Bartonella haenselae infective endocarditis following transcatheter edge-to-edge mitral valve repair: A case report.

Infective endocarditis following a Mitraclip procedure might be an under-recognized complication. We describe the case of infective endocarditis by Bartonella henselae as a late complication in a patient with a previously implanted MitraClip system for mitral valve repair. Due to the severity of infection, surgical treatment was performed despite the high preoperative surgical risk, but recurrence of endocarditis of the biological valve implanted occurred. Although infection with Bartonella is known as a possible source of endocarditis, it has never been described before in relation to failed MitraClip therapy.

Effectiveness of antibiotic therapy in pediatric patients with cat scratch disease.

Background Appropriate antibiotic treatment of cat scratch disease (CSD) in pediatrics is not well established. Objective The purpose of this study was to evaluate the response rates of antibiotic therapy in pediatrics with CSD. Methods The electronic medical records of a cohort of pediatric patients with confirmed diagnosis of CSD (2006-2016) were reviewed, retrospectively. Data collection included patient demographics, clinical and laboratory results, antibiotic treatment and follow-up evaluations. Results One hundred and seventy-five patients (aged 7.4 ± 4.4 years) had confirmed CSD. Azithromycin and trimethoprim/sulfamethoxazole (TMP/SMX) were the largest groups with documented effectiveness at follow-up visits. Resolution and improvement of CSD was observed in 51.4% and 61.5% of patients with azithromycin and TMP/SMX, respectively among those with follow-up assessment. The effectiveness of azithromycin and TMP/SMX was comparable (p = 0.56). Conclusion Azithromycin and TMP/SMX were most frequently prescribed antibiotics. Azithromycin appeared to be an appropriate option for the treatment of CSD. TMP/SMX may be considered as an alternative antibiotic when azithromycin cannot be used.

Fever of unknown origin and splenomegaly: A case report of blood culture negative endocarditis.

RATIONALE: Fever of unknown origin (FUO) can be determined by different conditions among which infectious diseases represent the main cause. PATIENT CONCERNS: A young woman, with a history of aortic stenosis, was admitted to our unit for a month of intermittent fever associated with a new diastolic heart murmur and splenomegaly. Laboratory tests were negative for infectious screening. The total body computed tomography (CT) scan excluded abscesses, occulted neoplasia, or lymphadenopathy. DIAGNOSES: The transthoracic and transesophageal echocardiogram showed an aortic valve vegetation. Three sets of blood cultures were negative for all microorganisms tested. According to these findings, Bartonella endocarditis was suspected and the serology tests performed were positive. Finally, real-time polymerase chain reaction (RT-PCR) detected Bartonella henselae DNA on tissue valve. INTERVENTIONS: The patient underwent heart valve surgery and a treatment of Ampicillin, Gentamicin, and oral Doxycycline was prescribed for 16 days and, successively, with Doxycycline and Ceftriaxone for 6 weeks. OUTCOMES: After surgery and antibiotic therapy, patient continued to do well. LESSONS: Bartonella species are frequently the cause of negative blood culture endocarditis. Molecular biology techniques are the only useful tool for diagnosis. Valvular replacement is often necessary and antibiotic regimen with Gentamicin and either Ceftriaxone or Doxycycline is suggested as treatment.Echocardiogram and blood cultures must be performed in all cases of FUO. When blood cultures are negative and echocardiographic tools are indicative, early use of Bartonella serology is recommended.

[A boy with a swelling under his right jaw]. / Een jongen met een zwelling onder zijn rechter kaak.

A 12-year-old boy presented with a painful swelling under his right jaw. Cat scratch disease was confirmed serologically. Two months later the swelling had increased in size and had become red. There was obvious fluctuation, which indicated abscess formation. After incision and drainage of the abscess, the swelling resolved within two weeks.

Persistent cat scratch disease requiring surgical excision in a patient with MPGN.

