The cat did it: erythema nodosum and additional atypical presentations of<i>Bartonella henselae</i>infection in immunocompetent hosts

Schattner, Ami; Uliel, Livnat; Dubin, Ina

doi:10.1136/bcr-2017-222511

Cited by 10 publications

(9 citation statements)

References 27 publications

(11 reference statements)

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“…Bartonella-associated cutaneous lesions, including vasoproliferative lesions (bacillary angiomatosis), nodular panniculitis, multifocal erythema (erythema multiforme), rashes, and linear dermal lesions, may be more prevalent dermatological manifestations of bartonellosis than is currently appreciated. [1][2][3]17,18 We have previously amplified B henselae DNA from a linear dermal lesion in another young man, whose infection was further confirmed by scanning confocal immunohistochemical visualization of the bacteria within the lesional biopsy. 18 Histologically, the cutaneous lesions in both of these boys were characterized by a mild lymphocytic/plasmacytic perivascular inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

“…This result is consistent with previous studies indicating that a subset of Bartonella spp.-infected individuals remain IFA seronegative, despite PCR documentation of chronic bloodstream infection. 9 , 10 , 17 , 18 The reason(s) for the lack of Bartonella spp. seroreactivity remain unclear, but immunologic anergy is a suspected mechanism.…”

Section: Discussionmentioning

confidence: 99%

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Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome

Breitschwerdt

Greenberg

Maggi

et al. 2019

J Cent Nerv Syst Dis

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Background:With the advent of more sensitive culture and molecular diagnostic testing modalities, Bartonella spp. infections have been documented in blood and/or cerebrospinal fluid specimens from patients with diverse neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an unusually abrupt onset of cognitive, behavioral, or neurological symptoms. Between October 2015 and January 2017, a 14-year-old boy underwent evaluation by multiple specialists for sudden-onset psychotic behavior (hallucinations, delusions, suicidal and homicidal ideation).Methods:In March 2017, Bartonella spp. serology (indirect fluorescent antibody assays) and polymerase chain reaction (PCR) amplification, DNA sequencing, and Bartonella enrichment blood culture were used on a research basis to assess Bartonella spp. exposure and bloodstream infection, respectively. PCR assays targeting other vector-borne infections were performed to assess potential co-infections.Results:For 18 months, the boy remained psychotic despite 4 hospitalizations, therapeutic trials involving multiple psychiatric medication combinations, and immunosuppressive treatment for autoimmune encephalitis. Neurobartonellosis was diagnosed after cutaneous lesions developed. Subsequently, despite nearly 2 consecutive months of doxycycline administration, Bartonella henselae DNA was PCR amplified and sequenced from the patient’s blood, and from Bartonella alphaproteobacteria growth medium enrichment blood cultures. B henselae serology was negative. During treatment with combination antimicrobial chemotherapy, he experienced a gradual progressive decrease in neuropsychiatric symptoms, cessation of psychiatric drugs, resolution of Bartonella-associated cutaneous lesions, and a return to all pre-illness activities.Conclusions:This case report suggests that B henselae bloodstream infection may contribute to progressive, recalcitrant neuropsychiatric symptoms consistent with PANS in a subset of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome

Breitschwerdt

Greenberg

Maggi

et al. 2019

J Cent Nerv Syst Dis

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“…Other, but extremely rare, cutaneous manifestations also described in Bartonella infection are: erythema multiforme, purpura, febrile morbilliform rash, erythema marginatus, granuloma annularis, and leukocytoclastic vasculitis (6,18). The histopathology of cutaneous lesions mimics those in the lymph nodes, with the formation of granulomas with a central necrotic area, surrounded by lymphocytes, and histiocytes and with a neutrophilic infiltrate (18,19).…”

Section: Clinical Presentationsmentioning

confidence: 99%

Cat Scratch Disease in Children

Lisičić-Konaković

Šmitran²

2022

CEJP

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The aim of this paper is to provide information on the clinical manifestations, diagnosis and treatments of Bartonella henselae infection in children. Cat scratch disease (CSD) is a zoonosis caused by Bartonela henselae. Cat fleas are responsible for spreading the bacterium among cats. Bacteria can be transmitted to humans from the site of a cat bite or scratch. The typical manifestation of CSD is regional lymphadenopathy with a pustule at the site of inoculation, usually self-limiting. Atypical CSD has a wide range of clinical manifestations (hepatosplenic disease, pulmonary infiltrates, encephalitis, skin or bone involvement, endocarditis), some of which are life-threatening. Atypical presentations mainly occur in immunocompromised children, but have also been described in immunocompetent children.Conclusion − In recent years the number of households with a pet is growing and the number of children visiting a pediatrician with CSD is growing.

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“…While titers of Bartonella henselae IgG 1/64 and above indicate possible infection, titers above 1/256 strongly suggest acute and recent infection (5,6). Low titer Bartonella henselae IgG positivity was found in healthy asymptomatic individuals with cat contact, and serology alone causes deficiencies in diagnosis (7). In fact, false PCR and serology negativities are also observed in blood tests due to temporary and low bacteremia (8).…”

Section: Figure 2amentioning

confidence: 99%

Hepatosplenic <i>Bartonella henselae</i> Infection in an Immunocompetent Patient

Öztürk¹,

Engin²,

Kavas³

et al. 2021

hamidiyemedj

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Kedi tırmığı hastalığı, genellikle sınırlı bölgesel lenfadenomegali ile kendini gösterir. Ancak retinit, tendinit, osteomiyelit, oküloglandüler sendrom, ensefalopati ve granülomatöz hepatit gibi atipik klinik tablolar da bildirilmiştir.Hasta nedeni bilinmeyen ateş tanısı ile yatırıldı. Hasta başvurudan önce eritema migrans benzeri lezyonu tanımladıktan sonra borreliyoz şüphesi ile doksisiklin tedavisi başlatılmıştır. Ancak Borrelia burgdorferi immünoglobulin (IgM) ve IgG negatif sonuçlandı. Doksisiklin tedavisine 48. saatte ateş yanıtı alınan hastadan, evde kedisi olması nedeniyle Bartonella henselae IgG (IFA) istendi. Bartonella henselae IgG, 1/512 titrede pozitif olarak sonuçlandı ve hastaya bartonelloz tanısı konuldu. Pozitron emisyon tomografi-bilgisayarlı tomografide malignite ve mikroabselerden şüphelenildiği bildirildiği için karaciğer biyopsisi yapıldı. Histopatolojik bulguların karaciğerdeki granülomatöz enflamasyonla uyumlu olduğu bildirilmiştir. Doksisiklin tedavisi kesildi ve rifampisin ilk gün 14 mg 600 mg/gün + azitromisin 500 mg ve 250 mg olarak tamamlandı. Hasta iyileşerek taburcu edildi. İlk takip yılı bitiminde nüks görülmedi. Sıklıkla kedi tırmığı hastalığı etkeni olan Bartonella henselae, çok nadir olarak bakteriyemiye sekonder hepatosplenik tutuluma neden olabilir. Olgumuzda olduğu gibi nedeni bilinmeyen ateş etiyolojisinde bartonelloz akılda bulundurulmalıdır.

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The cat did it: erythema nodosum and additional atypical presentations ofBartonella henselaeinfection in immunocompetent hosts

Cited by 10 publications

References 27 publications

Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome

Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome

Cat Scratch Disease in Children

Hepatosplenic <i>Bartonella henselae</i> Infection in an Immunocompetent Patient

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