zithromax and Cat-Scratch-Disease

Bartonella henselae infection can cause a wide spectrum of diseases in both the immunocompetent and immunocompromised host with BA a severe form relegated to immunocompromised hosts, including solid organ transplant population. There are established criteria for diagnosis of Bartonella infection based on clinical presentation, serologic testing, imaging studies and, when indicated, tissue sampling for histopathological evaluation, particularly for BA. However, treatment recommendations for BA are inconclusive. Furthermore, there are no studies in the pediatric solid organ transplant population for antimicrobial therapy during BA secondary to Bartonella henselae infection. A case of BA following heart transplant is presented along with a literature review of clinical presentation; diagnosis and therapy for BA in the pediatric solid organ transplant population.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Heart Transplantation; Humans; Immunocompromised Host

Cat scratch disease (CSD) can present as a systemic disease in 5-10% of cases and lead to various disease entities. A previously healthy 16-month-old boy presented with fever for 7 days without other obvious symptoms. Abdominal computed tomography scan demonstrated enlarged right inguinal lymph nodes and multiple small round hypodensities in the spleen. Despite antibiotic treatment for 1 week, the fever persisted and the intrasplenic lesions progressed. Inguinal lymph node biopsy confirmed CSD by immunohistochemistry staining. The diagnosis of CSD was also supported by a history of contact, imaging and serological findings. The patient recovered after treatment with azithromycin for a total of 5 weeks and, in serial follow-up, the hepatosplenic micro-abscesses resolved after 4th months.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Biopsy; Cat-Scratch Disease; Cats; Humans; Immunohistochemistry; Infant; Lymph Nodes; Male; Tomography, X-Ray Computed

Topics: Adult; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Arthritis, Rheumatoid; Azithromycin; Bartonella henselae; Biopsy; Cat-Scratch Disease; Diagnosis, Differential; Humans; Lymph Nodes; Lymphatic Diseases; Male; Receptors, Interleukin-6; Treatment Outcome

To present a clinicocytopathologic correlation of an atypical case of cat scratch disease (CSD) involving retroperitoneal lymph nodes, with emphasis on communication between service teams for managing lymphadenopathy of unknown origin. We consider clinical and cytologic differential diagnoses and review the literature on atypical cases of CSD, with emphasis on abdominal presentation and cytologic findings.. Clinical services met with the cytology service to review clinical and pathologic features. Literature was reviewed via PubMed search (Harbor-UCLA subscriptions). Immunohistochemistry and Steiner silver stains were performed by Harbor-UCLA Department of Pathology. Enzyme-linked immunosorbent assay IgG and IgM Bartonella henselae titers were carried out by Quest Nichols Institute.. Fine-needle aspirate Diff-Quik and Papanicolaou smears and H&E-stained cell block showed abundant histiocytes, monocytoid B cells, and numerous neutrophils associated with necrosis corresponding to a late stage of CSD infection. Silver stain was positive for clumps of pleomorphic organisms. IgM and IgG antibody titers were elevated.. The cytologic findings of CSD in an atypical abdominal presentation are similar to those of a classic presentation. Laboratory workup for atypical CSD should include at least two other modalities aside from cytomorphologic features. Close clinical and cytologic correlation avoided potentially unnecessary and harmful surgery and enabled timely treatment.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Diagnosis, Differential; Gentamicins; Humans; Immunohistochemistry; Lymph Nodes; Lymphatic Diseases; Male; Treatment Outcome; Young Adult

