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PubMed1976

Autoimmune factors associated with anaemia in acute Haemobartonella and Eperythrozoon infections of rodents.

Eperythrozoon coccoides and Haemobartonella muris produced in mice and rats respectively, essentially the same disease, characterized by anaemia, splenomegaly and in severe cases, haemoglobinuria with death. In both infections anaemia was associated with phagocytosis of erythrocytes by monocytes of the spleen, and with the presence of cold-active haema-glutinin for trypsinized red cells (CAH). An antigen similar to the serum antigen (SA) associated with acute malaria and babesiosis was also found in the blood of the anaemic animals. One or two days later antibody to SA (ABSA) was detected and for several days thereafter, both SA and ABSA could be detected in plasma samples. Anaemia crisis with haemoglobinuria was better correlated with the appearance of ABSA than with the presence of CAH. It is suggested that CAH, and complexes of SA and ABSA could have acted as anaemia factors and were in part causal in the sequestration or haemolysis of erythrocytes during acute infection.

Anaplasmataceae↗
PubMed2001

Molecular diagnosis of infective endocarditis--a new Duke's criterion.

The molecular approach of PCR amplification of specific gene targets and universal loci for bacteria (16S rRNA) and fungi (18S, 28S and 5.8S rRNA) and subsequent sequencing was used to identify the possible causal microbial agent(s) in blood culture (47 patients) and heart valve material (30 patients) from patients with suspected infective endocarditis (IE). Culture and molecular results were analysed with respect to the patients' clinical background and the Duke Criteria. The findings demonstrated that: (i) all patients who were definite or possible cases were positive by PCR, even patients whose blood culture and valve material were culture-negative; and (ii) all patients who were rejected as having IE were also negative by PCR, with the exception of 1 patient who had bacteraemia from another source and 5 patients whose blood culture material was believed to contain an environmental contaminant. Direct molecular identification of the aetiological agents responsible for IE from blood culture material may enable specific treatment to commence at an earlier stage of the disease and hence reduce the need for valve replacement. Such a molecular approach may aid in the diagnosis of IE and should therefore be included as an additional major criterion in the Duke's classification scheme.

Bartonella↗
PubMed2003

Nationalism, Carrión's disease and medical geography in the Peruvian Andes.

During the turn of the 20th century medical geography in Peru concentrated in the study of a native disease (bartonellosis, also known as Carrión's disease and Verruga Peruana) and reinforced the relationship between the country's 'natural' regions (coast, highlands and Amazon) and different patterns of disease. Expert knowledge on these themes was portrayed as important not only for the practice of medicine but also for the development of the country. This knowledge was instrumental for an emergent local medical tradition and for legitimizing the authority, power and prestige of Lima's medical elite. The city was the capital of a country whose population was mainly Indian and rural, and lived in the highlands. This article studies the development of medical geography in Peru emphasizing the role played by Ernesto Odriozola, an influential clinician from Lima trained in Paris.

Bartonella Infections↗
PubMed1994

[Rochalimaea henselae, Afipia felis and cat-scratch disease].

Several years ago, Rochalimaea henselae has emerged as an agent of bacillary angiomatosis, bacillary peliosis and recurrent septicaemia that generally occur in patients infected with human immunodeficiency virus. An aetiologic role in cat scratch disease is also suspected widely on the basis of a serologic survey. Its slow growth and its culture requirement explain that this pathogen, a gram-negative bacterium, could not be isolated until 1990. Moreover, blood and tissue samples request lysis and crushing for recovering by culture. The clinical, histological, microbiological and pathogenic aspects of these infections are described and discussed.

AIDS-Related Opportunistic Infections↗
PubMed1998

A man with fever and lymphadenopathy.

A 40-year-old man presented with a three-week history of malaise, nausea, night sweats, decreased appetite, and a 15-lb weight loss. He reported having had diarrhea, occasionally with bright red blood, for the first two weeks and a temperature as high as 39.4 degrees C for the last two weeks. He had not had cough, shortness of breath, wheezing, chest pain, arthralgias, rash, or conjunctivitis. He had not eaten raw oysters or raspberries.

Adult↗
PubMed2000

Parapharyngeal abscess due to cat-scratch disease.

