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Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report

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...

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Autores principales: Hempel, Amanda, Manzoor, Fizza, Petrescu, Dan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518968/
https://www.ncbi.nlm.nih.gov/pubmed/37743475
http://dx.doi.org/10.1186/s40794-023-00200-1
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author Hempel, Amanda
Manzoor, Fizza
Petrescu, Dan
author_facet Hempel, Amanda
Manzoor, Fizza
Petrescu, Dan
author_sort Hempel, Amanda
collection PubMed
description 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: 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: 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.
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spelling pubmed-105189682023-09-26 Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report Hempel, Amanda Manzoor, Fizza Petrescu, Dan Trop Dis Travel Med Vaccines Case Report 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: 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: 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. BioMed Central 2023-09-25 /pmc/articles/PMC10518968/ /pubmed/37743475 http://dx.doi.org/10.1186/s40794-023-00200-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Hempel, Amanda
Manzoor, Fizza
Petrescu, Dan
Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report
title Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report
title_full Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report
title_fullStr Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report
title_full_unstemmed Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report
title_short Hemophagocytic lymphohistiocytosis secondary to unrecognized Bartonella henselae infection: a case report
title_sort hemophagocytic lymphohistiocytosis secondary to unrecognized bartonella henselae infection: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518968/
https://www.ncbi.nlm.nih.gov/pubmed/37743475
http://dx.doi.org/10.1186/s40794-023-00200-1
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