Variantes en la presentación clínica de la enfermedad por arañazo de gato en niños del hospital Garrahan / Variants in the clinical presentation of cat scratch disease in children at Garrahan Hospital

La infección por Bartonella henselae (BH) adopta diversas formas de presentación clínica en pediatría. Según la bibliografía la forma de presentación más frecuente en pacientes inmunocompetentes es la linfadenopatía única asociada a fiebre. En el 85 % de los casos se compromete un solo ganglio siendo los axilares y los epitrocleares los más frecuentemente involucrados. Existen otras formas de presentación menos frecuentes que debemos tener en consideración, para poder realizar un diagnóstico precoz e indicar un tratamiento adecuado si así lo requiere. El diagnóstico requiere de la sospecha clínica del equipo de salud tratante, junto al antecedente epidemiológico, los hallazgos clínicos del examen físico y la realización de serologías que incluyan el dosaje de inmunoglobulina M y G. Los objetivos del presente trabajo fueron reconocer las manifestaciones clínicas típicas y atípicas de la EAG por Bartonella henselae, describir la epidemiología, características clínicas y evolución de esta enfermedad que se presentaron en nuestro hospital. Se estudiaron un total de 187 pacientes. La media de edad fue de 7.6 años (rango 1-14); siendo 53.5% de género masculino. Las formas de presentación más frecuentes en nuestro trabajo fueron la adenitis y la fiebre. La mayoría recibió diversos esquemas de tratamiento antibiótico, secundario al retraso en el diagnóstico. La tasa de hospitalización fue muy baja, remitió con tratamiento ambulatorio con antibióticos o sin ellos (AU)

Bartonella henselae infection has different clinical presentations in pediatrics. According to the literature, the most common form of presentation in immunocompetent patients is single lymphadenopathy associated with fever. In 85 % of the cases a single lymph node is involved, with the axillary and epitrochlear nodes being the most commonly involved. There are other, less frequent, forms of presentation that should be taken into consideration in order to make an early diagnosis and indicate appropriate treatment if required. Diagnosis relies on clinical suspicion by the treating healthcare team, together with the epidemiological history, clinical findings on physical examination, and serology including immunoglobulin M and G dosage. The objectives of this study were to identify both the typical and atypical clinical manifestations of Bartonella henselae cat scratch disease, to describe the epidemiology, clinical characteristics, and outcomes of cases presenting at our hospital. A total of 187 patients were studied. The mean age was 7.6 years (range 1-14); 53.5% were male. The most frequent forms of presentation in our study were adenitis and fever. Most of them received different antibiotic treatment regimens due to delayed diagnosis. The hospitalization rate was very low and the disease typically resolved with outpatient treatment, with or without antibiotics (AU)

Enfermedad por arañazo de gato: experiencia en unhospital pediátrico de tercer nivel / Cat-scratch disease: Experience in a tertiary care children's hospital

Introducción. Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato. Afecta a niños y a adultos jóvenes. El espectro clínico es amplio; la forma de presentación más frecuente es la linfadenopatía única. El objetivo de este estudio fue analizar epidemiología, características clínicas y evolución de esta enfermedad en un hospital de alta complejidad de Argentina. Población y métodos. Estudio retrospectivo, descriptivo y observacional realizado en un hospital pediátrico de tercer nivel, desde el 01 de enero de 2019 hasta el 30 de junio de 2021. Se incluyeron niños de 0 a 16 años con clínica compatible y serología positiva. Resultados. Se incluyeron 150 niños, con una media de edad de 7,9 años ± 3,68. El 68,7 % refirió tener contacto con gatos. El motivo de consulta más frecuente fueron las adenopatías únicas (84,7 %) localizadas en cabeza y cuello. El síndrome febril sin foco motivó la consulta en el 15,5 % de los casos, con ecografía abdominal patológica en el 85,7 %. Presentó IgM e IgG positivas el 88 %. Con el resultado de la serología positiva, el 44 % recibió tratamiento antibiótico. Las adenopatías prolongadas fueron la principal causa de su instauración; el más utilizado fue la azitromicina (42,4 %). El 14 % (n = 21) requirió internación. Conclusiones. El diagnóstico implica sospecha clínica, nexo epidemiológico y exámenes complementarios. Su forma típica son las adenomegalias únicas localizadas en cabeza y cuello. Debido a la alta frecuencia de compromiso hepatoesplénico, la realización de ecografía abdominal estaría indicada en niños con fiebre.

