows that the specimen type, with pus aspiration, fine needle aspiration, and primary inoculation lesion having significantly higher sensitivity than fresh or formalin-fixed paraffin-embedded lymph node biopsy specimen, rather than the type of the PCR assay, whether a conventional or a real-time assay, has a major impact on the performance of diagnostic PCR for CSD. The new data provide new tools for the clinical microbiologist when interpreting the results of the PCR assays. Primary inoculation lesions, although easily accessible, are often neglected and should be sampled more frequently for molecular diagnosis of CSD. Physicians should be aware that negative PCR, particularly if performed on fresh or paraffin-embedded lymph node biopsy specimens, does not exclude CSD.
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Affiliation(s)
- Sher Goaz
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Michal Rasis
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Lev Shapira
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ora Halutz
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Merav Graidy-Varon
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Cecilia Leibovitch
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Daniel Glikman
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Infectious Disease Unit, Padeh Poriya Medical Center, Tiberias, Israel
| | - Moshe Ephros
- Pediatric Infectious Disease Unit, Carmel Medical Center and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Giladi
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Eleftheriotis G, Skopelitis E. Concurrence of cat-scratch disease and paradoxical tuberculosis-IRIS lymphadenopathy: a case report. BMC Infect Dis 2022; 22:213. [PMID: 35241027 PMCID: PMC8895654 DOI: 10.1186/s12879-022-07170-3] [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: 11/20/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycobacterial infections can cause significant morbidity when cellular immunity is compromised. Patients with AIDS can be affected directly from infection or through mycobacterial IRIS, especially if they are previously untreated for HIV. Herein a case of tuberculous lymphadenitis is reported, which primarily responded to antimicrobials but complicated by IRIS and cat-scratch disease at a later course. CASE PRESENTATION A 23-year-old man, intravenous drug user with untreated HIV and HCV infection presented with fever and painful cervical lymphadenopathy. Mycobacterium tuberculosis was isolated from PCR and culture of ultrasound-guided lymph node aspirate and a four-drug anti-TB regimen was subsequently administered, leading to complete resolution of clinical and laboratory abnormalities. Given the patient's CD4 count (67 cells per mm3), antiretroviral treatment started seven weeks after TB treatment initiation. Within the first month of ART fever recurred along with cervical lymph node inflammation. Paradoxical IRIS was considered as the most probable diagnosis but workup expanded, revealing acute Bartonella infection. A posteriori, the patient remembered being scratched by a stray cat two weeks before his new symptoms started. Doxycycline and corticosteroid monotherapy failed to resolve symptoms, whereas a combination of doxycycline for 3 months and methylprednisolone with long-term tapering led to negative follow-up Bartonella antibodies and complete clinical and biochemical response, without recurrence. CONCLUSIONS Co-infection with TB and Bartonella presenting with lymphadenitis is unusual. Cat-scratch disease can be a rare clinical presentation of Bartonella infection in patients with AIDS, but coexistence of bartonellosis and paradoxical IRIS has never been reported before. However, physicians treating people living with HIV should be aware of this potential concurrence. Early testing for Bartonella infection could be offered in patients with TB and HIV co-infection in case of acute deterioration or partial response to treatment, especially if they have a history of cat exposure, since clinical picture can be indistinguishable.
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Affiliation(s)
- Gerasimos Eleftheriotis
- 2nd Department of Internal Medicine, General Hospital of Nikaia-Piraeus "Agios Panteleimon", 3 Andrea Petrou Mantouvalou Street, 185 43, Athens, Greece.