The spectrum of illness attributed to cat-scratch disease (CSD) continues to expand. Although a common cause of cervical adenitis in children, CSD has not been associated as a cause of deep fascial space infections of the head and neck. We describe a child with extensive parapharyngeal adenitis and abscesses due to CSD confirmed by histological and serological evaluations.

Abscess↗
PubMed2001

Circulating cytokines in patients with cat scratch disease.

Levels of circulating interleukin (IL)-2, IL-6, and IL-10, measured by enzyme-linked immunosorbent assay, were significantly higher in patients with cat scratch disease (CSD) than in healthy control subjects; no induction of IL-12 was observed, and levels of interferon-gamma and IL-4 were generally not detectable. This is the first report showing increased circulating cytokine levels in patients with CSD. The induction of these mediators can partly explain some clinical and pathological features of the disease.

Antibodies, Bacterial↗
PubMed2001

Bartonellosis (Carrión's disease) in the modern era.

Bartonellosis remains a major problem in Peru, but many contemporary aspects of this disease have not been adequately described. We examined the cases of 145 symptomatic patients in Lima, Peru, in whom bartonellosis was diagnosed from 1969 through 1992, including 68 patients in the acute (hematic) phase and 77 patients in the eruptive (verruga) phase. In modern Peru, symptomatic patients who have acute-phase bartonellosis typically present with a febrile illness and systemic symptoms caused by profound anemia; most patients respond successfully to treatment with chloramphenicol. Patients who have eruptive-phase bartonellosis most often present with cutaneous verrugas but may have less specific symptoms, such as fever and arthralgias; diagnosis can be confirmed in such patients by Western immunoblotting, and most patients appear to respond to treatment with rifampin.

Acute Disease↗
PubMed2001

Probable atypical cat scratch disease presenting as isolated posterior pancreatic duodenal lymphadenitis and abdominal pain.

We report a case involving a 15-year-old girl with atypical, clinically unsuspected cat scratch disease (CSD) presenting as isolated posterior pancreatic duodenal lymphadenitis, fever, and abdominal pain. The serological, abdominal ultrasonographic, and CT findings, as well as clinical and epidemiological data, indicate that B. henselae was likely an etiologic agent of CSD in our patient.

Abdominal Pain↗
PubMed2002

Isolated splenic cat scratch disease in an immunocompetent adult woman.

We report a case of isolated splenic cat scratch disease in an immunocompetent woman. The clinical presentation of prolonged fever, night sweats, weakness, and intrasplenic lesions was highly suggestive of lymphoma. This is the second reported case of isolated splenic cat scratch disease in an adult and the first in a healthy adult.

Adult↗
PubMed2005

Cat-scratch disease in elderly patients.

BACKGROUND: Cat-scratch disease (CSD) is mostly contracted by children and young adults. To our knowledge, CSD in elderly patients has never been characterized, and it may be underrecognized in this age group. METHODS: The study population included all patients with CSD diagnosed at our reference laboratory during 1991-2002. Demographic, clinical, and laboratory data for patients with CSD aged >or=60 years (elderly group) were compared with data for patients with CSD aged <60 years (nonelderly group). RESULTS: There were 846 immunocompetent patients with CSD included in this study. Fifty-two patients (6%) were >or=60 years old. Lymphadenopathy was less common in elderly patients than in nonelderly patients (76.5% vs. 94.4%; P<.001), and general malaise was more frequent in elderly patients (70.8% vs. 51.4%; P=.009). Atypical CSD was more common in elderly patients than in nonelderly patients (32.7% vs. 13.6%), including endocarditis (odds ratio [OR], 61.6; P<.001), encephalitis (OR, 6.3; P=.013), and fever of unknown origin (OR, 7.3; P<.001). The time period from onset of symptoms to diagnosis was >6 weeks for 29.5% of elderly patients versus 13.3% of nonelderly patients (P=.003). CONCLUSIONS: CSD affects elderly persons as well as nonelderly persons, but clinical features differ between the patient groups. Atypical CSD, including endocarditis, is more frequent in elderly than in nonelderly patients. Conversely, lymphadenitis, the hallmark of typical CSD, is often absent in elderly patients. Lack of awareness among clinicians may delay the diagnosis of CSD in elderly persons and result in unnecessary and often invasive diagnostic procedures.

Adolescent↗