Introduction. Bartonella henselae is the etiologic agent in cat-scratch disease. It affects children and young adults. The clinical spectrum is wide; the most common clinical presentation is a solitary lymphadenopathy. The objective of this study was to analyze the epidemiology, clinical features, and course of this disease in a tertiary care hospital in Argentina. Population and methods. Retrospective, descriptive, and observational study conducted at a tertiary care pediatric hospital from January 1st, 2019 to June 30 th, 2021. Children aged 0 to 16 years with compatible clinical signs and symptoms and positive serology were included. Results. A total of 150 patients were included; their mean age was 7.9 years ± 3.68. Of them, 68.7% reported having contact with cats. The most common reason for consultation was the presence of solitary lymphadenopathies (84.7%) in the head and neck. Febrile syndrome without source was the reason for consultation in 15.5% of cases, with a pathological abdominal ultrasound scan in 85.7%. IgM and IgG were positive in 88%. With the result of a positive serology test, 44% received antibiotic treatment. Protracted lymphadenopathy was the main reason for antibiotic treatment; the agent most commonly used was azithromycin (42.4%). Fourteen percent (n = 21) required hospitalization. Conclusions. Diagnosis is based on clinical suspicion, epidemiological history, and complementary testing. Its typical presentation is a solitary enlarged lymph node in the head and neck. Due to the high frequency of hepatosplenic involvement, an abdominal ultrasound scan would be indicated in children with fever.

Cat-scratch disease: Experience in a tertiary care children's hospital. / Enfermedad por arañazo de gato: experiencia en un hospital pediátrico de tercer nivel.

Introduction. Bartonella henselae is the etiologic agent in cat-scratch disease. It affects children and young adults. The clinical spectrum is wide; the most common clinical presentation is a solitary lymphadenopathy. The objective of this study was to analyze the epidemiology, clinical features, and course of this disease in a tertiary care hospital in Argentina. Population and methods. Retrospective, descriptive, and observational study conducted at a tertiary care pediatric hospital from January 1st , 2019 to June 30th, 2021. Children aged 0 to 16 years with compatible clinical signs and symptoms and positive serology were included. Results. A total of 150 patients were included; their mean age was 7.9 years ± 3.68. Of them, 68.7% reported having contact with cats. The most common reason for consultation was the presence of solitary lymphadenopathies (84.7%) in the head and neck. Febrile syndrome without source was the reason for consultation in 15.5% of cases, with a pathological abdominal ultrasound scan in 85.7%. IgM and IgG were positive in 88%. With the result of a positive serology test, 44% received antibiotic treatment. Protracted lymphadenopathy was the main reason for antibiotic treatment; the agent most commonly used was azithromycin (42.4%). Fourteen percent (n = 21) required hospitalization. Conclusions. Diagnosis is based on clinical suspicion, epidemiological history, and complementary testing. Its typical presentation is a solitary enlarged lymph node in the head and neck. Due to the high frequency of hepatosplenic involvement, an abdominal ultrasound scan would be indicated in children with fever.

Introducción. Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato. Afecta a niños y a adultos jóvenes. El espectro clínico es amplio; la forma de presentación más frecuente es la linfadenopatía única. El objetivo de este estudio fue analizar epidemiología, características clínicas y evolución de esta enfermedad en un hospital de alta complejidad de Argentina. Población y métodos. Estudio retrospectivo, descriptivo y observacional realizado en un hospital pediátrico de tercer nivel, desde el 01 de enero de 2019 hasta el 30 de junio de 2021. Se incluyeron niños de 0 a 16 años con clínica compatible y serología positiva. Resultados. Se incluyeron 150 niños, con una media de edad de 7,9 años ± 3,68. El 68,7 % refirió tener contacto con gatos. El motivo de consulta más frecuente fueron las adenopatías únicas (84,7 %) localizadas en cabeza y cuello. El síndrome febril sin foco motivó la consulta en el 15,5 % de los casos, con ecografía abdominal patológica en el 85,7 %. Presentó IgM e IgG positivas el 88 %. Con el resultado de la serología positiva, el 44 % recibió tratamiento antibiótico. Las adenopatías prolongadas fueron la principal causa de su instauración; el más utilizado fue la azitromicina (42,4 %). El 14 % (n = 21) requirió internación. Conclusiones. El diagnóstico implica sospecha clínica, nexo epidemiológico y exámenes complementarios. Su forma típica son las adenomegalias únicas localizadas en cabeza y cuello. Debido a la alta frecuencia de compromiso hepatoesplénico, la realización de ecografía abdominal estaría indicada en niños con fiebre.

