Bartonella henselae: Etiology of Pulmonary Nodules in a Patient with Depressed Cell-Mediated Immunity

Caniza, Miguela; Granger, Donald L.; Wilson, Kenneth H.; Washington, M. K.; Kordick, Dorsey L.; Frush, Donald P.; Blitchington, R B

doi:10.1093/clinids/20.6.1505

Cited by 64 publications

(42 citation statements)

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“…can induce granulomatous inflammation, including involvement of lymph nodes, lung, spleen, liver, and other tissues, in both dogs and people (13,17,30). Granulomatous pneumonitis, due to B. henselae infection, occurred in a renal transplant recipient who had extensive exposure to cats (8). Potentially consistent with Bartonella infection, a cytological diagnosis of pulmonary granulomatous inflammation was reported for dog 2 of this study, in conjunction with radiographic evidence of interstitial pneumonitis.…”

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confidence: 71%

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BartonellaSpecies as a Potential Cause of Epistaxis in Dogs

et al. 2005

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Infection with a Bartonella species was implicated in three cases of epistaxis in dogs, based upon isolation, serology, or PCR amplification. These cases, in conjunction with previously published reports, support a potential role for Bartonella spp. as a cause of epistaxis in dogs and potentially in other animals, including humans. CASE REPORTSCase 1. A 6-year-old, mixed breed, spayed female dog from Rockingham, NC, was referred to the North Carolina State University Veterinary Teaching Hospital for evaluation of intermittent episodes of epistaxis that had occurred during the previous 2 years. Nasal bleeding had become nearly continuous during the 2-month period prior to referral. At the time of initial examination by the referring veterinarian, epistaxis was accompanied by thrombocytopenia and pyrexia. Following administration of tetracycline hydrochloride (dosage unknown) for 14 days, the epistaxis resolved. A year later, several episodes of epistaxis were again observed by the owner. Hematologic abnormalities then included a nonregenerative anemia (hematocrit, 11.0%; reference range, 37.0 to 55.0%), mature neutrophilic leukocytosis (granulocytes, 36.6; reference range, 6.0 to 16.9 10 3 /l with 96% mature neutrophils), and thrombocytosis (platelet count, 562,000/l; reference range, 175 to 500 10 3 /l). Biochemical abnormalities included hyperproteinemia (11.7 g/dl; reference range, 5.0 to 7.4 g/dl), hypoalbuminemia (1.9 g/dl; reference range, 2.7 to 4.4 g/dl), and hyperglobulinemia (9.8 g/dl; reference range, 1.6 to 3.6 g/dl). A coagulation profile was within normal limits. Tetracycline hydrochloride (10 mg/kg for 14 days) was reinstituted. Epistaxis returned shortly after antibiotic administration was completed. Several months later, the dog was referred to the North Carolina State University Veterinary Teaching Hospital for diagnostic evaluation of the epistaxis.On physical examination, mucous membranes were pale. Fundic exam revealed an active chorioretinitis and tortuous retinal vessels, potentially associated with chronic hyperglobulinemia. There were focal areas of hemorrhage in the right eye. Blood pressure was normal. Hematological abnormalities included a mildly regenerative, microcytic, and hypochromic anemia, with normal numbers of white blood cells and platelets. Serum biochemical abnormalities included mild hypoglycemia, hyperproteinemia, hypoalbuminemia, hyperglobulinemia, hypocholesterolemia, decreased alkaline phosphatase activity, hyponatremia, and hyperkalemia. Urine was concentrated (specific gravity, 1.041) and contained a trace Bumin protein, with unremarkable sediment. A buccal mucosal bleeding time and a coagulation profile that included prothrombin time, partial thromboplastin time, fibrinogen, fibrinogen degradation products, and a manual platelet count were normal. Serum protein electrophoresis confirmed a polyclonal gammopathy.Serologic test results included reciprocal antibody titers to Ehrlichia canis, Ehrlichia chaffeensis, and Anaplasma phagocytophilum antigens of Ͼ10,240, Ͼ10,24...

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confidence: 71%

“…induce persistent intracellular infection of erythrocytes and endothelial cells in a wide variety of animal species (5,10,11). Depending upon the immune competence of the infected individual and potentially other uncharacterized factors, there is tremendous clinical variability in disease expression in both dogs and people (1,8).…”

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confidence: 99%

BartonellaSpecies as a Potential Cause of Epistaxis in Dogs

et al. 2005

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“…Histopathologically, cutaneous BA is characterized by a tumorlike growth pattern with proliferation of capillaries having protuberant epitheloid endothelial cells [127,193]. In transplant patients, various clinical manifestations or pathological lesions have been reported, such as pulmonary nodules [34] or sternal abscess [32], disseminated infection with granulomatous hepatitis [112], acute organ rejection [66], bacillary peliosis [2] and bacillary angiomatosis [118]. A case of hemophagocytic syndrome in a transplant patient was recently associated with B. henselae infection [119].…”