| | - Elias Skopelitis
- 2nd Department of Internal Medicine, General Hospital of Nikaia-Piraeus "Agios Panteleimon", 3 Andrea Petrou Mantouvalou Street, 185 43, Athens, Greece
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15
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Dietmann A, Colin-Benoit EN, Tinkhauser G, Meinel TR, Scheidegger O. Pearls & Oy-sters: Bilateral mononeuropathic neuralgic amyotrophy triggered by Bartonella henselae infection responsive to intravenous immunoglobulin. Neurology 2022; 98:597-600. [PMID: 35145008 PMCID: PMC8992605 DOI: 10.1212/wnl.0000000000200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of a cat owner with a scar on his right thenar eminence, followed by lymphadenopathy in the right axilla, general malaise and fever, and subsequent onset of bilateral neuralgic amyotrophy within one week. After a comprehensive workup, cat scratch disease caused by Bartonella henselae was confirmed serologically and adequately treated. Despite antibiotic treatment, the patient presented clinically with persistent bilateral, asymmetric neuropathy of the median nerve, predominantly the interosseous anterior nerve, which was confirmed by multifocal swelling and hyperintense signal of the nerves on T2-weighted MR neurography. Electrophysiological examination confirmed axonal median neuropathies bilaterally. After an unsuccessful steroid treatment trial, the patient showed an excellent and sustained response to intravenous immunoglobulin despite a delay from symptom onset to treatment of 10 months.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland;
| | - Eugà Nie Colin-Benoit
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switz, Switzerland
| | - Gerd Tinkhauser
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thomas Raphael Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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16
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Evaluation of ssrA-targeted real time PCR for the detection of Bartonella species in human clinical samples and reflex sequencing for species-level identification. Pathology 2022; 54:449-452. [PMID: 35125201 DOI: 10.1016/j.pathol.2021.10.014] [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: 06/17/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 11/22/2022]
Abstract
The genus Bartonella includes species capable of causing disease in animals and humans. Due to its fastidious nature, direct detection of Bartonella causing human infection relies largely on molecular microbiological methods. Thus, it is imperative that diagnostic assays in use have the ability to detect a range of Bartonella species associated with human disease. In this study, we compared the performance of a real time polymerase chain reaction (PCR) assay targeting the ssrA gene to conventional rpoB-targeted PCR and sequencing for detection and differentiation of Bartonella species in human clinical samples. The real time ssrA PCR performed better for non-Bartonella henselae species, detecting B. clarridgeiae and B. quintana DNA in heart valve specimens that were not detected by rpoB PCR, and improved the sensitivity of B. henselae detection in blood specimens. Our findings suggest the real time ssrA PCR assay is suitable for detection and identification of Bartonella species in human clinical specimens.
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17
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Ohno T, Saito S, Iwata E, Ushida S, Otsuka R, Miyahara K, Matsuura A. Blood culture-negative endocarditis caused by Bartonella henselae: a case report. Indian J Thorac Cardiovasc Surg 2021; 38:187-190. [PMID: 34754148 PMCID: PMC8568566 DOI: 10.1007/s12055-021-01266-2] [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] [Received: 06/18/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
Bartonella henselae is well known as a causative organism of cat scratch disease. Although this bacterium infrequently involves the heart, the diagnosis is difficult to confirm. A 75-year-old woman who had a pet cat presented with pancytopenia, hepatosplenomegaly, and low-grade fever. Echocardiography depicted sessile nodules on the aortic valve. C-reactive protein concentration was low, and leukocytosis was not seen. Two sets of blood culture turned out negative. However, elevated B. henselae immunoglobulin G titer led us to the diagnosis of infective endocarditis. Minocycline was administered orally in combination with intravenous administration of gentamicin as an antimicrobial treatment. The patient underwent aortic valve replacement 2 months after her initial visit. Warthin-Starry silver staining did not show any bacterial bodies. The culture of the vegetation tissue was negative. Polymerase chain reaction testing of the excised valve tissue detected the deoxyribonucleic acid of the organism. The postoperative course was uneventful, and the patient was discharged home.