Bartonella henselae is the causative agent of cat scratch disease and bacillary angiomatosis-peliosis. The spectrum of disease, diagnosis, and management of B. henselae infection in solid organ transplant recipients has not been well characterized. We identified 29 cases of solid organ transplant recipients who had Bartonella infection, 24 by a review of the English-language literature and 5 from our institution. Localized cat scratch disease was found in 8 patients (28%), and disseminated infection was found in 21 patients (72%). The mean time after transplantation to development of Bartonella infection among those with cat scratch disease was 5.6 ± 5.3 years, and among those with disseminated infection was 2.7 ± 2.4 years. Prominent clinical features included cat exposure in 26 patients (90%), fever in 27 patients (93%), lymphadenopathy in 12 patients (41%), and skin lesions in 7 patients (24%). Methods used in establishing the diagnosis of Bartonella infection included culture, polymerase chain reaction (PCR) assay, serologic assays, and histopathologic examination. Culture was positive in 2 of only 4 patients in whom this was performed, and PCR was positive in 12 of 14 patients (86%) in whom this test was performed. Serologic assays were positive in all 23 patients who were tested. Histopathologic examination of tissues in all 8 patients who had cat scratch disease revealed granulomatous inflammation in 4 (50%) and bacillary angiomatosis-peliosis in 2 (25%). Among the 15 patients who had disseminated infection and who had tissue examined, 8 (53%) had only granulomatous inflammation, 4 had only bacillary angiomatosis-peliosis (27%), and 2 had both granulomas and bacillary angiomatosis-peliosis (13%). A positive Warthin-Starry or Steiner stain was noted in 12 of 19 patients (63%) who had 1 of these stains performed. All 8 patients with cat scratch disease and 19 of 21 patients with disseminated bartonellosis were cured with antimicrobial therapy. Two patients, both of whom had endocarditis, died. Among solid organ transplant recipients, infection with B. henselae is uncommon and has diverse disease manifestations including disseminated disease. Persistent fevers or lymphadenopathy in a transplant recipient who has been exposed to cats should prompt clinicians to maintain a high index of suspicion for B. henselae infection. Identifying B. henselae as the causative organism often requires multiple diagnostic studies. Once the diagnosis is established, mos

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Gentamicins; Humans; Immunocompromised Host; Kidney Transplantation; Liver Transplantation; Male; Middle Aged

Cat scratch disease (CSD), caused by Bartonella henselae, is a zoonosis and characterized by self-limited lymphadenopathy. It is transmitted commonly by scratch or bite from cats or kitten. We report an unusual case of CSD caused by a domestic dog scratch that we believe is the first report in Taiwan. A 23-year-old healthy woman developed cervical lymphadenopathy, mild fever, headache, and malaise 3 days after dog scratch. Her symptoms improved after azithromycin treatment. Serology proved B. henselae infection. The owners of a domestic dog might be at risk of "cat" scratch disease.

Topics: Animals; Azithromycin; Cat-Scratch Disease; Dogs; Female; Humans; Middle Aged

Cat-scratch disease is an infection caused by Bartonella henselae, a fastidious gram-negative bacillus acquired from exposure to an infected kitten or cat. The most common manifestation of human disease is lymphadenitis. Atypical forms of infection include Parinaud oculoglandular syndrome, stellate neuroretinitis, persistent fever without localizing signs, hepatosplenic infection, encephalopathy, osteomyelitis, and endocarditis. Immunocompromised individuals with B. hensalae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia with fever syndrome. The bacillus is susceptible to several antibacterial agents in vitro, including penicillins, cephalosporins, aminoglycosides, tetracyclines, macrolides, quinolones, trimethoprim and sulfamethoxazole, and rifampin. Greatest clinical efficacy has been observed following treatment with rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin, and azithromycin. In one placebo-controlled study, azithromycin therapy was associated with more rapid diminution in size of infected lymph nodes. The majority of cases of cat-scratch disease occurring in normal hosts do not require anti-infective therapy for resolution of infection.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Disease Reservoirs; Humans; Immunocompromised Host; Lymphatic Diseases

The diagnosis of severe mitral stenosis with left atrial thrombus was rectified at valvular replacement in a 48-year old immuno-competent man who was a cat owner. The mass in the left atrium was, in fact, a large endocarditic vegetation. Pre- and postoperative blood cultures were negative as was culture of the excised mitral valve. The diagnosis of infectious endocarditis (IE) due to Bartonella Henselae was made from a positive serological test (1600) and identification of the germ by genetic amplification. Antibiotic therapy was continued for 6 months and the patient was cured with a follow-up of 4 years. Bartonella Henselae IE is very rare (14 reported cases) and affects mainly the aortic valve, often giving rise to very large vegetations which, in half the cases, are complicated by systemic emboli. Germs like Batonella are sensitive to most antibiotics, especially the aminosides and macrolides. In Bartonella Henselae IE, valve replacement is the rule (13 out of 14 cases) and the prognosis is usually good. Sero-diagnosis of Bartonellosis should be part of the systematic investigation of all blood culture negative IE.

