tetracycline and Fever-of-Unknown-Origin

Systemic cat scratch disease (CSD) is often associated with prolonged fever and microabscesses in the liver and/or spleen. We report a case of systemic CSD with hepatic, splenic and renal involvement in an aboriginal child in Taiwan. A previously healthy 9-year-old girl had an intermittent fever for about 17 days, and complained of abdominal pain, headache and weight loss. Abdominal computed tomography showed multiple tiny hypodense nodular lesions in the spleen and both kidneys. Laparotomy revealed multiple soft, whitish-tan lesions on the surface of the liver and spleen. Histopathologic examination of a biopsy specimen of the spleen showed necrotizing granulomatous inflammation with central necrosis surrounded by epithelioid cells and occasional Langhans' giant cells, strongly suggestive of Bartonella henselae infection. History revealed close contact with a cat. B. henselae DNA was detected by polymerase chain reaction in the tissue specimen, and the single antibody titer against B. henselae was greater than 1:2048. These results confirmed the diagnosis of visceral CSD caused by B. henselae. The patient's symptoms resolved after treatment with rifampin and tetracycline. This case illustrates the need for inclusion of systemic CSD in patients with fever of unknown origin and abdominal pain.

Topics: Animals; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Female; Fever of Unknown Origin; Humans; Polymerase Chain Reaction; Rifampin; Tetracycline

We have reported a case documenting the difficulties encountered in diagnosing and treating patients with brucellosis caused by Brucella canis, including the nonspecific clinical presentation, low level of intermittent bacteremias, the slow-growing, fastidious nature of the organism, and the lack of antigenic cross-reactivity with the antigens usually used in routine Brucella serology. Further, the predominant southeastern United States epidemiology of this organism and the importance of exposure to dogs are also demonstrated by this report. It is important that physicians caring for patients in this region of the country be aware of the epidemiologic, serologic, and microbiologic pitfalls encountered in diagnosing B canis infections.

Topics: Animals; Brucella; Brucellosis; Dog Diseases; Dogs; Fever of Unknown Origin; Humans; Male; Streptomycin; Tetracycline; Zoonoses

A 58-year-old woman with prolonged febrile illness was found to have brucellosis caused by Brucella canis, presumably acquired through contact with infected dogs. After initial laboratory tests failed to yield a diagnosis, the disease was confirmed by the Brucella agglutination test. A combination of tetracycline and streptomycin therapy was begun, and the illness resolved. B canis, a recently recognized cause of human brucellosis, must now be considered in patients with fever of unknown origin. With adequate medical therapy, rapid and complete recovery can be expected.

Topics: Animals; Brucellosis; Dogs; Drug Therapy, Combination; Female; Fever of Unknown Origin; Humans; Middle Aged; Streptomycin; Tetracycline; Zoonoses

Topics: Acute Disease; Adolescent; Adult; Brucellosis; Endocarditis, Bacterial; Female; Fever of Unknown Origin; Humans; Lung Diseases; Male; Middle Aged; Spinal Diseases; Streptomycin; Tetracycline