Diagnosis Based on History, Not Examination

2021 ◽  
pp. 1-3
Author(s):  
Philippa Tepper ◽  
◽  
Adel Ekladious ◽  
Keyword(s):  
Bartonella Henselae ◽  
Delayed Diagnosis ◽  
Low Grade ◽  
Cat Scratch Disease ◽  
Latent Disease

Cat scratch disease (CSD), caused by the bacterium Bartonella henselae, is usually self-limiting, presenting with low-grade fever and tender lymphadenopathy. With delayed diagnosis or reactivation of latent disease, CSD is associated with severe debilitating symptoms. We are presenting a patient who proved adiagnostic challenge, before being found to have reactivation of Bartonella henselae, requiring three-months IV Trimethoprim-Sulfamethoxazole andHydrocortisone.

scholarly journals A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child

2021 ◽  
Vol 9 (5) ◽  
pp. 950
Author(s):  
Chiara Sodini ◽  
Elena Mariotti Zani ◽  
Francesco Pecora ◽  
Cristiano Conte ◽  
Viviana Dora Patianna ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Bartonella Henselae ◽  
Delayed Diagnosis ◽  
Mitral Valve Regurgitation ◽  
Low Grade ◽  
Systemic Involvement ◽  
Mild Disease ◽  
Precise Diagnosis ◽  
Major Illness ◽  
The Right

In most cases, infection due to Bartonella henselae causes a mild disease presenting with a regional lymphadenopathy frequently associated with a low-grade fever, headache, poor appetite and exhaustion that spontaneously resolves itself in a few weeks. As the infection is generally transmitted by cats through scratching or biting, the disease is named cat scratch disease (CSD). However, in 5–20% of cases, mainly in immunocompromised patients, systemic involvement can occur and CSD may result in major illness. This report describes a case of systemic CSD diagnosed in an immunocompetent 4-year-old child that can be used as an example of the problems that pediatricians must solve to reach a diagnosis of atypical CSD. Despite the child’s lack of history suggesting any contact with cats and the absence of regional lymphadenopathy, the presence of a high fever, deterioration of their general condition, increased inflammatory biomarkers, hepatosplenic lesions (i.e., multiple abscesses), pericardial effusion with mild mitral valve regurgitation and a mild dilatation of the proximal and medial portion of the right coronary artery, seroconversion for B. henselae (IgG 1:256) supported the diagnosis of atypical CSD. Administration of oral azithromycin was initiated (10 mg/kg/die for 3 days) with a progressive normalization of clinical, laboratory and US hepatosplenic and cardiac findings. This case shows that the diagnosis of atypical CSD is challenging. The nonspecific, composite and variable clinical features of this disease require a careful evaluation in order to achieve a precise diagnosis and to avoid both a delayed diagnosis and therapy with a risk of negative evolution.

scholarly journals NCOG-42. INITIAL PRESENTATION AND OUTPATIENT VISIT COMPLIANCE OF INMATES WITH BRAIN TUMORS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii138-ii138
Author(s):  
Iyad Alnahhas ◽  
Appaji Rayi ◽  
Yasmeen Rauf ◽  
Shirley Ong ◽  
Pierre Giglio ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Civil Liberties ◽  
Delayed Diagnosis ◽  
Low Grade ◽  
Small Series ◽  
Initial Symptoms ◽  
The Ohio State University ◽  
American Civil Liberties Union ◽  
Lost To Follow Up