Cat-scratch Disease in the Pediatric Population: 6 Years of Evaluation and Follow-up in a Public Hospital in Chile.

BACKGROUND: Bartonella henselae is the etiologic agent of cat-scratch disease, which affects the entire world population. Due to how poorly characterized the child population is, the objective was to describe the clinical behavior of this disease in children younger than 16 years of age. METHODS: This was a descriptive study with prospective follow-up of all children younger than 16 years with clinical and serologic diagnoses between 2013 and 2018. RESULTS: There were 142 patients; of these, 55.6% had localized disease, 34.5% disseminated with hepatosplenic involvement and 9.8% had atypical disease. The cases of atypical disease were prolonged febrile illness, Parinaud syndrome, subacute bacterial endocarditis/glomerulonephritis and aseptic meningitis. Cervical lymphadenopathy was the most frequent, followed by inguinal adenopathy. There were no differences between the type of manifestation and laboratory values except for a higher erythrocyte sedimentation rate tendency in patients with disseminated and/or atypical disease. The serologic titers throughout were distributed as follows: titer of 1/1024, 71.7%; titer of 1/512, 10.4% and titer of 1/256, 17.9%. CONCLUSIONS: This is, to our knowledge, the largest series of cat-scratch disease published. We demonstrate that in our environment, the inguinal location is suggestive of this disease, the disseminated presentation, frequent, and that the titers are probably much higher than in other populations, which perhaps indicates the need to re-examine the cut-off point for positivity.

Infectious and Autoimmune Causes of Encephalitis in Children.

BACKGROUND AND OBJECTIVES: Encephalitis can result in neurologic morbidity and mortality in children. Newly recognized infectious and noninfectious causes of encephalitis have become increasingly important over the past decade. METHODS: We retrospectively reviewed medical records from pediatric patients in Houston diagnosed with encephalitis in both an urban and rural catchment area between 2010 and 2017. We conducted an investigation to understand the etiology, clinical characteristics, and diagnostic testing practices in this population. RESULTS: We evaluated 231 patients who met the case definition of encephalitis, among which 42% had no recognized etiology. Among those with an identified etiology, the most common were infectious (73; 31%), including viral (n = 51; 22%), with the most frequent being West Nile virus (WNV; n = 12), and bacterial (n = 19; 8%), with the most frequent being Bartonella henselae (n = 7). Among cases of autoimmune encephalitis (n = 60; 26%), the most frequent cause was anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (n = 31). Autoimmune causes were seen more commonly in female (P < .01) patients. Testing for herpes simplex virus and enterovirus was nearly universal; testing for anti-NMDAR encephalitis, WNV, and Bartonella was less common. CONCLUSIONS: WNV was the most common infectious cause of encephalitis in our pediatric population despite lower testing frequency for WNV than herpes simplex virus or enterovirus. Increasing testing for anti-NMDAR encephalitis resulted in frequent identification of cases. Increased awareness and testing for WNV and Bartonella would likely result in more identified causes of pediatric encephalitis. Earlier etiologic diagnosis of encephalitides may lead to improve clinical outcomes.

Cat Scratch Disease Presenting as Fever of Unknown Origin Is a Unique Clinical Syndrome.

BACKGROUND: Fever of unknown origin (FUO) is a rare manifestation of cat scratch disease (CSD). Data regarding CSD-associated FUO (CSD-FUO), particularly in adults, are limited. We aimed to study disease manifestations and long-term clinical outcome. METHODS: A national CSD surveillance study has been conducted in Israel since 1991. Data are obtained using questionnaires, review of medical records, and telephone interviews. FUO was defined as fever of ≥14 days without an identifiable cause. CSD-FUO patients were identified in the 2004-2017 CSD national registry. Follow-up included outpatient clinic visits and telephone/e-mail surveys. RESULTS: The study included 66 CSD-FUO patients. Median age was 35.5 years (range, 3-88). Median fever duration was 4 weeks (range, 2-9). Relapsing fever pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal osteomyelitis (6%) were the most common. Malignancy, particularly lymphoma, was the initial radiological interpretation in 21% of patients; 32% underwent invasive diagnostic procedures. Of the 59 patients available for follow-up (median duration, 31 weeks; range, 4-445), 95% had complete recovery; 3 patients remained with ocular sequelae. CONCLUSION: This is the first attempt to characterize CSD-FUO as a unique syndrome that may be severe and debilitating and often mimics malignancy. Relapsing fever is a common clinical phenotype. Multiorgan involvement is common. Recovery was complete in all patients except in those with ocular disease.