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Affiliation(s)
- Tsukasa Ohno
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Shunei Saito
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Eri Iwata
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Sen Ushida
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Ryohei Otsuka
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Ken Miyahara
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Akio Matsuura
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
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18
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Lashnits E, Neupane P, Bradley JM, Richardson T, Maggi RG, Breitschwerdt EB. Comparison of Serological and Molecular Assays for Bartonella Species in Dogs with Hemangiosarcoma. Pathogens 2021; 10:pathogens10070794. [PMID: 34201572 PMCID: PMC8308881 DOI: 10.3390/pathogens10070794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Currently, a gold standard diagnostic test for Bartonella infection in dogs is lacking. This represents a critical limitation for the development and evaluation of new diagnostic tests, as well as for the diagnosis of, and research on, bartonellosis in dogs. This retrospective observational study aims to compare the results of commonly performed and newly-reported Bartonella spp. diagnostic tests in banked clinical specimens from 90 dogs with hemangiosarcoma (HSA) using composite reference standard (CRS) and random effects latent class analysis (RE-LCA) techniques. Samples from each dog were tested using six serological or molecular diagnostic assays, including indirect fluorescent antibody (IFA) and Western blot (WB) for the detection of antibodies in serum, and qPCR and droplet digital PCR (ddPCR) in blood and fresh frozen tissue biopsy samples (mainly splenic HSA tumors and histopathologically normal spleen or skin/adipose tissue). Bartonella infection prevalence was estimated to be 78% based on the CRS (parallel testing with all six assays), and 64% based on the RE-LCA model. The assay with the highest diagnostic accuracy was qPCR performed on fresh frozen tissue biopsy samples (sensitivity: 94% by RE-LCA and 80% by CRS; specificity: 100%). When comparing newly-reported to traditional Bartonella diagnostic assays, ddPCR was more sensitive for the detection of Bartonella DNA than qPCR when testing blood samples (36% vs. 0%, p < 0.0001). Dogs that were positive on serological assays alone with negative molecular assays were highly unlikely (<3%) to be classified as infected by the RE-LCA model. These data indicate that Bartonella spp. DNA can be PCR amplified from fresh frozen tissues from a majority of dogs with HSA using both qPCR and ddPCR, supporting the use of these methods for future controlled studies comparing the prevalence of Bartonella spp. DNA in the tissue of dogs with HSA to that of unaffected controls.
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Affiliation(s)
- Erin Lashnits
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53713, USA;
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Pradeep Neupane
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Julie M. Bradley
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Toni Richardson
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Ricardo G. Maggi
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Edward B. Breitschwerdt
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
- Correspondence:
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19
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Tram N, Cheyssac É, Toumi C, Laurent A, Bertholet-Thomas A, Viremouneix L, Bacchetta J, Ranchin B. Disseminated bartonellosis in a child with steroid-dependent nephrotic syndrome receiving mycophenolate mofetil monotherapy. Nephrol Ther 2021; 17:463-465. [PMID: 33985919 DOI: 10.1016/j.nephro.2021.02.002] [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: 12/23/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
Cat scratch disease, usually a benign infectious disease, may develop as multisystem disease with multiorgan involvement, particularly in immunocompromised patients. We report on a patient who developed disseminated bartonellosis while receiving mycophenolate mofetil monotherapy treating steroid-dependent nephrotic syndrome, highlighting that severe infection can be observed in those patients. Therefore, this category of patients should be cautious when having contact with kittens and receives proper prevention advice.
