Bartonella henselae: Difference between revisions

Latest revision as of 21:14, 3 October 2022

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 Manifestations

Cat Scratch Disease

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
- Usually a history of cat exposure (adult or kitten), but 5-10% have no known exposure
- 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), mildly elevated C-reactive protein or ESR
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

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
Culture
- Fastidious organism which may not be detected by automated blood culture systems
- If suspected, cultures should be held for 21 days
Molecular
- PCR of node aspirate (or blood) is the best and most sensitive test
Serology
- 1:64 is suggestive, 1:256 is strongly suggestive, and a four-fold rise from acute to convalescent titres is diagnostic
- Cross-reacts with other Bartonella species, but possibly also with Chlamydia and Coxiella burnetii

Management

Cat-Scratch Disease

Disease is usually self-limited in immunocompetent patients
May wish to treat if extensive lymphadenitis
First-line: azithromycin 500 mg po on day 1 followed by 250 mg po daily for 4 more days (10 mg/kg and 5 mg/kg for children)
Hepatosplenic CSD in children may respond to combination azithromycin ± rifampin for 14 days

Endocarditis

Doxycycline and gentamicin for 14 days followed by doxycycline alone for three months, or until 6 weeks after valve replacement (if done)

@@ Line 1: / Line 1: @@
 ==Background==
-* Causes '''cat-scratch disease'''
+*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
+*Present worldwide
-==Clinical Presentation==
+*Main reservoir is cats, and especially kittens
-* Typical cat-scratch disease is a self-limited febrile illness with [[Causes::regional lymphadenopathy]]
+*Infections are more common in children, likely due to increased exposure to kittens
-** 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
+*Transmitted to humans by inoculation of cat flea (''[[Vector::Ctenocephalides felis]]'') feces into a cat scratch or bite
-** This is followed in 1 to 7 weeks by ipsilateral [[Causes::lymphadenopathy]] (usually the head or neck)
-*** May involve one or more lymph nodes
+==Clinical Manifestations==
-*** May drain pus
-*** Will eventually resolve, over months or longer
+=== Cat Scratch Disease ===
-** There may be a concurrent low-grade [[Causes::fever]] for several days, with [[Causes::malaise]] or [[Causes::fatigue]]
-** May have [[Causes::headache,]] sore throat, transient rash, or, rarely, [[Causes::erythema nodosum]]
+*Typical cat-scratch disease is a self-limited febrile illness with [[Causes::regional lymphadenopathy]]
-** May have mild leukocytosis (neutrophils or eosinophils)
+**Following an incubation period of [[Usual incubation period::3 to 10 days]], and initial pustule develops at site of inoculation which may last for up to 3 weeks
-* CSD may be complicated by [[Causes::encephalopathy]] in 2 to 4% of cases
+**Usually a history of cat exposure (adult or kitten), but 5-10% have no known exposure
-** Headache is common, and they may develop seizures and neurologic deficits
+**This is followed in 1 to 7 weeks by ipsilateral [[Causes::lymphadenopathy]] (usually the head or neck)
-** Resolves over weeks to months (to as long as a year)
+***May involve one or more lymph nodes
-** CSF is usually normal, although lymphocytic pleiocytosis and elevated protein are seen in one third
+***May drain pus
-** MRI brain is almost always normal
+***Will eventually resolve, over months or longer
-** EEG is nonspecific
+**There may be a concurrent low-grade [[Causes::fever]] for several days, with [[Causes::malaise]] or [[Causes::fatigue]]
-** Proportionally less common in children
+**May have [[Causes::headache,]] sore throat, transient rash, or, rarely, [[Causes::erythema nodosum]]
-* Other syndromes include:
+**May have mild leukocytosis (neutrophils or eosinophils), mildly elevated C-reactive protein or ESR
