ABSTRACT
La endocarditis bacteriana con hemocultivo negativo constituye un dilema diagnóstico. Tanto Bartonella como Coxiella pueden causarla, con presentaciones clínicas similares que pueden simular una vasculitis sistémica no infecciosa. Sin embargo, difieren en el tipo y la duración del tratamiento, por lo que es fundamental identificar el agente etiológico. Presentamos un caso de endocarditis por Bartonella henselae asociada a glomerulonefritis y neurorretinitis, con hemocultivo negativo, anticuerpos anticitoplasma de neutrófilos y antiproteinasa 3 positivos, y serología positiva para Bartonella con reacción cruzada para Coxiella burnetti. El diagnóstico etiológico fue confirmado a posteriori mediante amplificación y secuenciación parcial del gen ribC a partir de tejido de la válvula cardíaca. El paciente recibió tratamiento antibiótico e inmunosupresor seguido de recambio valvular aórtico y presentó evolución favorable.
Blood-culture negative endocarditis is a diagnostic challenge. Both Bartonella and Coxiella can cause it with similar clinical presentations mimicking a systemic vasculitis. The identification of the etiologic agent is essential because they differ in treatment type and duration. We present a case of blood-culture negative endocarditis caused by Bartonella henselae, associated with glomerulonephritis and neuroretinitis, with negative blood culture, positive anti-neutrophil cytoplasmic and antiproteinase 3 antibodies. The serology was positive for Bartonella with cross-reactivity to Coxiella burnetti. The etiological diagnosis was achieved by polymerase chain reaction amplification and sequencing of a ribC gene fragment. The patient received antibiotic and immunosuppressive treatment followed by replacement of the aortic valve with favorable medium-term evolution.
Subject(s)
Humans , Male , Adult , Retinitis/microbiology , Bartonella henselae/isolation & purification , Endocarditis, Bacterial/microbiology , Glomerulonephritis/microbiology , Retinitis/complications , Endocarditis, Bacterial/complications , Glomerulonephritis/complicationsABSTRACT
Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.
Subject(s)
Humans , Animals , Male , Cats , Young Adult , Retinitis/microbiology , Bartonella henselae/isolation & purification , Retinitis/diagnosis , Retinitis/drug therapy , Doxycycline/therapeutic use , Anti-Bacterial Agents/therapeutic useABSTRACT
Se reporta el caso de un varón de 36 años con neurorretinitis por Bartonella henselae, cuyo seguimiento periódico fue realizado con tomografía de coherencia óptica (TCO). El inicio de la enfermedad se caracterizó por disminución de agudeza visual (AV) unilateral, indolora, de inicio brusco en ojo derecho (OD), asociado a cuadro febril. El examen fundoscópico mostró edema en polo posterior, extendiéndose desde el disco óptico hasta la región macular en OD. La TCO confirmó el engrosamiento macular y del disco óptico así como la presencia de fluido macular subretinal. Los estudios sistémicos fueron normales con excepción del hemograma por presencia de leucocitosis y serología positiva a Bartonella henselae. El seguimiento tomográfico permitió valorar la disminución del edema macular, con la correspondiente mejora de la agudeza visual y ausencia de complicaciones asociadas. Este reporte describe la utilidad del seguimiento con TCO en un paciente con neurorretinitis por Bartonella henselae.
The case of a 36 year-old male with neuroretinitis caused by Bartonella henselae is reported, whose periodic follow-up was done through optical coherence tomography (OCT). The onset of this disease was characterized by unilateral low visual acuity (VA), painless, of sudden onset, in the right eye (RE), associated to l febrile symptom. The funduscopic examination showed edema in the posterior pole which extended from the optical disc to the macular region in the RE. The OCT confirmed macular and optical disc thickening, as well as the presence of subretinal macular fluid. Systemic studies were normal except for a blood count due to the presence of leukocytosis and positive for Bartonella henselae. The follow up with CT Scan helped to evaluate the decrease in macular edema, with the subsequent improvement of visual acuity and absence of related complications. This report describes the utility of the follow up with OCT in a patient with neuroretinitis caused by Bartonella henselae.
