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

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 ca...

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Autores principales: Sodini, Chiara, Zani, Elena Mariotti, Pecora, Francesco, Conte, Cristiano, Patianna, Viviana Dora, Prezioso, Giovanni, Principi, Nicola, Esposito, Susanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146596/
https://www.ncbi.nlm.nih.gov/pubmed/33924906
http://dx.doi.org/10.3390/microorganisms9050950
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author Sodini, Chiara
Zani, Elena Mariotti
Pecora, Francesco
Conte, Cristiano
Patianna, Viviana Dora
Prezioso, Giovanni
Principi, Nicola
Esposito, Susanna
author_facet Sodini, Chiara
Zani, Elena Mariotti
Pecora, Francesco
Conte, Cristiano
Patianna, Viviana Dora
Prezioso, Giovanni
Principi, Nicola
Esposito, Susanna
author_sort Sodini, Chiara
collection PubMed
description 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.
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spelling pubmed-81465962021-05-26 A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child Sodini, Chiara Zani, Elena Mariotti Pecora, Francesco Conte, Cristiano Patianna, Viviana Dora Prezioso, Giovanni Principi, Nicola Esposito, Susanna Microorganisms Case Report 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. MDPI 2021-04-28 /pmc/articles/PMC8146596/ /pubmed/33924906 http://dx.doi.org/10.3390/microorganisms9050950 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Sodini, Chiara
Zani, Elena Mariotti
Pecora, Francesco
Conte, Cristiano
Patianna, Viviana Dora
Prezioso, Giovanni
Principi, Nicola
Esposito, Susanna
A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child
title A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child
title_full A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child
title_fullStr A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child
title_full_unstemmed A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child
title_short A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child
title_sort case of atypical bartonellosis in a 4-year-old immunocompetent child
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146596/
https://www.ncbi.nlm.nih.gov/pubmed/33924906
http://dx.doi.org/10.3390/microorganisms9050950
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