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Unexplained Fever In Infectious Diseases: Section 2: Commonly Encountered Aerobic, Facultative Anaerobic, And Strict Anaerobic Bacteria, Spirochetes, And Parasites
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Bartonellosis (syn. Carrion’s disease) is caused by a small, motile aerobic Gram-negative bacillus, Bartonella bacilliformis. The disease is endemic in Peru, Ecuador, and Colombia. The organism invades the erythrocytes and reticuloendothelial cells. Various species of the sandfly vector, Phlebotomus, transmit the infection. There are two clinical forms: febrile (Oroya fever) and cutaneous (Verruga peruana). The former deserves a short mention because it may create problems of unexplained fever. After an incubation of approximately 20 days, or more, may appear a fever with shacking chills, malaise, headache, arthralgias, myalgias, changes in mentation, adenopathies, and severe anemia. Some critical forms may develop dyspnea, delirium, coma, and death. Intercurrent infections are common, especially salmonellosis, which may account for the prolongation of fever and adversely affect the prognosis. During the acute febrile stage, the organism may be identified on Giemsa-stained smears of the peripheral blood or by blood culture.80
Flies (Biting)
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Members of the sand fly genera Phlebotomus and Sergentomyia occur in the Old World, and Lutzomyia, Brumptomyia, and Warileya occur in the tropics and subtropics of the New World. Phlebotomus argentipes is the chief vector of visceral leishmaniasis in many areas of the Old World, but P. langeroni has recently been incriminated. Lutzomyia longipalpis is a major vector in the New World. Old World sand fly vectors of dermal leishmaniasis include P. caucasicus, P. papatasi, P. longipes, and P. pedifer. New World vectors of the malady include L. olmeca, L. trapidoi, L. ylephiletrix, L. verrucarum, L. peruensis, and others. Sandfly fever vectors are primarily P. papatasi and P. sergenti. Bartonellosis is transmitted by L. verrucarum. As P. papatasi is the most important and widespread vector of zoonotic cutaneous leishmaniasis caused by Leishmania major in the Old World, its distribution is given in Figure 19.19. Lutzomyia anthophora or L. diabolica, which generally occur in south and central Texas as well as in parts of Mexico, are thought to be the vectors of human cases of cutaneous leishmaniasis in Texas.
Doxycycline
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Many diseases are caused by infections with these bacteria, ranging from cat scratch disease (B. henselae and, rarely, B. clarridgeiae or Afipia felis) to bacillary angiomatosis and peliosis hepatis in AIDS patients (B. henselae), to bacteraemia, particularly in the homeless (B. quintana), and endemic bartonellosis or Carrion’s disease (B. bacilliformis). While macrolides are the mainstay of treatment for these infections, doxycycline can also be used. Indeed, when a series of patients with B. quintana bacteremia was analyzed, a combination of doxycycline with gentamicin was more likely to prevent relapse than either doxycycline or beta-lactam monotherapy (Foucault et al., 2002). Further exploration of the role of antimicrobial therapy for B. quintana bacteremia was undertaken with a randomized, placebo-controlled trial showing that doxycycline and gentamicin reduced the risk of recurrent bacteremia (Foucault et al., 2003). The rare neuroretinitis manifestation of cat-scratch disease (acute visual loss from optic nerve edema associated with macular exudates) appears to respond best to doxycycline and rifampicin (Reed et al., 1998).
Clinical Features and Multimodal Imaging in Atypical Posterior Uveitis Secondary to Bartonella Henselae Infection
Published in Ocular Immunology and Inflammation, 2022
Zachary A. Koretz, Anna Apostolopoulou, Edwin Chen, Oliver Beale, Peter Veldkamp, John Alex Viehman, José-Alain Sahel, Jay Chhablani, Kunal K. Dansingani, Marie-Hélène Errera, Gabrielle R. Bonhomme
Our clinical decision-making and differential diagnosis was achieved through a combination of her ocular findings, clinical manifestations, and key aspects of her social and exposure history. This led us to consider a broad differential of infectious (Table 1) and non-infectious etiologies. As detailed above, all the relevant diagnostic tests were negative except Bartonella henselae serologies. The standard diagnostic assay for Bartonella henselae is IFA with a reflex to IFA titer and, to our knowledge, there is no confirmatory assay such as a Western blot for B. henselae in common use. Therefore, to solidify the diagnosis of bartonellosis and minimize the possibility of false positive results, it is of paramount importance to repeat the serologic testing in 4 weeks in order to demonstrate resolution of the IgM titers and increase in IgG titers (convalescence). Our patient’s initial Bartonella henselae IgG titers were only borderline elevated, similar to other cases of Bartonella neuroretinitis reported in the literature.21 Her convalescent titers, however, showed a 4-fold elevation of IgG at 38 days and thus supported the diagnosis. Therefore, we would like to emphasize the diagnostic importance of obtaining convalescent titers when evaluating patients with suspected Bartonellosis, particularly those with atypical presentations.22
Antinuclear antibodies in infectious diseases
Published in Infectious Diseases, 2020
Jae Hyoung Im, Moon-Hyun Chung, Young Kyoung Park, Hea Yoon Kwon, Ji Hyeon Baek, Seung Yun Lee, Jin-Soo Lee
In the present study, tuberculosis was the most common infection among ANA-positive patients; interestingly, most of these patients had extrapulmonary tuberculosis, which may have been the result of the frequent use of ANA testing for the differential diagnosis of extrapulmonary tuberculosis. However, the existence of an association between tuberculosis and ANA is worth considering, as it has been reported that patients with tuberculosis have high levels of autoantibodies [27]. It was also intriguing to find that our cohort had five patients with confirmed scrub typhus infection and three with bartonellosis. A previous study reported that O. tsutsugamushi can increase ANA titres during acute illness [25]. It should also be noted that O. tsutsugamushi and Rickettsia sp. can be observed in the human cell nucleus [28]. We suggest that further study should be undertaken to determine whether immune response to intracellular bacteria may induce ANA. Although intracellular organisms were responsible for most of the confirmed infections in the present study, E. coli were identified in four patients. Interestingly, a previous study reported that E. coli biofilm formation can result in autoantibody production [29].
Presence of Leptospira spp. and absence of Bartonella spp. in urban rodents of Buenos Aires province, Argentina
Published in Pathogens and Global Health, 2022
Bartonellosis is caused by bacteria of the genus Bartonella (Bartonellaceae). These organisms are vector-borne, blood-borne, intracellular, Gram-negative bacteria that can induce prolonged infection in the host. These persistent infections make domestic and wild animals’ important reservoirs of Bartonella spp. in nature and can serve as a source for inadvertent human infection [2,32–37]. Urban and wild rodents are considered the primary source of infection for ten species of Bartonella, at least five of them, including – Bartonella elizabethae, Bartonella tribocorum, Bartonella grahamii, Bartonella vinsonii subsp. arupensis, and Bartonella washoensis have been implicated as the cause of human infections [38–40].