Subject(s)
Adult , Humans , Male , Cat-Scratch Disease/diagnosis , Retinitis/diagnosis , Retinitis/microbiology , Tomography, Optical Coherence , Follow-Up StudiesABSTRACT
Optic neuropathy due to cat scratch disease is a relatively infrequent occurrence associated with macular star formation and is characterized by sudden painless loss of vision mostly unilateral. Bartonella henselae is well recognized as the etiologic agent in cat scratch disease. Ocular complications of the disease occur in up to 10 percent of patients and include neuroretinitis. Ocular bartonelosis is usually self-limited with complete or near-complete recovery of vision in otherwise healthy patients. A case of a boy with neuroretinitis caused by B. henselae is reported.
Neuropatia óptica associada à doença da arranhadura do gato é relativamente infrequente, está associada com formação de estrela macular e caracterizase por perda visual súbita sem dor na maioria das vezes unilateral. Bartonella henselae é o agente etiológico da enfermidade. As complicações oculares da doença ocorrem em mais de 10 por cento dos casos, entre elas está a neurorretinite. Bartonelose ocular é uma doença autolimitada com completa ou quase completa recuperação da acuidade visual em pacientes imunocompetentes. Relatamos o caso de um adolescente com neuroretinite causada por B. henselae.
Subject(s)
Adolescent , Humans , Male , Bartonella henselae , Cat-Scratch Disease/complications , Eye Infections, Bacterial/microbiology , Optic Nerve Diseases/microbiology , Retinitis/microbiologyABSTRACT
La infección por Bartonella henselae se presenta característicamente con adenopatías regionales y fiebre de intensidad variable, entidad conocida como enfermedad por arañazo de gato. Alrededor de 5 a 10 por ciento de los casos desarrolla compromiso ocular, entre los que destacan el síndrome óculo-glandular de Parinaud, la neuro-retinitis y la retino-coroiditis focal. A continuación se presentan dos pacientes con infección aguda por B. henselae y compromiso ocular. Ambos recibieron tratamiento y evolucionaron con recuperación completa de la visión.
Cat scratch disease is the main clinical presentation of Bartonella henselae infection. However, ocular manifestations of bartonellosis occur in about 5 to 10 percent of the patients, mainly presenting as neuroretinitis, choroiditis or oculoglandular syndrome of Parinaud. We describe two patients with documented B. henselae infection and typical ocular compromise. Both patients were treated and had a favorable visual outcome.
Subject(s)
Adult , Animals , Cats , Humans , Male , Cat-Scratch Disease/complications , Eye Infections, Bacterial/microbiology , Retinitis/microbiology , Anti-Bacterial Agents/therapeutic use , Bartonella henselae/isolation & purification , Cat-Scratch Disease/diagnosis , Cat-Scratch Disease/drug therapy , Eye Infections, Bacterial/diagnosis , Fundus Oculi , Retinitis/diagnosisABSTRACT
Retinitis and panuveitis in immunocompetent patients is a rare and sight-threatening disease, of difficult diagnosis. A case of a 31-year-old male who presented with unilateral placoid retinitis and panuveitis, unsuccessfully treated as acute retinal necrosis, that in fact was syphilis, with neurosyphilis and excellent response to treatment is reported.
Retinite com panuveíte em pacientes imunocompetentes é um condição rara e ameaçadora para a visão, e de difícil diagnóstico. É relatado um caso de um paciente do sexo masculino com 31 anos de idade, que se apresentou com retinite em placas e panuveíte, inicialmente tratado sem sucesso como necrose aguda de retina, que na verdade era um caso de sífilis ocular, com afecção do sistema nervoso central e ótima resposta ao tratamento sistêmico para sífilis.