Pediatric neck masses: how clinical and radiological features can drive diagnosis.

Pediatric neck masses are a common occurrence and often represent a diagnostic challenge. The primary aim of this retrospective study was to evaluate the clinical and radiological features of neck masses in children and how they can drive diagnosis. The secondary aim was to create a diagnostic algorithm based on clinical features. We evaluated 190 children with neck masses who needed hospitalization. Clinical data and imaging findings were collected. The patients were divided into six groups: congenital/developmental lesions, tumors, acute and subacute lymphadenopathies, chronic nonspecific lymphadenopathies, cat-scratch disease, and mycobacteriosis. Reactive lymphadenopathies were observed in the majority of cases (65.8%). Congenital/developmental cysts were present in 28.9%, while 5.3% had a tumor. A lower mean age was observed for acute/subacute lymphadenopathies and mycobacteriosis. Fever and a painful mass were typical of acute/subacute lymphadenopaties and cat-scratch disease. A hard and fixed mass was not only typical of tumors. Concerning imaging findings, multiple lymph nodes at the same level was mainly observed in mycobacteriosis, while bilateral lymph node enlargement and colliquation were present in lymphadenopathies.Conclusion:A complete and adequate clinical assessment should be the basis for every diagnostic and therapeutic choice in children with neck masses. What is Known: • Pediatric neck masses are a common occurrence and often represent a diagnostic challenge. • Clinical features, serological exams and imaging findings should drive the physician to an appropriate diagnostic hypothesis. What is New: • A lower mean age was observed for acute/subacute lymphadenopathies and mycobacteriosis. • A hard and fixed mass was not only typical of tumors. • Multiple lymph nodes at the same level were mainly observed in mycobacteriosis, while bilateral lymph node enlargement and colliquation were present in nonspecific lymphadenopathies.

Bartonella henselae in Italy: a rare seasonal infection.

BACKGROUND: Symptomatic Bartonella henselae infection is considered rare in Europe. Cat fleas transmit the microorganism between cats, but their role in transmission of B. henselae to humans has not been defined. The aim of our study was to perform a retrospective study of detected cases at our Hospital. METHODS: We retrospectively analyzed data of all children showing lymphadenopathy and a 4-fold increase in specific IgM for B. henselae over the period from June 2010 to May 2015. We therefore examined clinical data, laboratory exams in order to achieve a description of the expression of Bartonella infection in our series: age, geographical area of origin, symptoms, laboratory exams, the seat of the swelling lymph nodes with ultrasound description, and data on biopsy of lymph node when performed. RESULTS: We could identify a total of 7 patients (4 females, range of age: mean age 8.75±2.87 SD): three cases in 2011 and 1 case per year in 2010, 2012, 2013 and 2014 with an average distance between one case and the sequent of 246.16±214.54 days. All patients came from small towns with no preference between the inland and coastal areas. The infection was characterized only by lymphadenopathy with nonspecific alterations at blood tests and with no history of cat scratch. CONCLUSIONS: By our experience, Bartonella infection presents as a seasonal disease with increased incidence in autumn, with peaks in October, and a decrease after spring. In conclusion, infection with B. henselae is an issue to keep in consideration in all cases of lymphadenopathy, especially in children coming from small towns even without a declared cat scratch.

Bartonella henselae infection in diverse clinical conditions in a tertiary care hospital in north India.