Topics: Azithromycin; Bartonella henselae; Cat-Scratch Disease; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Subacute Bacterial; Follow-Up Studies; Gentamicins; Heart Atria; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve Stenosis; Vancomycin

A patient on disopyramide developed disopyramide toxicity when treated concurrently with azithromycin. Evidence of toxicity included an elevated serum disopyramide level and ventricular tachycardia requiring cardioversion. The azalide antibiotic presumably inhibited dealkylation of disopyramide to its major metabolite, mono-N-dealkyldisopyramide. Physicians should avoid using azithromycin in patients on disopyramide. If this drug combination is unavoidable, disopyramide levels must be closely monitored.

Topics: Adult; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Azithromycin; Cat-Scratch Disease; Disopyramide; Drug Interactions; Drug Therapy, Combination; Electrocardiography; Female; Humans; Syncope, Vasovagal; Tachycardia, Ventricular

To determine the efficacy of azithromycin in the treatment of patients with typical cat-scratch disease.. Prospective, randomized, double blind, placebo-controlled clinical trial.. Large military medical center and its referring clinics.. Active duty military members and their dependents with laboratory-confirmed, clinically typical cat-scratch disease.. Study participants assigned by randomization to treatment with oral azithromycin or placebo for 5 days.. Lymph node volume was calculated using three dimensional ultrasonography at entry and at weekly intervals. The ultrasonographer was blinded to the treatment groups. Endpoint evaluations were predetermined as time in days to 80% resolution of the initial total lymph node volume.. Demographic and clinical data showed that the azithromycin and placebo treatment groups were comparable at entry although the placebo group tended to be older. Eighty percent decrease of initial lymph node volume was documented in 7 of 14 azithromycin-treated patients compared with 1 of 15 placebo-treated controls during the first 30 days of observation (P = 0.026). After 30 days there was no significant difference in rate or degree of resolution between the two groups.. Treatment of patients with typical cat-scratch disease with oral azithromycin for five days affords significant clinical benefit as measured by total decrease in lymph node volume within the first month of treatment.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Double-Blind Method; Female; Humans; Logistic Models; Lymph Nodes; Male; Middle Aged; Prospective Studies; Ultrasonography

Topics: Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Humans

Cat-scratch disease (CSD) is an infectious disease that usually presents with fever, headache, loss of appetite, weight loss, tender lymphadenopathy, and other symptoms. CSD is also the most common cause of infectious lymphadenitis in children, adolescents, and young adults. This contagious disease most often results from a scratch or bite of a cat. The course of this disease depends on the patient's immune status. CSD sometimes presents as a systemic disease and leads to various disease entities. In this study, we describe the case of a 23-year-old man exhibiting fever, generalized weakness, and neck swelling. The patient was unconscious when presented to the Emergency Department. He was given at least 3-4 liters IV bolus of 0.9% normal saline, but it failed to raise the blood pressure. He was then given an inotropic drug (noradrenaline) for low blood pressure and antibiotics (azithromycin) for fever. Venereal disease research laboratory (VDRL) and human immunodeficiency virus (HIV) serology came out negative. Histopathology ruled out tuberculosis and malignancy and confirmed necrotizing/suppurative granulomatous inflammation. These features favor the diagnosis of CSD.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Bites and Stings; Cat-Scratch Disease; Child; Humans; Male; Young Adult

A 4-year-old girl presented to the emergency department with right leg pain and associated limp for one day. There was no trauma or injury; she had no fever or recent illness. Her exam was notable for tenderness and swelling to the right knee, most prominent in the popliteal region. Initial laboratory testing was unremarkable except for a mildly elevated C-reactive protein. She had normal radiographs of the right lower extremity. A soft tissue ultrasound demonstrated popliteal lymphadenopathy, a rare finding in children. Reassessment of the patient revealed cat flea bites to the leg, which prompted concern for Bartonella henselae infection causing Cat-scratch Disease (CSD). The patient was treated empirically with Azithromycin and her Bartonella titers returned two days later consistent with active infection. This is a rare clinical report describing popliteal lymphadenitis and lower extremity arthropathy caused by Bartonella henselae infection secondary to cat flea bites.