We present the case of a 13-year-old immunosuppressed patient with unrelenting cat scratch disease despite 9 months of antibiotic therapy. The patient was being treated with mycophenolate and prednisone for membranoproliferative glomerulonephritis (type 1) diagnosed 13 months before the onset of cat scratch disease. Cat scratch disease was suspected due to epitrochlear lymphadenitis and an inoculation papule on the ipsilateral thumb, and the diagnosis was confirmed by the use of acute and convalescent titers positive for Bartonella henselae. The patient experienced prolonged lymphadenitis despite azithromycin and rifampin therapy, and she developed a draining sinus tract ∼4 months after initial inoculation while receiving antibiotics. Acute exacerbation of the primary supratrochlear node prompted incision and drainage of the area, with no improvement in the disease course. Ultimately, excision of all affected nodes and the sinus tract 9 months after the initial diagnosis was required to achieve resolution. Bartonella was detected at a high level according to a polymerase chain reaction assay in the excised nodes. Persistent treatment with oral antibiotics may have prevented disseminated infection in this immunosuppressed patient. Surgical excision of affected nodes should be considered in patients with cat scratch disease that persists beyond 16 weeks.

Cat scratch disease.

Approximately 24,000 people are infected with cat scratch disease (CSD) every year. CSD is caused by the bacteria Bartonella henselae, a gram-negative bacteria most often transmitted to humans through a bite or scratch from an infected cat or kitten. Although CSD is often a benign and self-limiting condition, it can affect any major organ system in the body, manifesting in different ways and sometimes leading to lifelong sequelae. It is a disease that is often overlooked in primary care because of the wide range of symptom presentation and relative rarity of serious complications. It is important for health care providers to recognize patients at risk for CSD, know what laboratory testing and treatments are available, and be aware of complications that may arise from this disease in the future.

Surgical wound infection by Streptococcus pneumoniae after a cat-scratch disease.

Streptococcus pneumoniae (pneumococcus) is mostly known as an agent of meningitis and pneumonia. We present what is believed to be a previously unreported case of pneumococcal disease, involving an inguinal wound. A 10-year-old male patient underwent surgical removal of a cat-scratch disease-related enlarged groin lymph node; infection of the wound was soon observed, with multidrug-resistant S pneumoniae growing from the lesion discharge. This communication expands the spectrum of skin ulcer-infecting pathogens; in fact, although pneumococcus has been known to mostly affect central nervous system and airways, we observed a surgical wound infection by this organism.

Cat scratch disease presenting as acute mastoiditis.

OBJECTIVE: To present the first published case of Cat Scratch Disease presenting as acute mastoiditis and review the relevant literature to discuss the Otolaryngologic manifestations of this disease and its treatment. DESIGN: A case report and literature review of the Otolaryngologic manifestations of Cat Scratch Disease. METHODS: A case report of a clinical scenario followed by a standard literature review. PubMed, EMBASE, and Cochrane database were used to find articles related to the Otolaryngologic manifestations of Cat Scratch Disease. RESULTS: A 6 year-old female presented to the Otolaryngologist with the typical appearance of acute mastoiditis. CT Scan confirmed breakdown of the osseous septae of the mastoid and mastoidectomy was undertaken. Granulation tissue and infected lymph nodes adjacent to the mastoid cortex were positive for Cat Scratch Disease. The patient was treated expectantly and recovered uneventfully. CONCLUSION: This is the first literature report of Cat Scratch Disease presenting as an acute mastoiditis.

[Cat scratch disease--an underestimated diagnosis]. / Choroba kociego pazura--lekcewazone schorzenie.

INTRODUCTION: Cat scratch disease is a rare and frequently underestimated cause of lymphadenopathy, which may occur also in the head and neck. The infection is most commonly caused by intracellular bacilli Bartonella, transmitted by domestic animals. AIM: We present a case report of a patient treated in the Department of Otolaryngology UJCM in Krakow. The patient presented with a neck tumor. Due to unclear clinical manifestation he underwent surgical treatment. The postoperative histopathological examination suggested cat scratch disease. In detailed anamnesis the patient admitted contact with cats and dogs in his household. No posoperative complications were observed. CONCLUSIONS: In every case of neck tumor it is advisable to consider cat scratch disease, remembering that exclusion of a neoplastic process remains a priority.

[Cat scratch disease--a diagnostic problem, case report]. / Choroba kociego pazura--problem diagnostyczny, opis przypadku.