BACKGROUND & OBJECTIVES: : Bartonella henselae causes infections which closely resemble febrile illness and chronic diseases such as tuberculosis and haematological malignancies. There are not many studies on Bartonella infections from India. The present study was undertaken to diagnose B. henselae infection in diverse clinical conditions in a tertiary care hospital in north India. METHODS: A total of 145 patients including those with fever and lymphadenopathy, infective endocarditis and neuroretinitis were enrolled in the study. Whole blood, serum and lymph node aspirate and valvular vegetations if available, were obtained. Samples were plated on chocolate agar and brain-heart infusion agar containing five per cent fresh rabbit blood and were incubated at 35°C for at least four weeks in five per cent CO2with high humidity. Immunofluorescent antibody assay (IFA) was done for the detection of IgM antibodies in the serum using a commercial kit. Whole blood was used to perform polymerase chain reaction (PCR) for the citrate synthase gene (gltA). RESULTS: IFA was positive in 11 of 140 (7.85%) patients and PCR was positive in 3 of 140 (2.14%) patients. Culture was negative in all the cases. A higher incidence of Bartonella infection was seen in patients with fever and lymphadenopathy (n=30), seven of whom were children. In ophthalmological conditions, four cases were IFA positive. INTERPRETATION & CONCLUSIONS: The present study shows that the threat of Bartonella infection is a reality in India. It is also an important treatable cause of fever and lymphadenopathy in children. Serology and PCR are useful tests for its diagnosis. Clinicians should consider. BARTONELLA: infection in the differential diagnosis of febrile illnesses and chronic diseases.

Bartonellosis in Chronic Kidney Disease: An Unrecognized and Unsuspected Diagnosis.

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.

Molecular survey of Bartonella henselae and Bartonella clarridgeiae in pet cats across Japan by species-specific nested-PCR.

Cats are known to be the main reservoir for Bartonella henselae and Bartonella clarridgeiae, which are the agents of 'cat-scratch disease' in humans. In the present study, we investigated the prevalence of the two Bartonella species on 1754 cat bloods collected from all prefectures in Japan during 2007-2008 by a nested-polymerase chain reaction (PCR) targeting the 16S-23S rRNA internal transcribed spacer region. Overall, Bartonella DNA was detected in 4·6% (80/1754) of the cats examined. The nested-PCR showed that 48·8% (39/80) of the positive cats were infected with B. henselae mono-infection, 33·8% (27/80) with B. clarridgeiae mono-infection and 17·5% (14/80) were infected with both species. The prevalence (5·9%; 65/1103) of Bartonella infection in the western part of Japan was significantly higher than that (2·3%; 15/651) of eastern Japan (P < 0·001). Statistical analysis of the cats examined suggested a significant association between Bartonella infection and FeLV infection (OR = 1·9; 95% CI = 1·1-3·4), but not with FIV infection (OR = 1·6; 95% CI = 1·0-2·6).

Posterior segment involvement in cat-scratch disease: A case series.

INTRODUCTION: Cat-scratch disease (CSD) is a systemic infectious disease. The most well-known posterior segment presentation is neuroretinitis with a macular star. In this study, we present a case series emphasising the heterogeneity of the disease and the various posterior segment manifestations. MATERIALS AND METHODS: A retrospective case series of consecutive patients presenting with posterior segment CSD, over a 5-year period (2010 to 2015), at two ophthalmological centres in Midi-Pyrénées. RESULTS: Twelve patients (17 eyes) were included, of whom 11 (92%) presented with rapidly decreasing visual acuity, with 6 of these (50%) extremely abrupt. CSD was bilateral in 5 (42% of all patients). Posterior manifestations were: 12 instances of optic nerve edema (100%), 8 of focal chorioretinitis (67%) and only 6 of the classic macular edema with macular star (25% at first examination, but 50% later). Other ophthalmological complications developed in three patients; one developed acute anterior ischemic optic neuropathy, one a retrohyaloid hemorrhage and one a branch retinal artery occlusion, all secondary to occlusive focal vasculitis adjacent to focal chorioretinitis. CONCLUSION: Classical neuroretinitis with macular star is not the only clinical presentation of CSD. Practitioners should screen for Bartonella henselae in all patients with papillitis or focal chorioretinitis.

