Enfermedad por arañazo de gato con compromiso hepato-esplénico en adultos inmunocompetentes / Hepatosplenic cat-scratch disease in immunocompetent adults cat scratch

La enfermedad por arañazo de gato (EAG) es una zoonosis emergente causada por Bartonella henselae. Puede presentarse de forma atípica, incluyendo meningitis, neuroretinitis, endocarditis y compromiso hepatoesplénico, lo cual es poco frecuente en adultos inmunocompetentes. Su manejo terapéutico es controvertido dada la ausencia de ensayos aleatorizados al respecto. Se describen 5 casos de EAG con compromiso hepato-esplénico, donde la correcta anamnesis epidemiológica permitió la sospecha diagnóstica, evitando la realización de procedimientos invasivos en la mayoría de los casos. La posibilidad de realización de PCR y serología para Bartonella spp. fueron de vital importancia

Cat scratch disease (CSD) is an emerging zoonosis caused by Bartonella henselae. It can occur atypically including meningitis, neuroretinitis, endocarditis and hepatosplenic involvement, a rare occurrence in immunocompetent adults. Therapeutic management is controversial, supported by case series and retrospective data published literature. Five cases of CSD with hepatosplenic involvement are described. The correct clinical and epidemiological anamnesis allow the diagnostic and avoid the performance of invasive procedures in most cases. The possibility of performing Bartonella spp PCR and serology is crucial

Neurological presentations of Bartonella henselae infection.

OBJECTIVE: Neurological symptoms in patients with cat-scratch disease (CSD) have been rarely reported. The aim of this study is to analyze the frequency of neurological CSD (NCSD) and describe the disease clinical presentation, management and outcome. MATERIAL AND METHODS: We retrospectively selected patients with a CSD syndrome and Bartonella IgG titers > 1:256. Data regarding epidemiological, clinical, management, and follow-up features were analyzed and discussed. A comparison between NCSD and non-neurological CSD (NNCSD) was established. RESULTS: Thirty-nine CSD patients were selected. NCSD frequency was 10.25%. No children were found affected in the NCSD group. A 65.7% of NNCSD and the entirety of the NCSD group had a history of cat exposure. Immunosuppression was only present in the NNCSD group (8.6%). NCSD presentations were as follows: isolated aseptic meningitis (25%), neuroretinitis (50%), and isolated optic neuritis (25%). A greater proportion of patients in the NCSD group had fever and raised levels of acute phase reactants and white blood cells. 85.7% of NNCSD had a complete recovery, whereas only 50% of the NCSD patients experienced a full recovery. CONCLUSION: NCSD may be a distinctive group compared to NNCSD due to its later age of presentation, the more intense systemic response, and the poorer outcome.

Disseminated Bartonella henselae disease mimicking Langerhans' cell histiocytosis.

Bartonella henselae, the causative agent of cat-scratch disease, has been recognized to be responsible for a broad range of clinical syndromes. We report the case of a patient with disseminated B. henselae infection mimicking Langerhans cell histiocytosis at presentation and its successful management with neurosurgery, prolonged antibacterial therapy, and observation.

Ophthalmic manifestations of bartonella infection.

PURPOSE OF REVIEW: The eye is commonly affected in disseminated cat scratch disease (CSD) caused by Bartonella species. This article reviews recently published data on epidemiology of CSD, clinical features of ocular involvement, diagnosis and treatment. RECENT FINDINGS: The annual incidence of CSD has been estimated as 4.7 per 100 000 in the United States. It occurs predominantly in the southern states, with a peak in January, and disproportionately affects children. Retinal infiltrates, neuroretinitis and branch retinal artery occlusions have been reported as common manifestations of ocular bartonellosis in recent series. The use of different antigens for serodiagnosis and new real-time PCR assays for molecular diagnosis have been described. Despite lack of a standard treatment, good visual outcomes were generally reported in patients with ocular bartonellosis. SUMMARY: Bartonella infections continue to be a burden worldwide and epidemiologic features may guide preventive measures in high-risk regions and populations. An increased awareness of diverse posterior segment manifestations will lead to an early diagnosis of ocular bartonellosis. Laboratory diagnostic methods continue to evolve and may be applied to the investigation of ocular fluids for a definitive diagnosis of ocular bartonellosis. Well designed clinical trials are required to establish the optimum treatment of especially sight-threatening manifestations.

Cat Scratch Disease in a Renal Transplant Recipient.

Cat scratch disease (CSD) is a disorder characterized by self-limited regional lymphadenopathy and fever. We reported a case of CSD in a kidney transplant recipient who presented with fever and lymphadenopathy. Lymph node biopsy demonstrated bacterial histiocytic lymphadenitis. The patient was diagnosed with CSD. Patient had good clinical improvement after treatment. Therefore, CSD should also be borne in mind for kidney recipients though CSD had been infrequently reported in this group.