Topics: Anti-Bacterial Agents; Azithromycin; Cat-Scratch Disease; Child, Preschool; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Leg; Lymph Nodes; Ultrasonography

Diagnosis of systemic cat scratch disease may be challenging. Here, we describe a case of an immunocompetent girl exhibiting fever and multifocal hepatosplenic abscesses. Diagnostic tests for Bartonella henselae infection (enzyme immunoassay and polymerase chain reaction) were found steadily negative and the diagnosis, suspected on the basis of the Margilet's criteria, was finally confirmed by indirect immunofluorescent antibodies.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Female; Fever; Fluorescent Antibody Technique; Humans; Serologic Tests

Topics: Administration, Intravenous; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Diagnosis, Differential; Humans; Lymphadenopathy; Male; Treatment Outcome; Ultrasonography

Cat scratch disease (CSD) is the main clinical manifestation caused by Bartonella henselae in immuno-competent patients. The bacterium is transmitted to humans from cats via scratches or bites. In this case report, we are presenting to our knowledge the first etiologically confirmed case of CSD in our country. Here we describe the case of a previously healthy adult female patient presenting with fever and axillar lymphadenopathy over 1-month period. She underwent numerous clinical and paraclinical investigations for potential etiologies associated with lymphadenopathy and fever. Finally, serological testing for B.henselae was performed with titers for IgG 1:1024 and 1:160 for IgM, which confirmed the diagnosis. Five-day treatment with azithromycin resulted with good clinical response and complete recovery. We proved that CSD is a reality in our country and this report should raise awareness in medical doctors, especially infectious disease specialist. Also, CSD should be included in differential diagnosis in patients with fever of unkown origin (FUO), who are presenting with regional lymphadenopathy, with or without history of cat contact.

Topics: Adult; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Diagnosis, Differential; Female; Humans; Republic of North Macedonia

Topics: Adolescent; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Biopsy; Blepharoplasty; Cat-Scratch Disease; Disease Reservoirs; Disease Transmission, Infectious; Disease Vectors; Dogs; Eye Injuries; Female; Humans; Magnetic Resonance Imaging; Treatment Outcome

Topics: Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Bone and Bones; Cat-Scratch Disease; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Liver; Magnetic Resonance Imaging; Osteomyelitis; Serologic Tests; Tomography, X-Ray Computed; Treatment Outcome

A 28-year-old man presented to our clinic over the course of 3 weeks with symptoms that progressed from mild headaches to fever, fatigue, myalgia and an enlarged right preauricular lymph node with ipsilateral conjunctivitis and upper eyelid weakness. Our differential included Epstein Barr Virus/Cytomegalovirus mononucleosis, bacterial conjunctivitis and lymphoma. We evaluated with CBC, EBV IgM Ab, lactate dehydrogenase level and a CMV IgG Ab which were all within normal limits. During his third visit, we discovered our patient had been scratched by two stray kittens he had adopted 2 months prior. We confirmed the diagnosis with a positive

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Conjunctivitis, Bacterial; Facial Nerve Diseases; Humans; Lymphadenitis; Male; Ocular Motility Disorders; Tomography, X-Ray Computed

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.

Topics: Anti-Bacterial Agents; Azithromycin; Cat-Scratch Disease; Child; Child, Preschool; Cohort Studies; Electronic Health Records; Female; Follow-Up Studies; Humans; Infant; Male; Pediatrics; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Cat scratch disease (CSD)'s lymphadenitis may have a protracted course with painful suppuration necessitating several needle aspirations or surgical drainage. The objective of this study was to evaluate the benefit of an intra-nodal injection of gentamicin add-on oral azithromycin treatment on the outcome of suppurated CSD's lymphadenitis.. We performed a retrospective monocentric study including 51 consecutive patients diagnosed between Jan 2009 and Mar 2014 with suppurated CSD who had a positive PCR for Bartonella henselae DNA in pus collected from lymph node by needle aspiration, and who were treated with azithromycin.. Among them, 26/51 patients (51%) received oral azithromycin only, of whom 8 patients (31%) were cured and 18 patients (69%) had complications, while 25/51 patients (49%) received an intra-nodal injection of gentamicin add-on oral azithromycin, of whom 16 patients (64 %) were cured and 9 patients (36%) had complications. In univariate analysis, the combined treatment was the only variable related to cure without complications (64 versus 31%, p = 0.01), but this difference did not remain statistically significant in multivariate analysis (OR = 3.84, 95% CI: 0.95-15.56, p = 0.06).. Intra-nodal injection of gentamicin add-on oral azithromycin treatment might improve the outcome of patients with suppurated CSD's lymphadenitis, deserving further randomized studies.