[Seroprevalence of Bartonella henselae and Bartonella quintana in blood donors in Aydin province, Turkey]. / Aydin ili kan donörlerinde Bartonella henselae ve Bartonella quintana seroprevalansi

Bartonella species cause several diseases in humans such as cat stratch disease, bacillary angiomatosis, peliosis hepatis, endocarditis, Carrion disease and trench fever. Cat scratch disease and bacillary angiomatosis cases have already been reported in Turkey. Studies from our region, namely Aydin (a province located at Western Anatolia, Turkey) indicated that mean Bartonella henselae IgG seropositivity rate is 11.5% in risk groups and may reach to 26.5% in pet owners. The aim of this study was to determine the seroprevalence of B.henselae and B.quintana in healthy blood donors in our university hospital in Aydin, for estimating the transmission risk via transfusion. The study was designed as a cross-sectional epidemiological study. A total of 333 samples taken from blood donors (49 female, 284 male) who were sequentially admitted to the blood center of the university hospital, in January 2011 were included in the study. All sera were screened in terms of B.henselae and Bartonella quintana IgG antibodies by using two different indirect immunofluorescent antibody (IFA) commercial kits (Vircell, Spain; Focus, USA). Slides were examined at a final magnification of x400 on fluorescent microscope by two different assigned researchers. Fluorescent intensity was graded between 1+ to 4+, and the samples with fluorescence value of ≥ 2+ were considered as positive. The seropositivity rate of IgG antibodies to B.henselae was found as 3.3% (11/333) in blood donors. This rate was 4.1% in female, and 3.2% in male donors, showing no statistically significant difference between the genders (p= 0.668). B.henselae antibody titers were detected as 1/64 in 6 (1.8%), 1/128 in 4 (1.2%) and 1/1024 in 1 (0.3%) patient. All of the B.henselae IgG positive samples also yielded relatively low positivity for B.quintana IgG, possibly indicating cross reactivity. The fluorescence intensity for different kits used was found to be the same in all but one titer. The results reported by two researchers were found to differ only in the samples graded 1+ or below. However, the evaluation differences between the kits and the researchers did not affect the results. It was concluded that B.henselae infection might be found in the blood donors in our region, thus, a detailed questionnaire prior to blood donation might be helpful to prevent transmission of B.henselae by blood transfusion.

[Cat scratch disease: still current zoonosis]. / Felinóza- stále aktuální zoonóza

OBJECTIVES: A retrospective evaluation of a group of patients which is focused on clinical picture, serological diagnosis, therapy and familial occurrence of the disease. MATERIAL AND METHODS: Cat scratch disease (CSD) was considered within the scope of a differential diagnosis of lymphadenopathy. Serological diagnosis was based on detection of antibodies against Bartonella henselae by indirect immunofluorescence, where the level of IgG antibodies of at least 1 : 256 or any positive level of IgM antibodies were considered positive for CSD. If a histological examination was conducted, the suspicion of CSD was supported by finding granulomatous inflammation. Macrolides were used for treatment in both children and adults. In addition to macrolides, doxycycline was used in adults. RESULTS: From 2004 to 2013, a total of 27 patients aged 7-73 years were diagnosed with CSD at the Clinic of Infectious Medicine, University Hospital in Ostrava. None of them suffered from immunodeficiency detected earlier. Diagnostic extirpation of a lymph node was performed in 5 patients diagnosed with granulomatous inflammation. Lymph node syndrome was observed in all patients, with cervical, inguinal and axillary nodes being most frequently affected. However, two patients had supraclavicular nodes affected and a 52-year-old woman had unusual swelling of lymphatic tissue in the scapular region with skin lesions. Lymph node syndrome accompanied by encephalopathy was observed in one 50-year-old patient. Positive IgM antibodies were detected in only 8 patients. There were two cases of familial occurrence affecting 2 and 3 family members. Antibiotic therapy with full resolution of clinical findings was successful in 24 patients, including the patient with encephalopathy. In spite of the antibiotic treatment, three patients developed lymph node colliquation requiring surgical intervention. CONCLUSIONS: Atypical lymph node localization in 3 patients, encephalopathy in 1 patient, positive levels of IgM antibodies in 8 only patients, delayed antibodies production in 4 patients and antibiotic therapy coupled with extirpation of colliquated lymph nodes in 3 patients were found in the group of 27 patients.