Osteomielitis vertebral por Bartonella henselae: a propósito de un caso / Bartonella henselae vertebral osteomyelitis: report of a case

Resumen: La enfermedad por arañazo de gato (EAG) causada por Bartonella henselae tiene prevalencia e incidencia desconocida en la población pediátrica chilena. La presentación como linfoadenopatía regional es la más frecuente, y sus formas atípicas constituyen un reto diagnóstico. Objetivo: Comunicar un caso de EAG con osteomielitis vertebral y entregar posibles lineamientos respecto al tratamiento. Cuadro clínico: Escolar de 8 años con síndrome febril prolongado y dolor dorsal con rigidez cervical. En estudio destaca IgG para Bartonella henselae positiva, ecotomografía abdominal con microabscesos esplénicos y resonancia magnética con lesiones vertebrales sugerentes de osteomielitis. Discusión: El diagnóstico de las formas atípicas requiere de un alto índice de sospecha, como en este caso, en que el paciente con síndrome febril manifiesta sintomatología musculoesquelética, lo que nos lleva a estudiar posibles complicaciones de la enfermedad. El conocimiento actual del tratamiento de EAG atípica o complicada se deriva de la observación de estudios de casos y no de ensayos aleatorios; se sugiere analizar de manera individual la terapia antimicrobiana y con ayuda de especialistas. Conclusión: Se discute y enfatiza la importancia de la alta sospecha clínica y se exponen algunas alternativas de tratamiento en función de la evidencia de la literatura actual.

Abstract: Cat scratch disease (CSD) is caused by Bartonella henselae, with unknown prevalence and incidence in the Chilean paediatric population. Regional lymphadenopathy is the most common presentation, while atypical forms constitute a diagnostic challenge. Objective: To report a case of CSD with osteomyelitis and present guidelines regarding treatment. Clinical case: An eight year-old patient, with prolonged febrile illness, back pain and neck stiffness. Laboratory studies highlight positive IgG for Bartonella henselae. The abdominal ultrasound showed splenic micro-abscesses, and the MRI showing vertebral lesions suggestive of osteomyelitis. Discussion: The diagnosis of atypical forms requires a high rate of suspicion, as in this case, in which the patient manifested the musculoskeletal symptoms simultaneously with the febrile syndrome, which led us to study possible complications of the disease. Current knowledge of the treatment of atypical or complicated CSD is derived from the observation of case studies, rather than randomized trials. It is suggested that antibiotic therapy is analysed individually, with the help of a specialist. Conclusion: The importance of high clinical suspicion are emphasised and discussed, as well presenting some treatment options based on the evidence from the current literature.

[Bartonella henselae vertebral osteomyelitis: report of a case]. / Osteomielitis vertebral por Bartonella henselae: a propósito de un caso.

UNLABELLED: Cat scratch disease (CSD) is caused by Bartonella henselae, with unknown prevalence and incidence in the Chilean paediatric population. Regional lymphadenopathy is the most common presentation, while atypical forms constitute a diagnostic challenge. OBJECTIVE: To report a case of CSD with osteomyelitis and present guidelines regarding treatment. CLINICAL CASE: An eight year-old patient, with prolonged febrile illness, back pain and neck stiffness. Laboratory studies highlight positive IgG for Bartonella henselae. The abdominal ultrasound showed splenic micro-abscesses, and the MRI showing vertebral lesions suggestive of osteomyelitis. DISCUSSION: The diagnosis of atypical forms requires a high rate of suspicion, as in this case, in which the patient manifested the musculoskeletal symptoms simultaneously with the febrile syndrome, which led us to study possible complications of the disease. Current knowledge of the treatment of atypical or complicated CSD is derived from the observation of case studies, rather than randomized trials. It is suggested that antibiotic therapy is analysed individually, with the help of a specialist. CONCLUSION: The importance of high clinical suspicion are emphasised and discussed, as well presenting some treatment options based on the evidence from the current literature.

Cat-Scratch Disease: Case Report and Review of the Literature.

Cat-scratch disease (CSD) is caused by Bartonella henselae and characterized by self-limited fever and granulomatous lymphadenopathy. In some cases signs of a visceral, neurologic, and ocular involvement can also be encountered. In this report we describe the development of CSD in a kidney transplant patient. Immunocompromised hosts are more susceptible to infection from Bartonella compared with the standard population. Infection of Bartonella should be considered as a differential diagnosis in kidney transplant patients with lymphadenopathy of unknown origin.

An 8-year-old boy with altered mental status.

