Seronegative disseminated Bartonella spp. infection in an immunocompromised patient

Abstract

An 11 year old, hispanic girl with a history of B-cell acute lymphoblastic leukemia was admitted to the hospital for symptoms compatible with Bartonella henselae infection. The first molecularly diagnosed case of disseminated Bartonella henselae infection was reported in an immunocompromised patient in Lima, Peru. The analysis was confirmed by Polymerase Chain Reaction and automated sequencing of a liver biopsy sample, even though the serologic tests were negative. In conclusion, Bartonella spp. infection should have a particular diagnostic consideration in immunocompromised patients with fever of unknown origin and further investigation regarding the patient's past exposures with cats should also be elicited.

Is Bartonella sp. infection relevant in hematological malignancies in HIV-negative patients? A literature review

“…diagnosis, similar to our patient. Fourteen of the patients reported were treated with antibiotics for long periods with remission, and one of them died of the malignancy before he could be treated [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . A summary of the findings is available in Table 1 [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] .…”

Imaging analysis of Bartonella species in the skin using single‐photon and multi‐photon (second harmonic generation) laser scanning microscopy

“…Therefore, despite using multiple Bartonella antigens, serology can lack sensitivity, can only implicate prior Bartonella spp. exposure, may be associated with cross reactivity with members of other genera 40 and these tests may be inaccurate in immunocompromised patients due to a diminished antibody response 41 . Our ability to detect Bartonella DNA in the same tissue sample, using hemi‐nested PCR, proves an effective and valuable ancillary tool to detect and diagnose suspected Bartonella spp.…”

“…bacteremia was confirmed in one in four patients. 38,41 When Bartonella bacterial infection cannot be confirmed by PCR, diagnosis often relies on a combination of clinical, epidemiological, and serologic criteria. 25,39 In addition, it is possible that some bacteremic patients become anergic and do not produce a detectable IFA antibody response against the bacteria while antigenic variation among Bartonella strains could also result in false-negative IFA results detected in some patients.…”

“…In that study, Bartonella spp. bacteremia was confirmed in one in four patients 38,41 . When Bartonella bacterial infection cannot be confirmed by PCR, diagnosis often relies on a combination of clinical, epidemiological, and serologic criteria 25,39 .…”