ABSTRACT
In 1993, an outbreak of 10 cases of Bartonella quintana bacteremia occurred among homeless, alcoholic, human immunodeficiency virus (HIV)-negative persons in Seattle. To estimate the prevalence of past exposure B. quintana among this population, a serosurvey was conducted in 1994 among patients at a downtown Seattle clinic. Microimmunofluorescent titers to B. quintana in 192 clinic patients were compared with titers in 199 age- and sex-matched Seattle volunteer blood donors. Titers > or = 64 were detected in 20% (39/192) of clinic patients compared with 2% (4/199) of blood donors (P<.001). Among clinic patients, alcohol abuse was independently associated in multivariate analysis with titers > or = 64 (odds ratio, 3.3; 95% confidence interval, 1.6-6.9). Of the 39 patients with B. quintana titers > or = 64, 24 (62%) also had titers > or = 64 to Bartonella henselae, indicating serologic cross-reactivity between Bartonella species. These results suggest that a substantial proportion of this indigent, inner-city Seattle population was infected with B. quintana.
Subject(s)
Bartonella quintana/immunology , Trench Fever/epidemiology , Adolescent , Adult , Antibodies, Bacterial/analysis , Community Health Centers , Female , Ill-Housed Persons , Humans , Male , Middle Aged , Risk Factors , Serologic Tests , WashingtonABSTRACT
Differentiating between primary and ectopic or pseudohyperparathyroidism may be difficllt, but certain aspects of the patient's clinical history as well as laboratory tests may be helpful. We present an unusual case report of a patient who had massive splenomegaly secondary to a localized histiocytic lymphoma. On the basis of a lower serum parathormone level for a given serum calcium increase combined with normal serum phosphorous and chloride values, the diagnosis of psuedohyperparathyroidism was made and was confirmed when the patient's serum calcium level and temperature returned to normal following splenectomy.