AIM OF THE STUDY: Cat scratch disease as a possible cause of neck limphadenopathy. MATERIAL AND METHODS: We present a case of 40-years old men operated in our department on regional unilateral lymphadenopathy. The diagnosis of cat scratch disease was confirmed by the histopathologic examination. CONCLUSIONS: Regional lymphadenopathy with history of contact with cats or other animals suggests the diagnosis of cat scratch disease. If we considered this disease in differential diagnosis it would mean less traumatic treatment for the patient. Cat scratch disease is diagnosed in Poland very rarely; we need to spread the knowledge about this infectious disease.

Cat-scratch disease of the head and neck in a pediatric population: surgical indications and outcomes.

OBJECTIVE: To identify the presentation of pediatric patients with head and neck manifestations of cat-scratch disease, one of the most common causes of subacute or chronic lymphadenitis in children, and to determine surgical indications and outcomes. STUDY DESIGN: Case series. SUBJECTS AND METHODS: All pediatric patients from infancy to age 19 years who presented with clinical symptoms of cat-scratch disease and had an IgG serological test result of more than 1:128 for Bartonella henselae. RESULTS: Nine patients had cat-scratch disease of the head and neck. Median age at presentation was 4 years; median time from symptom onset to presentation was 20 days. Six (67%) children underwent surgical procedures, and median time from presentation to surgical procedure was 43 days. CONCLUSION: Despite conservative treatment, a minority of pediatric patients with cat-scratch disease may require surgical drainage of abscess and removal of lymph nodes. Surgical treatment provides tissue for diagnosis, is generally well tolerated, affords improved recovery, and has minimal complications.

Native valve endocarditis due to Bartonella henselae in an immunocompetent man.

Culture-negative endocarditis accounts for 2.5-31% of all endocarditis cases and remains a diagnostic and therapeutic challenge. Bartonella spp. has only recently been recognized as an important cause of culture-negative endocarditis. We report a case of Bartonella henselae endocarditis occurring in an immunocompetent man who owned a cat and had previously been diagnosed with valvulopathy. Diagnosis was made only after prolonged diagnostic work-up with serology and with PCR and subsequent sequencing to identify the microorganism in the excised valves. The duration of treatment in patients with bartonella endocarditis is not clearly defined, and we decided to treat our patient with a prolonged course of antibiotic. Surgical treatment is usually necessary and was also successful in our patient. To our knowledge, this is the first case of bartonella endocarditis occurring in our geographic area.

[Painful soft-tissue swelling of the upper arm]. / Schmerzhafte Weichteilschwellung am Oberarm.

Cat-scratch disease is an infection by Bartonella henselea and resolves spontaneously. We present a case of untypical Bartonella infection which was misinterpreted by MRI as a soft-tissue sarcoma of the upper arm. The histological findings of an incision biopsy were unspecific, without signs of malignancy. The tumor was excised completely and the final histology, however, showed no evidence of malignant changes. The Bartonella henselae infection could be confirmed by polymerase chain reaction. The untypical presentation of cat-scratch disease should be considered in the differential diagnosis of clinically suspected soft tissue sarcoma.

An unusual outcome in a child with hepatosplenic cat-scratch disease.

Typical cat-scratch disease (Bartonella henselae infection) in an immunocompetent child is usually associated with a history of scratch, bite or intimate contact with a cat. Most patients develop a non-tender papule in the scratch line after three to ten days. This may persist for only a few days or as long as two to three weeks. During the next two weeks or more, regional lymph nodes that drain the area gradually enlarge and then slowly resolve in more than 10% of patients. The nodes develop overlying erythema and may suppurate. Atypical forms of cat-scratch disease occur in a minority of cases and are characterized by ocular or neurological manifestations, hepatosplenic involvement, vertebral osteomyelitis, endocarditis etc. Immunocompromised individuals with B. henselae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia. There have been several reports of hepatosplenic granulomas caused by B. henselae in immunocompetent children. We report a case of a 6-year-old boy with the hepatosplenic form of cat-scratch disease. Despite early diagnosis and long-term antimicrobial treatment, splenectomy could not be avoided.

Transient paresis associated with cat-scratch disease: case report and literature review of vertebral osteomyelitis caused by Bartonella henselae.