Bartonella henselae en niños con adenitis regional atendidos en un hospital nacional del Perú, 2012 / Bartonella henselae in children with regional adenitis treated in a Peruvian national hospital, 2012

Con el objetivo de determinar la frecuencia de casos seropositivos a Bartonella henselae en niños con adenitis regional atendidos en un hospital nacional del Perú, se realizó un estudio trasversal en 106 niños con adenitis regional mayor de 1 cm de diámetro, de aparición aguda, con tiempo de enfermedad mayor de cinco días, atendidos en el Instituto Nacional de Salud del Niño durante el año 2012. Se definió seropositividad para B. henselae mediante el examen de inmunofluorescencia indirecta, siendo positivos 86 niños (81,1%) con una mediana de edad de 7 años, rango de 5 a 11; en el análisis bivariado se encontraron como factores asociados, edad mayor de 5 años, antecedentes de fiebre, adenopatía mayor de 4 cm y reporte de contacto con gato. En conclusión, los niños con adenitis regional atendidos en este hospital de referencia nacional presentaron una frecuencia alta de serología positiva para B. henselae.

In order to determine the frequency of seropositive cases of Bartonella henselae in children with regional adenitis treated in a national hospital in Peru, a cross-sectional study was conducted in 106 children with regional adenitis greater than 1 cm in diameter. The sample was selected from patients aged 5-11 years seen at the National Institute of Child Health for acute onset of regional adentitis, with more than five days of symptoms. B. henselae seropositivity was defined by indirect immunofluorescence test. We found that 86 children (81.1%) were positive for B.henselae. The median age of the patients was 7 years. In the bivariate analysis, the following associated factors were found: aged 5 years, history of fever, lymphadenopathy greater than 4 cm and reported contact with cat. In conclusion, children with regional adenitis treated in this national referral hospital showed a high frequency of positive serology for B. henselae.

Infecções associadas a felinos domésticos com esporotricose atendidos no IPEC/FIOCRUZ com ênfase na infecção por Bartonella spp / Infections in domestic cats with sporotrichosis with emphasis on infection by Bartonella spp

A doença da arranhadura do gato é uma zoonose causada por bactérias do gênero Bartonella. O gato atua como reservatório de Bartonella henselae e a transmissão ao humano ocorre através da arranhadura ou mordedura. A esporotricose, causada por fungos do complexo Sporothrix, é transmitida aos humanos através da implantação traumática deste microrganismo no tecido subcutâneo. Os gatos com esporotricose apresentam lesões cutâneas ulceradas com elevada carga parasitária e têm importante papel na transmissão. Nos últimos 14 anos foram diagnosticados mais de 3.000 casos de esporotricose felina no IPEC/FIOCRUZ. Com o objetivo de estudar a soroprevalência de infecção por Bartonella spp. em gatos com esporotricose, 112 amostras de soro foram submetidas ao teste de imunofluorescência indireta utilizando o kit B. henselae IFA IgG (Bion®, USA). Além disso, foi realizada a pesquisa de anticorpos anti-vírus da leucemia felina (FeLV) e antígenos do vírus da imunodeficiência felina (FIV) utilizando kit comercial Snap Combo FIV-FeLV (Idexx®, USA). Um grupo composto por 77 amostras de soro de gatos sem lesões cutâneas aparentes também foi incluído no estudo. No grupo de gatos com esporotricose, 93 eram machos, a idade mediana foi 22 meses e oito (7,1 por cento) foram positivos para FIV e 15 (13,4 por cento) para FeLVNo grupo sem lesões cutâneas, 36 eram machos, a idade mediana foi 48 meses, e dez (13,0 por cento) gatos foram positivos para FIV e oito (10,4 por cento) para FeLV. Dos 112 gatos com esporotricose e dos 77 sem leões cutâneas, 72 (64,3 por cento) e 35 (45,5 por cento), respectivamente, foram reativos ao teste de imunofluorescência para Bartonella spp. Não houve associação entre as variáveis faixa etária, sexo, status sorológico para FIV/FeLV e a presença de anticorpos anti-Bartonella spp. Os resultados obtidos sugerem que a população de gatos com esporotricose deste estudo pode ser considerada uma potencial fonte de infecção humana também para Bartonella spp...

