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.

A pediatric case with peripheral facial nerve palsy caused by a granulomatous lesion associated with cat scratch disease.

BACKGROUND: Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown. CASE REPORT: A previously healthy 7-year-old boy presented with fever, cervical lymphadenopathy, and peripheral facial nerve palsy associated with serologically confirmed cat scratch disease. The stapedius muscle reflex was absent on the left side and brain magnetic resonance imaging revealed a mass lesion at the left internal auditory meatus. The patient's symptoms and imaging findings were gradually resolved after the antibiotics and corticosteroids treatment. CONCLUSIONS: The suspected granulomatous lesion was considered to have resulted from the host's immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course.

Fever, bone pain and erectile dysfunction. Where is the cat?

Cat-scratch disease is due to Bartonella henselae and commonly presents as a localised papular lesion with regional lymphadenopathy. We report the case of a young man suffering general symptoms and dysautonomy characterised by an erectile dysfunction due to an invasive cat-scratch disease. He was successfully treated by tetracyclines during 3 weeks.

Malaltia per esgarrapada de gat: un repàs / Enfermedad por arañazo: un repaso / Cat-scratch disease: a review

Fonament: la serologia específica permet comprovar que la malaltia per esgarrapada de gat pot presentar un ventall clínic ample, tot i que la majoria de pacients cursen un quadre clínic típic de lesió dèrmica al lloc d'inoculació, adenopatia regional i febre. Per als casos típics i per a la majoria de casos que hom considera atípics, o amb complicacions, la involució espontània és el fet més probable. Objectiu: recordar les característiques clíniques de les formes atípiques d'aquesta malaltia, que només afecten una minoria de pacients, i el diagnòstic i el tractament de les formes típiques, que són les més habituals. Mètode: revisió bibliogràfica, tant de sèries de casos com de les nombroses notes clíniques publicades. Resultats: més enllà del quadre clínic típic, la malaltia per esgarrapada de gat pot provocar una síndrome de febre perllongada, compromís hepatoesplènic, compromís pulmonar (pneumònia, pleuritis), renal (glomerulonefritis), osteoarticular (osteomielitis), neurològic (encefalitis), dèrmic (diversos exantemes), hemàtic (anèmia hemolítica, púrpura trombocitopènica), ocular (conjuntivitis fol•licular). El compromís cardíac (endocarditis) és greu. En el pacient immunocompromès, la malaltia pot assolir més gravetat. La clínica i la serologia són les formes de diagnòstic més útils. En el cas de malaltia típica, sense complicacions, d'un pacient sense compromís immunitari, el tractament antibiòtic és motiu de controvèrsia: la recomanació acadèmica, que no n'indica cap, s'oposa a la pràctica, que sol indicar azitromicina. Conclusions: s'ha de considerar aquest diagnòstic en més situacions clíniques que les típiques d'adenopatia, febre i antecedent de contacte amb un gat

Fundamento. La serología específica permite comprobar que la enfermedad por arañazo de gato puede presentar amplia variedad clínica, aunque la mayoría de pacientes cursan un cuadro clínico típico de lesión dérmica en el lugar de inoculación, adenopatía regional y fiebre. Para los casos típicos y para la mayoría de los casos considerados atípicos, o con complicaciones, la involución espontánea es el hecho más probable. Objetivo. Recordar las características clínicas de las formas atípicas de esta enfermedad, que sólo afectan a una minoría de pacientes, y el diagnóstico y el tratamiento de las formas típicas, que son las más habituales. Método. Revisión bibliográfica, tanto de series de casos como de las numerosas notas clínicas publicadas. Resultados. Más allá del cuadro clínico típico, la enfermedad por arañazo de gato puede provocar un síndrome de fiebre prolongada, compromiso hepatoesplénico, compromiso pulmonar (neumonía, pleuritis), renal (glomerulonefritis), osteoarticular (osteomielitis), neurológico (encefalitis), dérmico (diversos exantemas), hemático (anemia hemolítica, púrpura trombocitopénica), ocular (conjuntivitis folicular). El compromiso cardíaco (endocarditis) es grave. En el paciente inmunocomprometido, la enfermedad puede presentar más gravedad. La clínica y la serología son las formas de diagnóstico más útiles. En el caso de enfermedad típica, sin complicaciones, de un paciente sin compromiso inmune, el tratamiento antibiótico es motivo de controversia: a la recomendación académica, que no indica antibiótico, se le opone la práctica, que suele indicar azitromicina. Conclusiones. Se debe considerar este diagnóstico en más situaciones clínicas que las típicas de adenopatía, fiebre y antecedente de contacto con un gato (AU)