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Affiliation(s)
- Nathalie Tram
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Élodie Cheyssac
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Chadia Toumi
- Service des maladies infectieuses pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Audrey Laurent
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Aurélia Bertholet-Thomas
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Loïc Viremouneix
- Service d'imagerie médicale, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Justine Bacchetta
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Faculté de médecine Lyon Est, Université de Lyon, Lyon, France
| | - Bruno Ranchin
- Centre de référence des Maladies rénales rares, service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
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20
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Sodini C, Zani EM, Pecora F, Conte C, Patianna VD, Prezioso G, Principi N, Esposito S. A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child. Microorganisms 2021; 9:microorganisms9050950. [PMID: 33924906 PMCID: PMC8146596 DOI: 10.3390/microorganisms9050950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
In most cases, infection due to Bartonella henselae causes a mild disease presenting with a regional lymphadenopathy frequently associated with a low-grade fever, headache, poor appetite and exhaustion that spontaneously resolves itself in a few weeks. As the infection is generally transmitted by cats through scratching or biting, the disease is named cat scratch disease (CSD). However, in 5–20% of cases, mainly in immunocompromised patients, systemic involvement can occur and CSD may result in major illness. This report describes a case of systemic CSD diagnosed in an immunocompetent 4-year-old child that can be used as an example of the problems that pediatricians must solve to reach a diagnosis of atypical CSD. Despite the child’s lack of history suggesting any contact with cats and the absence of regional lymphadenopathy, the presence of a high fever, deterioration of their general condition, increased inflammatory biomarkers, hepatosplenic lesions (i.e., multiple abscesses), pericardial effusion with mild mitral valve regurgitation and a mild dilatation of the proximal and medial portion of the right coronary artery, seroconversion for B. henselae (IgG 1:256) supported the diagnosis of atypical CSD. Administration of oral azithromycin was initiated (10 mg/kg/die for 3 days) with a progressive normalization of clinical, laboratory and US hepatosplenic and cardiac findings. This case shows that the diagnosis of atypical CSD is challenging. The nonspecific, composite and variable clinical features of this disease require a careful evaluation in order to achieve a precise diagnosis and to avoid both a delayed diagnosis and therapy with a risk of negative evolution.
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Affiliation(s)
- Chiara Sodini
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.S.); (E.M.Z.); (F.P.); (C.C.); (V.D.P.); (G.P.)
| | - Elena Mariotti Zani
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.S.); (E.M.Z.); (F.P.); (C.C.); (V.D.P.); (G.P.)
| | - Francesco Pecora
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.S.); (E.M.Z.); (F.P.); (C.C.); (V.D.P.); (G.P.)
| | - Cristiano Conte
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.S.); (E.M.Z.); (F.P.); (C.C.); (V.D.P.); (G.P.)
| | - Viviana Dora Patianna
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.S.); (E.M.Z.); (F.P.); (C.C.); (V.D.P.); (G.P.)
| | - Giovanni Prezioso
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.S.); (E.M.Z.); (F.P.); (C.C.); (V.D.P.); (G.P.)
| | | | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.S.); (E.M.Z.); (F.P.); (C.C.); (V.D.P.); (G.P.)
- Correspondence: ; Tel.: +39-0521-704790
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21
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Blondeau JM, Rankin SC. Diagnostic clinical microbiology. J Vet Pharmacol Ther 2021; 44:250-269. [PMID: 33686661 DOI: 10.1111/jvp.12962] [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: 10/06/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
Technological advancements have changed the way clinical microbiology laboratories are detecting and identifying bacterial, viral, parasitic, and yeast/fungal pathogens. Such advancements have improved sensitivity and specificity and reduce turnaround time to reporting of clinically important results. This article discusses and reviews some traditional methodologies along with some of the technological innovations introduced into diagnostic microbiology laboratories. Some insight to what might be available in the coming years is also discussed.
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Affiliation(s)
- Joseph M Blondeau
- Division of Clinical Microbiology, Royal University Hospital and Saskatchewan Health Authority, Saskatoon, SK, Canada.,Department of Microbiology and Immunology, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Ophthalmology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shelley C Rankin
- Department of Pathobiology, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA
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22
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Abstract
Diagnosis of systemic cat scratch disease may be challenging. Here, we describe a case of an immunocompetent girl exhibiting fever and multifocal hepatosplenic abscesses. Diagnostic tests for Bartonella henselae infection (enzyme immunoassay and polymerase chain reaction) were found steadily negative and the diagnosis, suspected on the basis of the Margilet's criteria, was finally confirmed by indirect immunofluorescent antibodies.
