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Our interesting case
A 23-year-old male patient presented with a fever and abdominal distension for 1 month.
On history taking it was revealed that patient have multiple animals at home like buffaloe, cow, cat, dog.
The patient investigated with CBC (Complete Blood Counts) which showed Leukocytosis means increased white blood cells (WBCs).
CT scan of chest and abdomen also done. It showed the multiple cystic lesion in the liver and spleen which is suggestive of peliosis hepatic.
For further investigation USD guided cyst aspirated and the smear showed RBC and few pus cells. Fluid culture also done. But there was no growth for any organism.
A close examination of peripheral smear was done and that revealed intraerythrocytic corpuscles compatible with one bacteria.
Final diagnosis: Bartonella henselae
Bartonella causes nonhemolytic intracellular colonization of RBCs.
On evaluating the deep history, it found that he used to feed cats every day. Bartonella can be transmitted to humans by cats via flea or louse present on cat.
Important points to remember
- History of pet animal and pet exposure is very important in evaluating PUO (Pyrexia of Unknown Origin).
- Peripheral smear study is equally important as blood culture in the diagnosis of PUO.
- Keep Bartonella in the differential diagnosis of peliosis hepatic.
This case study was shared with us by Dr. Pratik Savaj (infectious disease physician) in acknowledgment with Dr. Mayank Kabrawala (experience Gastroenterologist and hepatology), Dr. Nisarg Patel (Gastroenterologist), and Dr. Priya Arora (pathologist).
Also read:
A herpetic pharyngitis case study with common infections spread by kissing
Bartonella henselae FAQs
What is Bartonella henselae disease?
Bartonella is a bacterial infection that is transmitted to humans by different animals especially cats via fleas or louse present on it or cat scratches. There are different species of Bartonella that causes the disease in human.
Bartonella henselae is common and cat is a natural reservoir of it. Fleas and tick is the vector present in the cat that is responsible for the transmission of the disease to a human. It is also transmitted by scratches of cats and so it is also known as cat scratch fever or disease (CSD).
Another species is the Bartonella quintana in which the natural reservoir is humans and cats and it is transmitted by the louse.
Bartonella bacilliformis is transmitted by sandflies causing carrion’s disease which is earlier known as bartonellosis. The disease mostly occurs in the Andes mountains ranging from 3000 to 10,000 feet of elevation in western South America. Most cases are seen in Peru.
What are the symptoms of Bartonella or cat scratch fever?
The common symptoms are low-grade fever which may remain for days, enlarged and painful lymph nodes, papule or pustule at the site of the scratch, muscle aches, fatigue, headache, etc.
Eye symptoms or infection may also be there but it is rare.
Rare neurological symptoms may also occur causing encephalitis, insomnia, disorientation, loss of coordination, blurred vision, etc.
What is the treatment of cat scratch fever?
As it is a bacterial infection, it responds to antibiotics very well. Aminoglycoside antibiotics are bactericidal and they can be the first choice as the first-line treatment of Bartonella infection.
What can cause intraerythrocytic infection?
Intraerythrocytic infection is commonly caused by malaria, babesiosis, and Bartonella.
How common is cat scratch fever?
Every year around 22,000 individuals are affected by Bartonella in the United States. Children below the age of 10 years are more commonly affected as they are more likely to be scratched by cats. Veterinary personnel is more prone to be infected around 7 to 51% due to their profession of handling cats and animals. Overall 2 to 6% of people carry antibodies of Bartonella henselae.
In animals, kittens are more affected or common carriers of the bacteria. 1 to 81% of the cats are affected by the bacteria and it varies from a different region to region and humidity also. Once the cat is infected, the bacteria remain for 5 to 8 months or even a year also. After clearance of the bacterial strains, a cat may be infected by different strains again.
Can dogs transmit Bartonella to humans?
It is rare but dogs can also carry Bartonella henselae bacteria in less than 1%. But there is no sure evidence that suggests the transmission of the infection to humans by dogs. Other than dogs and cats, animals such as bovines, canines, rodents, and humans are also hosting as a reservoir for different kinds of Bartonella spp.
What does Bartonella’s rash look like?
There is much misinformation on the internet when you search for this. The mislabelled images show a rash of Bartonella as of stretch marks in pregnancy.
Bartonella rash may appear as papular or macular eruption, mostly at the site of cat scratch a few days after inoculation. It may not appear also in many cases.