Background. The availability of a serological diagnosis for catscratch disease has allowed for the description of its wide range of clinical features, although most patients (90%) present with the typical form of the disease, an erythematous lesion at the site of inoculation, regional lymphadenopathy, and fever. In all patients with the typical form of the disease, and in most of those with atypical or complicated presentation, spontaneous resolution is likely. Objective. To review the clinical manifestations of patients presenting with atypical cat-scratch disease, and to review the diagnosis and treatment in those presenting with its typical form. Method. A literature review of case reports and published studies. Results. Beyond the typical clinical presentation, cat-scratch disease can also manifest with prolonged fever of unknown origin, hepatosplenomegaly, pneumonia or pleural thickening or effusion, glomerulonephritis, osteomyelitis, encephalitis, skin rash, hemolytic anemia, thrombocytopenic purpura, endocarditis, and oculoglandular syndrome (follicular conjunctivitis). Immunocompromised individuals may develop severe disease. The key to diagnosis is a careful history and serological testing. In immunoclícompetent patients with typical clinical manifestations and no complications, antibiotic therapy is controversial; although published studies have shown little or no effect, in clinical practice azithromycin is often prescribed. Conclusions. Cat-scratch disease should be considered in the differential diagnosis of more clinical scenarios than the typical presentation of regional lymphadenopathy and fever after contact with a ca (AU)

Prolonged course of hepatic granulomatous disease due to Bartonella henselae infection.

Cat-scratch disease (CSD) is an emerging zoonosis caused by Bartonella henselae. The disease is usually self-limiting and typically presents in about 90% of all cases as a subacute regional lymphadenopathy. We present a case report of an unusual CSD presentation, persistent hepatic granulomatous disease due to Bartonella henselae infection despite combination therapy with doxycycline and rifampicin. Furthermore, a review of literature was conducted. (Acta gastroenterol. belg., 2016, 79, 497-499).

New-onset refractory status epilepticus in an adult with an atypical presentation of cat-scratch disease: successful treatment with high-dose corticosteroids.

New-onset refractory status epilepticus (NORSE) is defined as a sudden onset of refractory status epilepticus in patients who do not have a history of epilepsy. It is a neurologic emergency, and determining the underlying etiology is an important factor for effectively managing and predicting the prognosis of NORSE. We describe the case of a 28-year-old woman who was hospitalized with NORSE secondary to an unknown etiology. She did not respond to traditional anticonvulsant therapy, including benzodiazepines, fosphenytoin, propofol, and levetiracetam. The patient was placed on continuous electroencephalography (EEG) monitoring and was treated further with multiple antiepileptics, which were titrated aggressively based on EEG readings and therapeutic drug levels; despite this treatment, EEG monitoring revealed continued seizures. Thus, high-dose corticosteroids were started for seizure control. Her workup included computed tomography and magnetic resonance imaging of the head, a lumbar puncture, toxicology screening, and extensive testing for multiple infectious and inflammatory etiologies. The patient's history revealed recent exposure to a new cat. Serologic results were positive for Bartonella henselae, and she was diagnosed with cat-scratch disease (CSD). She did not have the typical presentation of symptoms of lymphadenopathy, however, which is common in CSD. Doxycycline 100 mg and rifampin 300 mg twice daily were added to the patient's anticonvulsant and corticosteroid therapy. She was hospitalized for a total of 26 days and discharged with only minor neurologic impairment (short-term memory deficits and minor cognitive problems). The patient was discharged receiving antiepileptics, antibiotics, and a corticosteroid taper. To our knowledge, this is the first clinically known case of NORSE secondary to CSD without typical CSD symptoms in the adult population. The patient failed to respond to traditional anticonvulsant therapy alone. With the addition of high-dose corticosteroids to aggressive anticonvulsant therapy, seizure control was achieved. Further studies are needed to determine the effectiveness of high-dose corticosteroid and anticonvulsant therapy followed by antibiotics in patients with NORSE secondary to CSD.

Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis.