Section: Humansmentioning

confidence: 99%

Factors associated with the rapid emergence of zoonotic Bartonella infections

et al. 2005

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-The present manuscript reviews the factors associated with the emergence of these zoonotic pathogens, including better diagnostic tools and methods to identify these fastidious bacteria, host immunosuppression (caused by infectious agents, cancer, aging or induced by immunosuppressive drugs), the interaction of co-infection by several infectious agents that may enhanced the pathogenecity of these bacteria, increased outdoor activity leading to exposure to wildlife reservoirs or vectors, poverty and low income associated with infestation by various ectoparasites, such as body lice and finally the dispersal of Bartonellae around the world. Furthermore, a description of the main epidemiological and clinical features of zoonotic Bartonellae is given. Finally, the main means for diagnosis, treatment and prevention of these diseases are presented.

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“…4,5 In addi- tion, renal transplant recipients with a sternal abscess and pulmonary nodules caused by Bartonella spp have been described. 7,8 It is possible that many cases of infection may go unrecognized in transplant recipients because of unusual clinical manifestations and/or blunted serological responses. Molecular diagnosis using polymerase chain reaction may prove more useful, although it is not routinely available.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Bartonella infection with granulomatous hepatitis in a liver transplant recipient

Humar

Salit

1999

Liver Transpl

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Disseminated infection with Bartonella spp with granulomatous hepatitis was diagnosed in a liver transplant recipient presenting with fever of unknown origin. Pathological findings on liver biopsy were atypical, with scant granulomas seen only after a second biopsy. The patient responded promptly to antibiotic therapy. Infections caused by Bartonella spp should be considered in transplant recipients with fever of unknown origin. Copyright 1999 by the American Association for the Study of Liver Diseases Bartonella henselae has been recognized as the etiologic agent of cat-scratch disease and the cause of skin lesions known as bacillary angiomatosis, most commonly described in HIV-positive patients. 1 Also, disseminated disease caused by B henselae may result in necrotizing granulomatous involvement of the liver and other organs. 1,2 Infections caused by Bartonella spp are uncommonly reported in transplant recipients. We report a case of a liver transplant recipient who presented with fever of unknown origin and was found to have infection caused by Bartonella spp with granulomatous hepatitis of the transplant allograft. Case ReportA 44-year-old woman who had undergone an orthotopic liver transplantation for hepatitis C and alcoholic cirrhosis 4 years earlier presented with a 3-week history of fever. Past medical history included diabetes mellitus, hypertension, and splenectomy. She complained of daily fever spikes of 39°C to 40°C, headaches, myalgias, arthralgias, fatigue, and drenching night sweats. She had no abdominal pain or gastrointestinal symptoms. Travel history was unremarkable. She had two cats, aged 1 and 3 years, but did not recall any recent scratches. She had no history of tuberculosis exposure, other animal contact, or ingestion of raw milk or cheese. Her current immunosuppression therapy consisted of prednisone, 5 mg/d, and mycophenolate mofetil, 2 g/d. On physical examination, her temperature was 39.5°C. Her liver was palpable 3 cm below the right margin. The remainder of her examination was normal. Laboratory studies showed a normal leukocyte count; aspartate aminotransferase level, 77 U/L; alanine aminotransferase level, 44 U/L; and alkaline phosphatase level, 317 U/L. Routine blood cultures and a cytomegalovirus antigenemia assay were negative. A computed tomographic (CT) scan of her head and a cerebrospinal fluid analysis both showed normal results. Abdominal and thoracic CT scans showed an enlarged liver with no focal lesions and several mildly enlarged mediastinal and intraabdominal lymph nodes. Toxoplasma serological test results and a tuberculin skin test result were negative.A liver biopsy specimen (stained with hematoxylin and eosin) showed moderate to severe portal and parenchymal cellular infiltrates (plasma cells, lymphocytes, and eosinophils). Routine cultures of the liver tissue were negative, as were mycobacterial, fungal, and viral cultures. A second liver biopsy was performed and showed patchy severe portal and periportal cellular infiltrates and a few clusters of cells with foc...

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Bartonella henselae: Etiology of Pulmonary Nodules in a Patient with Depressed Cell-Mediated Immunity

Cited by 64 publications

References 15 publications

BartonellaSpecies as a Potential Cause of Epistaxis in Dogs

BartonellaSpecies as a Potential Cause of Epistaxis in Dogs

Factors associated with the rapid emergence of zoonotic Bartonella infections

Disseminated Bartonella infection with granulomatous hepatitis in a liver transplant recipient

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