Topics: Administration, Oral; Adolescent; Adult; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Child, Preschool; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant; Injections; Lymphadenitis; Male; Middle Aged; Retrospective Studies; Suppuration; Treatment Outcome; Young Adult

Cat scratch disease (CSD) is an infectious disease caused by Bartonella henselae. Atypical clinical presentations of CSD include prolonged fever and multiple hepatosplenic lesions. Furthermore, multiple renal lesions are extremely rare in CSD. An 11-year-old Japanese girl presented at our hospital with a prolonged fever of unknown cause after being scratched and bitten by a kitten. Abdominal computed tomography (CT) revealed multiple small, round hypodense lesions in both kidneys and the spleen. Based on her history and the CT results, her diagnosis was CSD. The diagnosis was confirmed by serological tests, which indicated antibodies against B. henselae. After treatment with azithromycin, her fever immediately improved. Careful history taking and imaging are essential for the diagnosis of atypical CSD. In CT images, not only hepatosplenic lesions but also renal lesions are important features indicative of a diagnosis of atypical CSD. Subsequently, a diagnosis of CSD can be confirmed by specific serological tests. This is the first reported Japanese case of multiple renal and splenic lesions in a patient with CSD. Although difficult to diagnose, an early diagnosis atypical CSD and appropriate treatment are important to prevent complications and the need for invasive examinations.

Topics: Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Bartonella henselae; Bites and Stings; Cat-Scratch Disease; Cats; Child; Female; Humans; Kidney; Radiography, Abdominal; Serologic Tests; Spleen; Tomography, X-Ray Computed; Treatment Outcome

Patients with cat-scratch disease (CSD), which is caused by Bartonella henselae, typically present with local lymphadenopathy with a brief period of fever and general symptoms. Most cases are self-limiting and usually afflict children and young adults. Although rare, CSD can lead to serious complications, especially in immunocompromised patients. These rare complications often require intensive treatment. We describe the case of a 79-year-old man who presented with general malaise and a high fever. The physical examination findings were unremarkable. Of note, the lymph nodes were not enlarged. An abdominal CT scan with intravenous contrast revealed a solitary splenic abscess and no lymphadenopathy. The initial antibiotic treatment was ineffective and a splenectomy was indicated. A history of contact with cats raised the possibility of CSD, which was confirmed by a positive serology test result for B henselae. Antibiotic treatment with azithromycin successfully treated the splenic abscess and splenectomy was avoided.

Topics: Abscess; Aged; Anti-Bacterial Agents; Azithromycin; Cat-Scratch Disease; Delayed Diagnosis; Diagnosis, Differential; Humans; Male; Splenic Diseases; Treatment Outcome

A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Duodenal Diseases; Duodenum; Female; Humans; Immunoglobulin M; Liver; Liver Diseases; Lymph Nodes; Lymphatic Diseases; Middle Aged

Bartonella henselae, the cause of cat-scratch disease in humans, may lead to characteristic vision-threatening ocular findings, which importantly indicate diagnosis.. This is an observational case report of a 6-year-old boy who presented with bilateral stellate maculopathy and lymphadenopathy.. After serologic verification of B. henselae infection, systemic azithromycin therapy initiated the full recovery of visual acuity and bilateral complete resolution of stellate exudates during the following months.. Stellate maculopathy should always include the differential diagnosis of B. henselae infection. In this rare case of bilateral stellate maculopathy, we observed full recovery of function following systemic macrolide therapy.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Diagnosis, Differential; Eye Infections, Bacterial; Humans; Macula Lutea; Male; Retinitis; Treatment Outcome; Visual Acuity

Cat scratch neuroretinitis (CSN) is a clinical diagnosis supported by serological testing. We present 2 cases of CSN in which initial acute titers were negative or equivocal for Bartonella henselae while convalescent titers were shown to be positive. We report these cases to emphasize that a single acute negative titer is insufficient to exclude the diagnosis of CSN and that convalescent titers should be obtained in patients for whom there is a high clinical suspicion of the disease.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Female; Humans; Immunoglobulin G; Magnetic Resonance Imaging; Male; Retinitis