Abstract INTRODUCTION While advocacy for inmates with cancer has recently gained momentum, little is known about management of brain tumors in inmates. Delays in acknowledging or recognizing nonspecific initial symptoms can lead to delayed diagnosis and treatment. Inmates with cancer are reported to either be ignored or receive substandard care due in part to cost or logistics (American Civil Liberties Union; ASCO Post 2018). METHODS In this retrospective study, we identified inmates with gliomas seen in the Ohio State University Neuro-oncology Center between 1/1/2010-4/20/2019. RESULTS Twelve patients were identified. Median age at presentation was 39.5 years (range 28-62). Eleven patients were Caucasian and one was African American. Diagnoses included glioblastoma (GBM) (n=6), anaplastic astrocytoma (n=1), anaplastic oligodendroglioma (n=1), low-grade astrocytoma (n=3) and anaplastic pleomorphic xanthroastrocytoma (n=1). Patients were more likely to present early after seizures or focal neurologic deficits (9/12) than after headaches alone. Patients with GBM started RT 12-71 days after surgery (median 34.5). One patient’s post-RT MRI was delayed by a month and another with GBM had treatment held after 4 cycles of adjuvant temozolomide (TMZ) due to “incarceration issues”. For one patient who received adjuvant TMZ, the facility failed to communicate with the primary team throughout treatment. Two patients suffered significant nausea while on chemotherapy due to inability to obtain ondansetron in prison, or due to wrong timing. 7/12 (58%) patients were lost to follow-up for periods of 3-15 months during treatment. Three patients refused adjuvant treatment. CONCLUSIONS Although this is a small series, our results highlight the inequities and challenges faced by inmates with gliomas who are more likely to forego treatments or whose incarceration prevents them from keeping appropriate treatment and follow-up schedules. Additional studies are needed to define and address these deficiencies in the care of inmates with brain tumors and other cancers.

scholarly journals Cervical Cat Scratch Disease Lymphadenitis in a Patient with Immunoglobulin M Antibodies to Toxoplasma gondii

2002 ◽  
Vol 9 (2) ◽  
pp. 496-498
Author(s):  
Mardjan Arvand ◽  
Ilkay Kazak ◽  
Sergije Jovanovic ◽  
Hans-Dieter Foss ◽  
Oliver Liesenfeld
Keyword(s):  
Toxoplasma Gondii ◽  
Clinical Symptoms ◽  
Bartonella Henselae ◽  
Cervical Lymphadenopathy ◽  
Immunoglobulin M ◽  
Cat Scratch Disease ◽  
Specific Immunoglobulin ◽  
Acute Toxoplasmosis

ABSTRACT We report on a young patient with chronic cervical lymphadenopathy and serological and histological evidence for infection with Bartonella henselae and Toxoplasma gondii. Serological follow-up studies, including testing for avidity of Toxoplasma-specific immunoglobulin G antibodies, assisted in the determination of the cause of the acute lymphadenitis. Our results suggest that the clinical symptoms were most likely due to cat scratch disease rather than to acute toxoplasmosis.

Positional Hand Pallor and Isolated Epitrochlear Lymphadenitis Secondary to Bartonella henselae Infection.

2021 ◽  
Vol 20 (4) ◽  
pp. 914-917
Author(s):  
Siti Nuradliah Jamil ◽  
Ilham Ameera Ismail ◽  
Siti Fatimah Badlishah Sham ◽  
Norliana Dalila Mohamad Ali
Keyword(s):  
Lymph Node ◽  
Communicable Disease ◽  
Bartonella Henselae ◽  
Medical Science ◽  
Neck Region ◽  
Rare Condition ◽  
Cat Scratch Disease ◽  
Serological Evidence ◽  
External Compression ◽  
Head And Neck Region

Cat scratch disease is a communicable disease caused by the Bartonella henselae bacteria. Regional lymphadenopathy is the hallmark of cat scratch disease and about 75% of lymphadenopathy cases are localized in the head and neck region. An epitrochlear lymphadenopathy is a rare condition at any age and often misdiagnosed as it is not normally palpable. External compression of an enlarged epitrochlear lymph node compromising vascularity was not mentioned in any literature before. We present a case of a 13-year-old girl with right positional ipsilateral hand pallor and epitrochlear lymphadenitis with serological evidence of Bartonella henselae infection. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.914-917

A Case of Fatal Disseminated Bartonella henselae Infection (Cat-Scratch Disease) With Encephalitis

2007 ◽  
Vol 131 (10) ◽  
pp. 1591-1594
Author(s):  
Brandy Fouch ◽  
Susan Coventry
Keyword(s):  
Bartonella Henselae ◽  
Neurologic Manifestations ◽  
Cat Scratch Disease ◽  
Systemic Dissemination ◽  
Lymphocytic Infiltrates ◽  
The Brain ◽  
Limited Process

