Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report.
Bartonella
Bartonellosis
Cat-scratch disease
Dog
HLH
Hemophagocytic lymphohistiocytosis
Immunocompetent
Journal
Tropical diseases, travel medicine and vaccines
ISSN: 2055-0936
Titre abrégé: Trop Dis Travel Med Vaccines
Pays: England
ID NLM: 101674442
Informations de publication
Date de publication:
25 Sep 2023
25 Sep 2023
Historique:
received:
06
04
2023
accepted:
28
06
2023
medline:
25
9
2023
pubmed:
25
9
2023
entrez:
24
9
2023
Statut:
epublish
Résumé
Bartonella henselae is a species of intracellular bacteria transmitted to humans through animal bites and scratches contaminated with the feces of arthropod vectors, and are most commonly associated with cat exposure although transmission from other mammals has been reported. Bartonella henselae infection has a spectrum of clinical manifestations and has rarely been reported as cause of hemophagocytic lymphohistiocytosis (HLH) in immunocompromised hosts. We present a report of Bartonella henselae infection progressing to HLH in an immunocompetent patient. The patient initially presented with regional lymphadenopathy but the diagnosis was not suspected as the patient reported no exposure to cats. On further history, he did report a scratch from a dog prior to development of symptoms. The patient was treated with methylprednisolone, intravenous immunoglobulin and anakinra for the HLH and three months of Doxycycline for Bartonella infection, with complete resolution of symptoms. Although commonly associated with cat exposure, Bartonella henselae transmission can occur after exposure to other animals and vectors including dogs and clinicians need to maintain an index of suspicion for timely diagnosis. Bartonella henselae is associated with a spectrum of clinical manifestations which can include disseminated infection with severe complications such as hemophagocytic lymphohistiocytosis. Prompt initiation of Bartonella treatment is essential when thought to be the trigger for hemophagocytic lymphohistiocytosis although the optimal treatment regimen is unclear.
Sections du résumé
BACKGROUND
BACKGROUND
Bartonella henselae is a species of intracellular bacteria transmitted to humans through animal bites and scratches contaminated with the feces of arthropod vectors, and are most commonly associated with cat exposure although transmission from other mammals has been reported. Bartonella henselae infection has a spectrum of clinical manifestations and has rarely been reported as cause of hemophagocytic lymphohistiocytosis (HLH) in immunocompromised hosts.
CASE PRESENTATION
METHODS
We present a report of Bartonella henselae infection progressing to HLH in an immunocompetent patient. The patient initially presented with regional lymphadenopathy but the diagnosis was not suspected as the patient reported no exposure to cats. On further history, he did report a scratch from a dog prior to development of symptoms. The patient was treated with methylprednisolone, intravenous immunoglobulin and anakinra for the HLH and three months of Doxycycline for Bartonella infection, with complete resolution of symptoms.
CONCLUSIONS
CONCLUSIONS
Although commonly associated with cat exposure, Bartonella henselae transmission can occur after exposure to other animals and vectors including dogs and clinicians need to maintain an index of suspicion for timely diagnosis. Bartonella henselae is associated with a spectrum of clinical manifestations which can include disseminated infection with severe complications such as hemophagocytic lymphohistiocytosis. Prompt initiation of Bartonella treatment is essential when thought to be the trigger for hemophagocytic lymphohistiocytosis although the optimal treatment regimen is unclear.
Identifiants
pubmed: 37743475
doi: 10.1186/s40794-023-00200-1
pii: 10.1186/s40794-023-00200-1
pmc: PMC10518968
doi:
Types de publication
Journal Article
Langues
eng
Pagination
14Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Parasit Vectors. 2016 May 10;9(1):261
pubmed: 27161111
Pediatr Transplant. 2014 May;18(3):E83-7
pubmed: 24829973
Vet Clin North Am Small Anim Pract. 2022 Nov;52(6):1163-1192
pubmed: 36336416
Lancet. 2014 Apr 26;383(9927):1503-1516
pubmed: 24290661
Crit Care Med. 2022 May 1;50(5):860-872
pubmed: 34605776
Vet Dermatol. 2015 Feb;26(1):60-3, e21-2
pubmed: 25292107
Trop Med Infect Dis. 2019 Apr 19;4(2):
pubmed: 31010191
Ann Clin Microbiol Antimicrob. 2020 Jun 9;19(1):28
pubmed: 32517705
Clin Infect Dis. 2016 Mar 15;62(6):804-6
pubmed: 26646679
Postepy Dermatol Alergol. 2015 Jun;32(3):216-20
pubmed: 26161064
Parasit Vectors. 2018 Dec 4;11(1):624
pubmed: 30514361
Transplantation. 2004 Jan 27;77(2):238-43
pubmed: 14742988
Eur J Case Rep Intern Med. 2020 Aug 07;7(11):001850
pubmed: 33194860
Hematology Am Soc Hematol Educ Program. 2013;2013:605-11
pubmed: 24319239
Int J Antimicrob Agents. 2014 Jul;44(1):16-25
pubmed: 24933445