Topics: Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Chorioretinitis; DNA, Bacterial; Humans; Immunocompetence; Liver Diseases; Male; Splenomegaly

We report on 2 patients with unusual retinal manifestations of cat scratch disease (CSD), caused by Bartonella henselae. Case 1. A 42-year-old farmer presented with a 5-day history of blurred vision in his right eye. Right visual acuity was 20/25. Fundus examination of the right eye revealed mild vitreous hemorrhage and diffuse retinal hemorrhages in the mid-peripheral retina. Fluorescein angiography showed multiple vasculitic occlusions in the same area. A blood sample taken on the day of examination revealed the presence of immunoglobulin (Ig)M and IgG to B. henselae. Oral azithromycin was given for 8 days. One month later, right visual acuity was 20/20, the vitreous and retinal hemorrhages resolved, and arteriolar attenuation and sclerosis was observed in the peripheral temporal retina. Case 2. A 66-year-old craftsman with systemic hypertension and hypercholesterolemia complained of sudden visual loss (light perception) in his left eye. Fundus evaluation and fluorescein angiography revealed central retinal artery occlusion (CRAO) in the affected eye. About 2 weeks earlier, he had been bitten and scratched on his right hand by a stray cat. Serologic testing detected the presence of IgM to B. henselae. Oral azithromycin was given for 6 days. One month later, left visual acuity was hand motion. Ophthalmologists should be aware that unusual ocular complications associated with CSD include vitreous hemorrhage with retinal vasculitis and isolated CRAO. Vitreous hemorrhage and retinal vasculitis may be the only clinical manifestation of CSD.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Fluorescein Angiography; Fundus Oculi; Humans; Male; Retinal Artery Occlusion; Retinal Hemorrhage; Retinal Vasculitis; Visual Acuity; Vitreous Hemorrhage

Topics: Antibodies, Bacterial; Azithromycin; Bartonella henselae; Bell Palsy; Cat-Scratch Disease; Child; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Fever of Unknown Origin; Glucocorticoids; Granuloma; Horner Syndrome; Humans; Immunoglobulin G; Prednisone; Retinal Diseases; Vision Disorders; Visual Acuity

Cat scratch disease, caused by Bartonella henselae, is a worldwide zoonosis that is most frequently associated with the bite or scratch of a kitten under 6 months of age, as well as from a fleabite. Toxoplsma gondii is also another important zoonotic agent in cats and humans, which is mainly acquired by ingestion of food or water that is contaminated with oocytes shed by cats or by eating undercooked or raw meat containing tissue cysts. Here, we report a first case of young patient with cervical lymphadenitis, which shows serological and histological evidence of B. henselae and T. gondii coinfection in Korea with literature review.

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Female; Humans; Lymph Nodes; Lymphadenitis; Toxoplasma; Toxoplasmosis

Using Bartonella henselae isolates from cats and a human, the activity of pradofloxacin was compared with those of enrofloxacin and azithromycin. By Etest and disc diffusion assay, pradofloxacin showed greater antimicrobial activity than did other antibiotics. We conclude that pradofloxacin may prove useful for the treatment of B. henselae infections.

Topics: Angiomatosis, Bacillary; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat Diseases; Cat-Scratch Disease; Cats; Enrofloxacin; Fluoroquinolones; Humans; Microbial Sensitivity Tests

Bartonella henselae is the causative agent of cat-scratch disease and other disorders, including hepatosplenic granulomatosis. This infection has only rarely been reported after solid organ transplantation, where it can mimic the more common post-transplant lymphoproliferative disease. Here we present a case of asymptomatic B. henselae hepatic and lymph nodal granulomatosis in a pediatric patient who had received orthotopic liver transplant 2 months before; we hypothesize that the causative agent was transmitted from the donor. This infection developed early in the post-transplant period; the disease involved only the graft liver and the regional lymph nodes, and the patient did not have a cat or any history of contact, scratches, or bites by a cat. In our patient this infection resolved successfully with a combination of 2 associated antibiotics and reduction of immunosuppressive therapy.