Cat-scratch disease (CSD) rarely presents as vertebral osteomyelitis. We describe a case with paresis of the arm with total recovery after antibiotic and neurosurgical therapy. We reviewed 20 other cases of CSD vertebral osteomyelitis in the literature. This diagnosis should be considered in patients with systemic symptoms, back pain, and cat contact. The prognosis is generally good.

[Endocarditis due to Bartonella spp. Three new clinical cases and Spanish literature review]. / Endocarditis por Bartonella spp. Aportación de tres nuevos casos y revisión de la literatura nacional.

INTRODUCTION: Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases, such as culture-negative endocarditis. METHODS: Description of 3 cases of endocarditis due to Bartonella spp. and review of those previously reported in Spain. RESULTS: Including these 3 new cases of endocarditis due to Bartonella spp., a total of 6 cases have been reported in Spain. The median age of the patients was 51.6 years and 83.3% were men. There was history of contact with cats in 66.7%, and 50% were alcoholic. Only one patient had prior valvular disease. There were no clinical manifestations typical to any of the Bartonella species. The aortic valve was the one most commonly affected. In all cases, B. henselae was the agent implicated. The diagnosis was made by serology in 5 cases (83.3%). The outcome was favorable in all patients, although 4 of them (66.7%) required valve replacement. CONCLUSION: Endocarditis due to Bartonella spp. is present in Spain and is likely to be underestimated. We should suspect this pathogen in patients with negative blood cultures and a history of chronic alcoholism, homeless patients, and those who have had contact with cats or who have been bitten by fleas or lice, as well as patients with endocarditis and positive serology against Chlamydia spp.

Endocarditis por Bartonella spp. Aportación de tres nuevos casos y revisión de la literatura nacional / Endocarditis due to Bartonella spp. Three new clinical cases and Spanish literature review

Introducción. Las infecciones por Bartonella spp. incluyen un amplio espectro de enfermedades infecciosas (emergentes y reemergentes), entre las que figura la endocarditis con hemocultivo negativo. Métodos. Descripción de tres nuevos casos de endocarditis por Bartonella spp. y revisión de los casos publicados en España. Resultados. Con la aportación de estos tres nuevos casos de endocarditis por Bartonella spp., se describen en España un total de 6 casos. De forma global la media de edad fue de 51,6 años y el 83,3% eran varones. En el 66,7% de los pacientes existía el antecedente de contacto con gatos y en el 50% el de alcoholismo. Sólo un paciente presentó una valvulopatía previa. No existen manifestaciones clínicas propias de alguna de las especies de Bartonella. La válvula más afectada fue la aórtica. El agente responsable de todos los casos de endocarditis fue B. henselae. El diagnóstico se realizó mediante serología en 5 pacientes (83,3%). Todos los casos evolucionaron de forma favorable, si bien en 4 casos (66,7%) fue preciso el recambio valvular. Conclusión. La endocarditis por Bartonella spp. está presente en nuestro medio y sin duda subestimada. Esta entidad debe ser sospechada en pacientes con hemocultivos negativos y antecedentes epidemiológicos relacionados tales como alcoholismo crónico, ausencia de vivienda habitual, contacto con gatos y picaduras por pulgas o piojos, así como en aquellos pacientes con endocarditis y con serologías positivas frente a Chlamydia spp (AU)

Introduction. Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases, such as culture-negative endocarditis. Methods. Description of 3 cases of endocarditis due to Bartonella spp. and review of those previously reported in Spain. Results. Including these 3 new cases of endocarditis due to Bartonella spp., a total of 6 cases have been reported in Spain. The median age of the patients was 51.6 years and 83.3% were men. There was history of contact with cats in 66.7%, and 50% were alcoholic. Only one patient had prior valvular disease. There were no clinical manifestations typical to any of the Bartonella species. The aortic valve was the one most commonly affected. In all cases, B. henselae was the agent implicated. The diagnosis was made by serology in 5 cases (83.3%). The outcome was favorable in all patients, although 4 of them (66.7%) required valve replacement. Conclusion. Endocarditis due to Bartonella spp. is present in Spain and is likely to be underestimated. We should suspect this pathogen in patients with negative blood cultures and a history of chronic alcoholism, homeless patients, and those who have had contact with cats or who have been bitten by fleas or lice, as well as patients with endocarditis and positive serology against Chlamydia spp (AU)