Bartonella henselae: Difference between revisions
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Bartonella henselae
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==Clinical Presentation== |
==Clinical Presentation== |
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* Typical cat-scratch disease is a self-limited febrile illness with [[Causes::regional lymphadenopathy]] |
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** Following an incubation period of 3 to 10 days, and initial pustule develops at site of inoculation which may last for up to 3 weeks |
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** This is followed in 1 to 7 weeks by ipsilateral [[Causes::lymphadenopathy]] (usually the head or neck) |
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*** May involve one or more lymph nodes |
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*** May drain pus |
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*** Will eventually resolve, over months or longer |
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** There may be a concurrent low-grade [[Causes::fever]] for several days, with [[Causes::malaise]] or [[Causes::fatigue]] |
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** May have [[Causes::headache,]] sore throat, transient rash, or, rarely, [[Causes::erythema nodosum]] |
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** May have mild leukocytosis (neutrophils or eosinophils) |
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* CSD may be complicated by [[Causes::encephalopathy]] in 2 to 4% of cases |
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** Headache is common, and they may develop seizures and neurologic deficits |
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** Resolves over weeks to months (to as long as a year) |
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** CSF is usually normal, although lymphocytic pleiocytosis and elevated protein are seen in one third |
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** MRI brain is almost always normal |
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** EEG is nonspecific |
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** Proportionally less common in children |
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* Other syndromes include: |
* Other syndromes include: |
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** Parinaud oculoglandular syndrome, with granulomatous conjunctivitis and ipsilateral |
** [[Causes::Parinaud oculoglandular syndrome]], with granulomatous conjunctivitis and ipsilateral (usually preauricular) lymphadenopathy |
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** Neuroretinitis and other ophthalmic complications |
** [[Causes::Neuroretinitis]] and other ophthalmic complications |
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** Fever of unknown origin, in children |
** [[Causes::Fever of unknown origin]], in children |
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** Culture-negative endocarditis in patients with existing valve abnormalities |
** Culture-negative [[Causes::endocarditis]] in patients with existing valve abnormalities |
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** Chronic endocarditis, with vasculitis and glomerulonephritis |
** Chronic endocarditis, with [[Causes::vasculitis]] and [[Causes::glomerulonephritis]] |
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* Disseminated disease is possible in immunocompromised patients, including bacteremia, disseminated skin lesions, and |
* Disseminated disease is possible in immunocompromised patients, including bacteremia, disseminated skin lesions, and hepatosplenic lesions |
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==Diagnosis== |
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* Histopathology of node aspirate shows nonspecific inflammation, with granulomas and stellate ncerosis |
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** Microabscesses are classic finding |
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** Bacilli may be seen with Warthin-Starry staining |
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* PCR of node aspirate is the best and most sensitive test |
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* Serology for acute and convalescent titres |
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{{DISPLAYTITLE:''Bartonella henselae''}} |
{{DISPLAYTITLE:''Bartonella henselae''}} |
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Revision as of 01:06, 16 May 2020
Background
- Causes cat-scratch disease
Epidemiology
- Present worldwide
- Main reservoir is cats, and especially kittens
- Infections are more common in children, likely due to increased exposure to kittens
- Transmitted to humans by inoculation of cat flea (Ctenocephalides felis) feces into a cat scratch or bite
Clinical Presentation
- Typical cat-scratch disease is a self-limited febrile illness with regional lymphadenopathy
- Following an incubation period of 3 to 10 days, and initial pustule develops at site of inoculation which may last for up to 3 weeks
- This is followed in 1 to 7 weeks by ipsilateral lymphadenopathy (usually the head or neck)
- May involve one or more lymph nodes
- May drain pus
- Will eventually resolve, over months or longer
- There may be a concurrent low-grade fever for several days, with malaise or fatigue
- May have headache, sore throat, transient rash, or, rarely, erythema nodosum
- May have mild leukocytosis (neutrophils or eosinophils)
- CSD may be complicated by encephalopathy in 2 to 4% of cases
- Headache is common, and they may develop seizures and neurologic deficits
- Resolves over weeks to months (to as long as a year)
- CSF is usually normal, although lymphocytic pleiocytosis and elevated protein are seen in one third
- MRI brain is almost always normal
- EEG is nonspecific
- Proportionally less common in children
- Other syndromes include:
- Parinaud oculoglandular syndrome, with granulomatous conjunctivitis and ipsilateral (usually preauricular) lymphadenopathy
- Neuroretinitis and other ophthalmic complications
- Fever of unknown origin, in children
- Culture-negative endocarditis in patients with existing valve abnormalities
- Chronic endocarditis, with vasculitis and glomerulonephritis
- Disseminated disease is possible in immunocompromised patients, including bacteremia, disseminated skin lesions, and hepatosplenic lesions
Diagnosis
- Histopathology of node aspirate shows nonspecific inflammation, with granulomas and stellate ncerosis
- Microabscesses are classic finding
- Bacilli may be seen with Warthin-Starry staining
- PCR of node aspirate is the best and most sensitive test
- Serology for acute and convalescent titres