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Pediatric Bartonella henselae Infection: The Role of Serologic Diagnosis and a Proposed Clinical Approach for Suspected Acute Disease in the Immunocompetent Child. Pediatr Infect Dis J 2020; 39:984-989. [PMID: 32826721 DOI: 10.1097/inf.0000000000002852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bartonella henselae serology is commonly used to diagnose cat-scratch disease (CSD). Titers above a threshold for positivity suggest either a recent or remote infection. Recent infection can be confirmed by a 4-fold rise in the convalescent titer in some cases. Many atypical presentations attributed to CSD utilize a low threshold for positivity without supportive evidence from convalescent sera or supplemental testing, raising a concern for the overdiagnosis of CSD. METHODS We conducted a retrospective chart review of immunocompetent pediatric patients at the Hospital for Sick Children, Toronto, spanning an 11-year period. A total of 154 cases were included with serologic titers ≥1:128. These were divided into 3 groups: group 1 = 1:128, group 2 = 1:256, and group 3 ≥ 1:512. Cases within groups were evaluated with respect to cat contact, clinical presentation, further testing, and final diagnosis. RESULTS One-third of patients with a titer of 1:128 had an alternative diagnosis. Most cases with a titer of 1:128 or 1:256 did not have convalescent serologic testing performed. Within these 2 groups, only 1 case had a 4-fold rise in the convalescent titer. A trend of decreasing number of cases with alternative diagnoses (P = 0.03) and increasing number of cases presenting with regional lymphadenopathy (P = 0.07) was associated with higher titers in group 3 compared with group 1. CONCLUSION Concerns about the serologic diagnosis of CSD include the use of low titers for positivity, incomplete diagnostic evaluation, and the lack of convalescent serologic testing. We propose a clinical guide to assist in managing suspected cases of CSD.
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Bayart JL, Gusbin C, Lardinois B, Scohy A, Kabamba-Mukadi B. Analytical and clinical evaluation of new automated chemiluminescent immunoassays for the detection of IgG and IgM anti-Bartonella henselae antibodies. Diagn Microbiol Infect Dis 2020; 98:115203. [PMID: 33032158 DOI: 10.1016/j.diagmicrobio.2020.115203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/23/2022]
Abstract
Serological diagnosis of Bartonella henselae infection mainly rely on microscopic immunofluorescence assays (IFA), which are however time-consuming and poorly standardized. The aim of the study was to assess the use of the new fully automated VirClia® chemiluminescent immunoassays for the detection of IgG and IgM anti-B. henselae antibodies. Eighty-one patients with a well-defined B. henselae infection as well as 80 patients with an alternative disease were included. The VirClia® IgG antibody assay showed a sensitivity of 79.0% and a specificity of 93.8% for the diagnosis of B. henselae infection. For the VirClia® IgM assay, results were more conflicting with a sensitivity of 42.0% and a specificity of 98.2% to predict IFA IgM results. In 11 additional patients with uninterpretable IFA due to autoimmune antibodies, VirClia® assays were able to deliver valuable quantitative results. The VirClia® IgG assay shows good analytical and clinical performances and could be easily integrated in the diagnostic workflow of B. henselae infection.
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Affiliation(s)
- Jean-Louis Bayart
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium.
| | - Catherine Gusbin
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Lardinois
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
| | - Anaïs Scohy
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
| | - Benoît Kabamba-Mukadi
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium; Pôle de Recherche en Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Centre National de Référence Bartonella, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
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Johnson A. Ocular complications of cat scratch disease. Br J Ophthalmol 2020; 104:1640-1646. [PMID: 32122915 DOI: 10.1136/bjophthalmol-2019-315239] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/22/2020] [Accepted: 02/13/2020] [Indexed: 11/03/2022]
Abstract
Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud's oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.
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Affiliation(s)
- Alan Johnson
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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