BartonellaOsteomyelitis of the Acetabulum: Case Report and Review of the Literature

Abstract

Introduction: Bartonella henselae commonly involves the mononuclear phagocyte system (MPS), and its most common presentation is lymphadenitis. Rarely, it can cause isolated osteomyelitis. We present a case of a 3 year old with constitutional symptoms and new onset of limp. Previously reported cases of osteomyelitis due to B. henselae are also reviewed here, keeping the index case in mind. Methods: We conducted a Medline search using MeSH subject headings Bartonella and osteomyelitis, limited to humans. Results: The index case is a 3-year-old female who had a subacute presentation with new-onset leg pain and fever. Subsequent imaging demonstrated osteomyelitis of the acetabulum. Multiple diagnostic attempts were unsuccessful, and the patient did not respond to empiric therapy. Despite indeterminate serology, the diagnosis of Bartonella osteomyelitis was eventually confirmed by PCR on bone biopsy of the lesion. The literature search revealed 48 publications, which were reduced to 28 when limiting articles to the English language and the pediatric population. After a report of 36 pediatric cases in 2007, there have been an additional 12 pediatric cases since 1998. Generally, these patients had a subacute presentation with relatively mild constitutional symptoms. Most commonly, bone involvement occurred as osteolytic lesions of the axial skeleton. Of the total 48 cases reported, only four reported involvement of the axial skeleton. Conclusion: We present the first case, to our knowledge, of pediatric osteomyelitis of the pelvis due to B. henselae with indeterminate serologic and positive PCR results. Bartonella osteomyelitis should be included in the differential diagnosis when typical pathogens are not identified or if the patient is slow to respond to standard therapies. The sensitivity of tissue PCR for Bartonella osteomyelitis is now better than the current gold standard of serology, and new management guidelines may need to reflect this.

Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review

“…Furthermore, while osteomyelitis caused by other common organisms mainly involves the legs [ 46 ], we found that the most affected bones during CSD are vertebral bodies followed by limbs [ 41 , 45 , 47 ]. Osteomyelitis of the skull is a rare manifestation with 10 cases in 50 years in the literature [ 48 – 50 ].…”

“…PCR involves amplification of Bartonella species genes (16S rRNA gene, citrate synthase gene (gltA), and htrA gene) directly from tissue or aspirate. It is specific but with a variable sensitivity (40–70%) with high risk of negative results if sample collection occurs too early (<6 weeks) [ 47 , 57 – 61 ]. PCR testing of the lymph node was not performed in our case since it is an invasive procedure and requires sedation in pediatric patients.…”

An Atypical Case of Bartonella henselae Osteomyelitis and Hepatic Disease

“…Bartonella henselae , a Gram-negative bacterium, is the causative agent of cat scratch disease (CSD) that typically involves the mononuclear phagocyte system and presents as local lymphadenopathy, often accompanied by fever [ 1 ]. B. henselae infections are thought to occur when a human is bitten or scratched by an infected cat [ 2 – 4 ] and may be transmitted by cat fleas or by an infected cat licking the nonintact skin of a human [ 5 – 7 ].…”

Skull osteomyelitis as a rare complication of cat scratch disease

“…Fever was present in 78% as part of their initial presentation, and most cases involved the axial skeleton. [ 4 ],[ 5 ] Since 2007, skull involvement was noted in just 1 of the 14 cases reported by Puri et al . [ 5 ] The frontal bone, parietal bone, and mastoid bone have all been reported to be involved.…”

“…The pathogenesis of Bartonella osteomyelitis is poorly understood, but both direct extension from infected lymph nodes (contiguous infection) and distant infection (presumably from hematogenous or lymphohematogenous spread) have been reported. [ 4 ],[ 5 ],[ 7 ] Eight of the 14 cases reported by Puri et al . tested positive for Bartonella by PCR at the site of the infection.…”