Bartonellosis: suggestive case reports in adult and pediatric patients and therapeutic issues

Abstract

Cat-scratch disease warrants extensive investigation, from an epidemiological, a diagnostic, but especially a therapeutic point of view. Two suggestive episodes of Bartonella henselae-caused cat-scratch disease are reported, and discussed in the light of the most recent literature evidence. The first case occurred in a 60-year-old man, thus suggesting that it is important to maintain an elevated level of suspicion for this disease in adults as well. Both episodes were characterized by a very prolonged and complicated disease course (with the involvement of three lymph node sets in the first case), a need for lymph-node drainage, and apparently negligible activity of many antimicrobial courses, with a very slow local cure. While specific culture and molecular biology techniques proved negative (probably due to late availability of appropriate clinical specimens), indirect immunofluorescence antibody assay was positive since the first weeks of disease, and elevated levels were also fond many months after disease onset. When clinicians face patients with prominent swelling of lymph nodes draining from the upper limbs, cat-scratch disease may be suspected on the grounds of epidemiological and clinical features, with a limited systemic involvement contrasting with a prominent local disease. The significance of specific antibody temporal kinetics in the subacute disease course is still unknown. Although biomolecular assays are now available, the time elapsed from disease onset to clinical diagnosis usually hampers diagnosis, while the roles of surgical debridement and of the unpredictable activity of antimicrobial chemotherapy warrant careful investigation.

Evaluation of Cat Scratch Disease Cases Reported from Turkey between 1996 and 2013 and Review of the Literature

“…The association between B. henselae and CSD was first made by Regnery et al (24) in 1992 in a study demonstrating that sera from CSD patients reacted with antigen prepared from the bacterium. From an epidemiological point of view, 87-99% of the patients report some contact with cats, although the exact mechanism of cat-to-human transmission remains partly unknown, a scratch and/or bite were documented in around a half of the episodes (6,25). In this study, cat contact was determined in 77.7% of the patients.…”

“…A careful physical examination, including scrutiny of the hands, arms, face, chest, and scalp for possible inoculation sites, is invaluable (6). Routine haematologic and biochemistry laboratory testing is usually not very useful: hepatic transaminases may be elevated in the rare cases of systemic involvement (25). However, leukocytosis, mild anaemia and elevated ESR have already been described by Huarcaya et al (2) in Peru, and elevated serum alkaline phosphatase level, often the only abnormal laboratory value in hepatosplenik CSD, was described by Rocco et al (35).…”

“…In general, immunocompetent patients who are otherwise healthy tend to present with typical CSD and patients who are immunocompromised tend to have systemic disease (31). The incubation period of CSD is estimated to be 7-15 days; some local nonpruritic papules or papules and vesicles may follow the inoculation lesion and precede the characteristic regional lymph node involvement (25). In typical form, regional LAP is the hallmark of the disease and appears proximal to the inoculation site about two weeks after the introduction of organism into the skin.…”

Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella henselae DNA in lymph node samples

“…24 Suppurative tense and painful nodes should be drained, while incision of nonsuppurative lesions should be avoided, as chronic draining fistulae or compromised healing may result. 4,5,25,26 As the clinical status of our patient was not improving despite antibiotic treatment, the use of an invasive approach was rendered necessary. Surgical exploration revealed the abscesses not clearly depicted by the CT.…”

Doença da arranhadura do gato (DAG) e a importância de um diagnóstico preciso: relato de caso clínico

“…Nestes casos, os linfonodos supurativos devem ser drenados. Incisões de linfonodos não supurativos devem ser evitadas, podendo resultar em baixa tendência de cura 9 .…”