Management of an acutely ill pediatric patient with undifferentiated altered mental status is a common challenge facing air medical crewmembers. The transport team is often the vital link between the referring agency and a tertiary care center; it is incumbent upon the team to be able to meet the challenges of patient management including airway management, providing hemodynamic support, and addressing presenting symptoms. This case presents a child with altered mental status and seizure activity requiring advanced interventions and support. His hospital course is described and reveals an encephalopathy caused by the Bartonella henselae bacterium also known as cat-scratch disease. This case shows the pathology, symptomology, and management along with the importance of proper management and interventions by air medical crewmembers to maximize outcomes.

Hepatosplenic cat scratch disease in immunocompetent adults: report of 3 cases and review of the literature.

Cat-scratch disease (CSD) is the most frequent presentation of Bartonella henselae infection. It has a worldwide distribution and is associated with a previous history of scratch or bite from a cat or dog. CSD affects children and teenagers more often (80%) than adults, and it usually has a self-limiting clinical course. Atypical clinical course or systemic symptoms are described in 5%-20% of patients. Among them, hepatosplenic (HS) forms (abscess) have been described. The majority of published cases have affected children or immunosuppressed patients. Few cases of HS forms of CSD in immunocompetent adult hosts have been reported, and data about the management of this condition are scarce. Herein, we present 3 new cases of HS forms of CSD in immunocompetent adults and review 33 other cases retrieved from the literature. We propose an approach to clinical diagnosis and treatment with oral azithromycin.

Fever and lymphadenitis in an immunocompromised patient.

OBJECTIVE AND IMPORTANCE: Bartonella henselae infections are among the most common causes of fever and lymphadenopathies, but can lead to severe complications in immunocompromised hosts; early recognition of these infections is of paramount importance in immunocompromised patients. CLINICAL PRESENTATION: Here we report the case of a renal transplant recipient who presented with fever, lymphadenopathies, and a splenic abscess secondary to Bartonella henselae infection, successfully treated with doxycycline. DISCUSSION AND CONCLUSIONS: We discuss the various clinical presentations of Bartonella henselae infections in immunocompromised patients and the available diagnostic tools for this potentially severe complication.

Cat scratch disease of the eye: a case report and literature review.

This is the case of a middle-aged male with no other medical issues who presented with acute, unilateral visual disturbance. In lieu of specific ophthalmologic findings, his age and presentation, he was treated for presumed inflammatory process. It was only after steroids and the results of serological testing that an infectious agent was determined. He was eventually diagnosed with ocular Bartonellosis. He was treated with oral doxycycline and rifampin and slowly improved. The thesis of this case report is that a thorough history prior to rapid and somewhat presumptive treatment may have prevented unnecessary immunosuppression and delay in appropriate antimicrobial therapy.

Cat scratch disease and other Bartonella infections.

First described in 1931, cat scratch disease remains the most commonly identified clinical syndrome associated with Bartonella infection. Over the last 20 years, however, the discovery and use of modern diagnostic tests has greatly expanded our understanding of the pathogenesis, clinical spectrum, and treatment options for Bartonella infections of all types. Indeed, each varies substantially depending on the infecting species and the immune status of the host.

Parainfectious meningo-encephalo-radiculo-myelitis (cat scratch disease, Lyme borreliosis, brucellosis, botulism, legionellosis, pertussis, mycoplasma).

Parainfectious disorders of the nervous system encompass those meningo-encephalo-radiculomyelitic conditions that are temporally associated with a systemic infection, antigenic stimuli, or toxin exposure, in the absence of evidence of direct neuronal infection or invasion of the central nervous system (CNS) or peripheral nervous system (PNS). Pathogenetic mechanisms can be due to immune-mediated processes (such as bystander activation, molecular mimicy) or the inciting insult can be due to toxic factors, as in the case of botulism. A myriad of clinical manifestations can occur including headache, seizures, and mental status changes, ranging from mood and behavioral disturbances to varying levels of alteration in consciousness. Focal neurological deficits can include aphasia, hemiparesis, or paraparesis. The PNS can also be affected leading to cranial nerve involvement, focal or multifocal neuropathies, and dysfunction of the autonomic nervous system. Diagnosis is based not only on the history, examination, laboratory, and neuroimaging data but also on epidemiological factors. The parainfectious disorders covered in this review are cat scratch disease, Lyme borreliosis, legionellosis, brucellosis, botulism, pertussis, and mycoplasma. Each is associated with a distinct organism, has both systemic and neurological manifestations, and has a different epidemiological profile.

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...

Enfermedad por arañazo de gato. ¿Es necesario el tratamiento antibiótico? / Cat scratch disease. Is antibiotic treatment necessary?

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