-** [[Causes::Parinaud oculoglandular syndrome]], with granulomatous conjunctivitis and ipsilateral (usually preauricular) lymphadenopathy
+*CSD may be complicated by [[Causes::encephalopathy]] in 2 to 4% of cases
-** [[Causes::Neuroretinitis]] and other ophthalmic complications
+**Headache is common, and they may develop seizures and neurologic deficits
-** [[Causes::Fever of unknown origin]], in children
+**Resolves over weeks to months (to as long as a year)
-** Culture-negative [[Causes::endocarditis]] in patients with existing valve abnormalities
+**CSF is usually normal, although lymphocytic pleiocytosis and elevated protein are seen in one third
-** Chronic endocarditis, with [[Causes::vasculitis]] and [[Causes::glomerulonephritis]]
+**MRI brain is almost always normal
-* Disseminated disease is possible in immunocompromised patients, including bacteremia, disseminated skin lesions, and hepatosplenic lesions
+**EEG is nonspecific
+**Proportionally less common in children
+=== Other Syndromes ===
+*Other syndromes include:
+**[[Causes::Parinaud oculoglandular syndrome]], with granulomatous conjunctivitis and ipsilateral (usually preauricular) lymphadenopathy
+**[[Causes::Neuroretinitis]] and other ophthalmic complications
+**[[Causes::Fever of unknown origin]], in children
+**Culture-negative [[Causes::endocarditis]] in patients with existing valve abnormalities
+**Chronic endocarditis, with [[Causes::vasculitis]] and [[Causes::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
+*Histopathology of node aspirate shows nonspecific inflammation, with granulomas and stellate ncerosis
-** Microabscesses are classic finding
+**Microabscesses are classic finding
-** Bacilli may be seen with Warthin-Starry staining
+**Bacilli may be seen with Warthin-Starry staining
-* Culture
+*Culture
-** Fastidious organism which may not be detected by automated blood culture systems
+**Fastidious organism which may not be detected by automated blood culture systems
-** If suspected, cultures should be held for 21 days
+**If suspected, cultures should be held for 21 days
-* Molecular
+*Molecular
-** PCR of node aspirate (or blood) is the best and most sensitive test
+**PCR of node aspirate (or blood) is the best and most sensitive test
-* Serology
+*Serology
-** 1:64 is suggestive, 1:256 is strongly suggestive, and a four-fold rise from acute to convalescent titres is diagnostic
+**1:64 is suggestive, 1:256 is strongly suggestive, and a four-fold rise from acute to convalescent titres is diagnostic
-** Cross-reacts with other ''[[Bartonella]]'' species, but possibly also with ''[[Chlamydia]]'' and ''[[Coxiella burnetii]]''
+**Cross-reacts with other ''[[Bartonella]]'' species, but possibly also with ''[[Chlamydia]]'' and ''[[Coxiella burnetii]]''
 ==Management==
-===Cat-scratch disease===
+===Cat-Scratch Disease===
-* Disease is usually self-limited in immunocompetent patients
+*Disease is usually self-limited in immunocompetent patients
-* May wish to treat if extensive lymphadenitis
+*May wish to treat if extensive lymphadenitis
-* First-line: [[Is treated by::azithromycin]] 500 mg po on day 1 followed by 250 mg po daily for 4 more days (10 mg/kg and 5 mg/kg for children)
-* Hepatosplenic CSD in children may respond to combination [[Is treated by::azithromycin]] ± [[Is treated by::rifampin]] for 14 days
+*First-line: [[Is treated by::azithromycin]] 500 mg po on day 1 followed by 250 mg po daily for 4 more days (10 mg/kg and 5 mg/kg for children)
+*Hepatosplenic CSD in children may respond to combination [[Is treated by::azithromycin]] ± [[Is treated by::rifampin]] for 14 days
 ===Endocarditis===
-* [[Is treated by::Doxycycline]] and [[Is treated by::gentamicin]] for 14 days followed by [[doxycycline]] alone for three months, or until 6 weeks after valve replacement (if done)
+*[[Is treated by::Doxycycline]] and [[Is treated by::gentamicin]] for 14 days followed by [[doxycycline]] alone for three months, or until 6 weeks after valve replacement (if done)
 {{DISPLAYTITLE:''Bartonella henselae''}}