Abstract Cat-scratch disease resulting from Bartonella henselae infection is usually a benign, self-limited process in immunocompetent children. Even the rare cases associated with neurologic manifestations are not generally fatal. We report a case of a previously healthy 6-year-old boy with cat-scratch disease, systemic dissemination, and encephalitis that led to his death. Autopsy revealed perivascular lymphocytic infiltrates and microglial nodules in the brain. To our knowledge, this finding has not been previously reported in B henselae infection, possibly because of the paucity of material available for complete neuropathologic evaluation. This case illustrates the extreme severity of the spectrum with which cat-scratch disease can present and provides evidence of brain histopathology that may be representative of the disease.

Cat-Scratch Disease

1986 ◽  
Vol 94 (6) ◽  
pp. 622-627 ◽  
Author(s):  
James R. Spires ◽  
Richard J.H. Smith
Keyword(s):  
Symptomatic Relief ◽  
Lymph Node Involvement ◽  
Low Grade ◽  
Outpatient Basis ◽  
Cat Scratch Disease ◽  
Cutaneous Infections ◽  
Recommended Treatment ◽  
Disease Spectrum ◽  
Granulomatous Lymphadenitis ◽  
Initial Description

Cat-scratch disease has been reported with increasing frequency since its initial description in 1931. It is now recognized as being so prevalent that it probably represents the most common cause of unilateral lymphadenopathy in children, once nonspecific viral diseases and cutaneous infections have been excluded. The cardinal feature of the disease is a subacute regional granulomatous lymphadenitis. Because of its relatively mild natural course, most cases are treated on an outpatient basis. Forty-four children, representing the more seriously ill portion of the disease spectrum, were treated at Texas Children's Hospital from 1972 to 1984 and constitute the data base for this article. Most patients were symptomatic for nearly 1 month prior to admission, typically complaining of low-grade fever and regional lymphadenopathy. The two most common sites of lymph node involvement were the axilla (54%) and the neck (46%). Although there is, at this time, no specifically recommended treatment, 80% of patients received antibiotics and 70% underwent a surgical procedure—usually total nodal excision. Nodal excision was followed by rapid resolution of symptoms. Because cat-scratch disease is benign, surgery should be reserved for severe cases with signs of significant suppuration. Generally, symptomatic relief can be afforded by warm soaks and analgesics and recovery over the course of several weeks is uneventful.

The Bartonella henselae sucB gene encodes a dihydrolipoamide succinyltransferase protein reactive with sera from patients with cat-scratch disease

2004 ◽  
Vol 53 (12) ◽  
pp. 1221-1227 ◽  
Author(s):  
Christine M Litwin ◽  
Joel M Johnson ◽  
Thomas B Martins
Keyword(s):  
Coxiella Burnetii ◽  
Brucella Melitensis ◽  
Bartonella Henselae ◽  
Immunoblot Analysis ◽  
Cross Reactivity ◽  
Cosmid Library ◽  
Cat Scratch Disease ◽  
Igg Antibodies ◽  
Bacillary Angiomatosis ◽  
Dihydrolipoamide Succinyltransferase

Bartonella henselae is a recently recognized pathogenic bacterium associated with cat-scratch disease, bacillary angiomatosis and bacillary peliosis. A recombinant clone expressing an immunoreactive antigen of B. henselae was isolated by screening a genomic DNA cosmid library by Western blotting with sera pooled from patients positive for B. henselae IgG antibodies by indirect immunofluorescence (IFA). The deduced amino acid sequence of the 43.7 kDa encoded protein was found to be 76.3 % identical to the dihydrolipoamide succinyltransferase enzyme (SucB) of Brucella melitensis. SucB has been shown to be an immunogenic protein during infections by Brucella melitensis, Coxiella burnetii and Bartonella vinsonii. The agreement between reactivity with a recombinant SucB fusion protein on immunoblot analysis and the results obtained by IFA was 55 % for IFA-positive sera and 88 % for IFA-negative sera. Cross-reactivity was observed with sera from patients with antibodies against Brucella melitensis, Mycoplasma pneumoniae, Francisella tularensis, Coxiella burnetii and Rickettsia typhi.

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