PURPOSE: To describe the macular findings on optical coherence tomography (OCT) in patients with cat-scratch disease (CSD) neuroretinitis. METHODS: Medical records of all patients diagnosed with CSD neuroretinitis at the Tel Aviv Medical Center between April 2006 and May 2010 were retrospectively reviewed. All patients underwent Stratus OCT macular examination. RESULTS: Eight eyes of seven patients with confirmed CSD neuroretinitis, (mean age 33 ± 9.9 years, range 6-48 years) were included in the study. All patients presented clinically with optic nerve swelling and macular edema or macular exudates. OCT demonstrated flattening of the foveal contour, thickening of the neurosensory retina, and accumulation of subretinal fluid (SRF) in all studied eyes. Retinal exudates appeared as multiple hyper-reflective foci in the outer plexiform layer. The average central macular thickness was 460 µm (range 170-906 µm) and the average maximal retinal thickness was 613 µm (range 387-1103 µm), at presentation. The macula appeared normal on repeated exams during follow-up. CONCLUSION: Similar OCT findings were demonstrated in patients with CSD neuroretinitis. SRF was found in all eyes, although was not visible on clinical examination or fluorescein angiography. OCT may be used as an adjunct imaging tool in the diagnosis and follow-up of patients with CSD neuroretinitis.

A serologically proven case of cat-scratch disease presenting with neuroretinitis.

Cat-scratch disease is a clinical syndrome that usually presents as a self-limiting illness featuring regional lymphadenopathy, fever, and small skin lesions in association with a cat scratch or bite. It is caused by the Gram-negative bacillus Bartonella henselae, which commonly affects children and young adults. Ocular bartonellosis is the most common atypical manifestation of cat-scratch disease. It can present with a wide spectrum of ocular diseases including neuroretinitis, Parinaud's oculoglandular syndrome, and other forms of intra-ocular inflammation. This case report describes cat-scratch disease neuroretinitis in a 10-year-old girl who presented with typical signs, including optic disc swelling and a macular star, preceded by pyrexia of unknown origin and cervical lymphadenopathy.

Unusual otolaryngological manifestations of certain systemic bacterial and fungal infections in children.

OBJECTIVE: Systemic bacterial and fungal infections may sometimes present local manifestations within otolaryngological district whose early detection may be useful in establishing a correct diagnosis and more appropriate treatment. This paper reviews certain systemic bacterial and fungal diseases presenting ENT manifestations in the pediatric population from an otolaryngological perspective. METHODS: A medline searching for specific issues was performed in order to achieve more information as possible with regards to ENT manifestation of systemic bacterial and fungal infections. Limits for pediatric age were used. Two separate sections for bacterial and fungal disease are included. The section on systemic bacterial infections considers cat-scratch disease, Lyme borreliosis, actinomycosis, Lemierre's syndrome and congenital syphilis, and the section on systemic fungal infections includes candidiasis, aspergillosis and histoplasmosis. CONCLUSIONS: Pediatricians and ear, nose and throat (ENT) specialists, approaching head and neck disorders in children, should therefore consider them among the possible differential diagnoses. This means that physicians need to recognize the first head and neck manifestations of systemic infections promptly in order to be able to treat them efficaciously and avoid the dangerous systemic spreading of the infective process.

[Cat scratch disease: a diagnosis to be aware of!]. / Maladie des griffes du chat: un diagnostic a ne pas méconnaître!

Subacute cervical lymphadenopathy among young adults may be of an infectious or malignant aetiology. We report two cases of young males with chronic cervical lymphadenopathy. A diagnosis of Cat scratch disease (CSD) was made by serological and molecular studies. CSD is one of the most frequent infectious lymphadenopathies among young people. Diagnosis of CSD is dependent on clinical, epidemiological, molecular and histological criteria. The detection of antibodies to Bartonella Henselae and the amplification of its DNA by Polymerase Chain Reaction (PCR) are the two main methods of laboratory diagnosis. The evolution of CSD is usually benign; however therapeutic management remains problematic, particularly in atypical forms.

Visceral involvement in an immunocompetent male: a rare presentation of cat scratch disease.

We report a case of an adult, immunocompetent male with lymphadenopathy of both groins, para-aortal lymph nodes and multiple lesions in the spleen. A neoplasm was excluded by histology of the largest lymph node from the left groin. The diagnosis of cat-scratch disease (CSD ) became apparent when serological testing for Bartonella henselae showed to be positive. A review of literature shows that disseminated (visceral) infection is a rare presentation of CSD.