Topics: Amikacin; Anti-Infective Agents; Antibodies, Bacterial; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Humans; Immunosuppressive Agents; Liver; Liver Neoplasms; Liver Transplantation; Lymph Nodes; Lymphomatoid Granulomatosis; Male; Postoperative Complications; RNA, Bacterial; RNA, Ribosomal, 16S; RNA, Ribosomal, 23S; Tacrolimus; Tissue Donors; Transplants; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

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.. Case series.. 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.. 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.. 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.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cat-Scratch Disease; Child; Child, Preschool; Female; Humans; Lymph Node Excision; Male; Retrospective Studies; Treatment Outcome

Cat-scratch disease is a common disease, occurring in an estimated 24,000 patients annually in the United States, and is one of the most common causes of chronic lymphadenitis in children. A wide array of neurologic complications occurs as a result of cat-scratch disease. However, there have been no reports of acute-onset, self-resolving, recurrent, expressive aphasia, as we report here in an adolescent boy. In our case, establishing the diagnosis of cat-scratch encephalopathy saved time and resources and afforded the family a benign diagnosis. Cat-scratch encephalopathy must be considered in the differential diagnoses when pediatric patients present with unusual neurologic symptoms.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Aphasia, Broca; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Diagnosis, Differential; Humans; Male; Recurrence; Stroke; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Humans; Male

Cat-scratch disease is one of several diseases known to be caused by Bartonella species. Some infections due to Bartonella resolve spontaneously without treatment with antibiotics, but in other cases the disease can be fatal without treatment. This case study reports a 7-year-old male who presented with an unexplained encephalopathy and unusual retinal findings associated with evidence supporting infection by B. henselae. The 7-year-old male presented with a 2-week history of general malaise and cervical lymphadenopathy progressing onto fever, headache, vomiting, and confusion associated with meningism. Lumbar puncture revealed a raised cerebrospinal fluid protein, low glucose, and raised white cell count. Abnormal retinal findings and raised antibodies titres to B. quintana indicated a diagnosis of cat-scratch disease. He was treated with azithromycin orally for 3 weeks and made a complete recovery.

Topics: Anti-Bacterial Agents; Azithromycin; Bartonella Infections; Bartonella quintana; Brain; Brain Damage, Chronic; Cat-Scratch Disease; Child; Diagnosis, Differential; Fever; Humans; Male; Retinitis

Cat scratch disease (CSD) which is usually seen in children and young adults and characterized by self limited lymphadenopathy, is caused by Bartonella henselae. In this report, a 30-year-old male patient who was admitted to the outpatient clinic with the complaint of lymphadenopathy, was presented. Erythrocyte sedimentation rate and C reactive protein values of the patient were normal, and anti-HIV, Brucella agglutination and anti-toxoplasma IgM and IgG tests were negative. No bacterial growth was detected in the cultures of repetetive blood samples and biopsy specimens taken from the right axillar lymph node. This might probably be due to the prior antibiotic therapy (ciprofloxacin and cefazolin) given by another health center. Polymerase chain reaction performed with biopsy specimen by using 27f and 1525r primers, also yielded negative result. CSD was diagnosed depending on the history of direct contact with a cat (being scratched and bitten), together with the clinical features and histopathologic findings (necrotizing granulomatous inflammation concordant with CSD). Lymphadenopathies of patient had completely resolved after five-days oral azithromycin therapy. Since CSD is a rare infection of adults, it should be taken into consideration in the patients who suffer from silent lymphadenopathy and present with the history of direct contact with cats.

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Diagnosis, Differential; Humans; Male

Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever.. To report the clinical and laboratory features of eight patients with cat-scratch disease.. Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence).. Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials.. Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Diagnosis, Differential; Female; Fever; Humans; Lymph Nodes; Male; Middle Aged; Retrospective Studies

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Retinal Diseases; Scotoma; Time Factors; Visual Acuity

Topics: Animals; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Ciprofloxacin; Clarithromycin; Humans; Insect Vectors; Serologic Tests; Siphonaptera; Zoonoses

Topics: Aged; Ampicillin; Animals; Aortic Valve; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Prolapse; Ultrasonography

Topics: Anti-Bacterial Agents; Azithromycin; Cat-Scratch Disease; Drainage; Humans; Punctures

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Cat-Scratch Disease; Child; Child, Preschool; Female; Humans

Topics: Abscess; Adult; Animals; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Hepatolenticular Degeneration; Humans; Male; Serotyping; Siphonaptera

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Humans; Male