Epithelioid angiomatosis in HIV infection: neoplasm or cat-scratch disease?
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This infection usually results from transmission to humans by the scratch of a cat, but may also follow spine stings or cuts from fresh bones of various animals, this explaining the ubiquity of the causative agent and its resistance to various physical agents. The primary lesion develops in the skin at the inoculation site, to be followed by the appearance of one or several satellite adenopathies, of regional distribution and evolving towards suppuration. Apart from some rare nervous manifestations the prognosis is usually good, but regression of the adenopathy is a slow process. Histology shows tumefaction of massed reticular cells with central necrosis, leucocyte diapedesis and ultimate abscess formation. Diagnosis is by evidence of allergy to a specific antigen formed of the pus from infected glands after sterilization. The responsibility of a gram-positive bacterium of the genus Rothia has just been demonstrated.
Histological picture of the lymph nodes from 10 patients with benign lymphoreticulosis is described. Granulomas are characterized in the long course of the disease, from 8 days to 3 months. Most marked morphological changes in the lymph nodes were observed during the 3rd and 4th weeks of the disease. The process ends with sclerosis of the lymph nodes.
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In summary, CSD is a relatively common cause of localized lymphadenopathy, with 80 per cent of cases occurring in children. This self-limited infection is caused by a small pleomorphic bacillus that has been identified in ocular granuloma, skin, and lymph node specimens. Unusual manifestations of the disease such as the oculoglandular disease of Parinaud, encephalopathy, or severe systemic disease occur in about ten per cent of patients. Management consists of symptomatic treatment and occasionally aspiration of a node that suppurates. The disease usually resolves spontaneously in 2 to 4 months.
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We describe here an immunocompetent boy with fever, regional adenopathy, multifocal hepatosplenic granulomas, and high and increasing serum antibody titers for Bartonella henselae in whom diffuse bilateral reticulonodular pulmonary infiltrates developed in the absence of respiratory symptoms.
A 23-year-old woman who presented with a branch retinal artery occlusion followed by encephalopathy showed, by brain magnetic resonance imaging, a nonenhancing lesion in the right parietal gray matter with normal diffusion-weighted imaging. Of 64 reported cases of cat-scratch encephalopathy with documented neuroimaging findings, only 12 (18.8%) have had abnormal imaging findings. The abnormalities have included cerebral white matter lesions, basal ganglia and thalamic lesions, and multifocal lesions in immunocompromised patients, but no gray matter lesions similar to those in this patient. The variety of neuroimaging findings supports multiple pathophysiologic mechanisms of central nervous system involvement in this disorder.
The IgG and IgM titers to Bartonella henselae were determined by an enzyme immunoassay (EIA). The EIA test for detection of IgG and IgM antibodies to B. henselae concerning CSD showed that 8 (40%) of 20 patients with CSD had a serum IgG antibody titer of 12 EIA unit or more and that 5 (25%) patients had a serum IgM titer of 12 EIA unit or more. Totally 12 (60%) of the 20 patients with CSD were seropositive for B. henselae. The mean age of IgG positive patients were higher than IgM positive patients. The IgM antibodies to B. henselae disappeared within 4 to 12 weeks after onset of disease. The IgG antibodies to B. henselae disappeared within 3 to 8 weeks after onset of the symptoms in 2 cases of CSD. Another 2 cases CSD produced high levels of IgG antibodies in the acute phase of the disease. Different course of IgG and IgM antibody titers were found in sera from patients.
We describe 2 children with prolonged fever of unknown origin and prominent skeletal pain who had multifocal bone disease caused by Bartonella infection. Initial radiologic studies, including plain films, radionuclide scintigraphy and computed tomography, yielded negative results. In both cases, magnetic resonance imaging revealed multiple enhancing bone marrow lesions consistent with clinical symptoms. Microbiologic diagnoses were established serologically.
An unusual Bartonella henselae infection presenting clinically as a putative parotid cancer was diagnosed based on serological tests, histomorphology and amplification of a 16S-rDNA sequence of Bartonella henselae. The patient improved greatly upon antibiotic treatment and did not require surgery. Although uncommon, infection with Bartonella spp., particularly Bartonella henselae, should be included in the differential diagnosis of parotid tumors.
Few data are available on the seroprevalence of antibodies to Bartonella henselae among children. We retrospectively evaluated the presence of immunoglobulin G and M class antibodies to B. henselae in 508 children living in central Italy who were apparently free of any features suggesting B. henselae infection. We found that B. henselae infection is common among children in central Italy, occurs early in life, is in most cases asymptomatic, and resolves spontaneously.
Sequential serologic testing for IgG and IgM titers to Bartonella henselae were evaluated by an indirect fluorescence assay (IFA) in patients with CSD. The IFA test for the detection of IgG and IgM antibodies to B. henselae in 52 CSD patients showed that 40 (76.9%) were positive for IgG antibody and 9 (17.3%) were positive for IgM antibody. Two or more consecutive serum samples from 30 patients with CSD were assessed. In regard to the detection of IgG antibody, 5 patients had rapidly elevated titers in the acute phase, 12 patients had high titers from the acute phase, and 5 patients had a positive titer 24 weeks after the onset. B. henselae IgM antibody kinetics varied widely between patients with CSD. The seropositive rate for the antibody to B. henselae was analyzed at overtime after the onset and we found that the IgG-seropositive rate was high from 2 weeks after the onset and low after 25 weeks. The sensitivity of the IgM IFA was low, and IgM antibody to B. henslelae was not detected from 9 weeks. The detection from consecutive serum samples of antibodies to B. henselae by IFA is very useful for diagnosis in the case of clinically suspected CSD.