Cat scratch disease is a zoonosis caused by species of genus Bartonella. Cats are the mainreservoir of Bartonella henselae. Transmission of these bacteria to humans occurs throughbites or scratches of infected cats. Sporotrichosis, caused by fungus of Sporothrix complex,is transmitted by traumatic inoculation of soil, plants and organic matter contaminated withthe fungus. Cats are important in zoonotic transmission because of the large amount ofyeast cells in the lesions. In the last 14 years were diagnosed more than 3.000 cases offeline sporotrichosis in IPEC/FIOCRUZ. The main objective of this study was toinvestigate the prevalence of infection by Bartonella spp. in cats with sporotrichosis. Serumsamples from 112 domestic cats were analyzed by indirect immunofluorescence test assay(IFA) using the commercial kit B. henselae IFA IgG (Bion®, USA). In addition, it wasdetected the presence of antibodies to feline leukemia vírus (FeLV) and antigens of felineimmunodeficiency virus (FIV) using the commercial kit Snap Combo FIV-FeLV (Idexx®,USA). One group of 77 serum samples from cats with no apparent skin lesions was alsoincluded in the study. In the group of animals with sporotrichosis, 93 were males, medianage was 22 months, and eight (7.1 percent) were positive for FIV, 15 (13.4 percent) were positive forFeLV. In the group of animals without skin lesions 36 were males, median age was 48months, and ten (13.0 percent) were positive for FIV, eight (10.4 percent) were positive for FeLV. Ofthe 112 cats with sporotrichosis and 77 cats without skin lesions, 72 (64.3 percent) e 35 (45.5 percent),respectively, were reactive to IFA. There was no association between age, sex, FIV/FeLVand the presence of antibodies to Bartonella spp. The results suggest that the studypopulation can be considered a potential source of human infection by both zoonosis...

Seasonality of cat-scratch disease, France, 1999-2009.

Cat-scratch disease is seasonal in the United States and Japan; but no data are available from Europe. To assess the seasonality of the disease in France, we analyzed lymph node biopsy specimens collected during 1999-2009. Most (87.5%) cases occurred during September-April and peaked in December.

[Bartonella henselae, an ubiquitous agent of proteiform zoonotic disease]. / Bartonella henselae, un agent d'infections ubiquitaires.

Bartonella henselae is the causative agent of cat scratch disease, a human infection usually characterized by persistent regional lymphadenopathy. It is transmitted to humans by cat scratches or bites. Cats are the major reservoir for this bacterium thus B. henselae has a worldwide distribution. The bacterial pathogenicity may bay emphasized by the immune status of the infected host. Angiomatosis or hepatic peliosis are the most frequent clinical manifestations in immunocompromised patients. B. henselae is also responsible for endocarditis in patients with valvular diseases, and may induce various clinical presentations such as: bacteriemia, retinitis, musculoskeletal disorders, hepatic or splenic diseases, encephalitis, or myocarditis. Several diagnostic tools are available; they may be combined and adapted to every clinical setting. B. henselae is a fastidious bacterium; its diagnosis is mainly made by PCR and blood tests. No treatment is required for the benign form of cat scratch disease. For more severe clinical presentations, the treatment must be adapted to every clinical presentation.

Feline bartonellosis and cat scratch disease.

Bartonella species are important emerging zoonotic pathogens. Transmission of these organisms in nature may be much more complex than is currently appreciated. Cats can be infected with five Bartonella species, including, Bartonella henselae, Bartonella clarridgeae, Bartonella bovis, Bartonella koehlerae and Bartonella quintana. In addition to cats, numerous domestic and wild animals, including bovine, canine, human, and rodent species can serve as chronically infected reservoir hosts for various intra-erythrocytic Bartonella species. In addition, an increasing number of arthropod vectors, including biting flies, fleas, keds, lice, sandflys and potentially ticks have been implicated in the transmission of various Bartonella species to animals or human beings. In the reservoir host, Bartonella species cause chronic intra-erythrocytic and vascular endothelial infections, with a relapsing bacteremia documented in experimentally infected cats. Although the immunopathology induced by Bartonella infection requires additional study, the organisms can localize to the heart valve (endocarditis), cause granulomatous inflammation in lymph nodes, liver or spleen, induce central nervous system dysfunction with or without cerebrospinal fluid changes, and may contribute to inflammatory polyarthritis. Hematological abnormalities are infrequent, but thrombocytopenia, lymphocytosis, neutropenia, and eosinophilia have been reported in B. henselae-infected cats. Serology, PCR and culture can be used to support a diagnosis of feline bartonellosis, however, due to the high rate of sub-clinical infections among various cat populations, documenting causation in an individual cat is difficult, if not impossible. Response to treatment can be used in conjunction with serology or organism isolation to support a clinical diagnosis of feline bartonellosis. As fleas are involved in the transmission among cats, the use of acaracide products to eliminate fleas from the environment is of critical importance to decrease the risk of B. henselae transmission among cats and to humans.