A case of Bartonellosis presenting as a puzzling multisystem disorder complicated by nosocomial COVID-19 infection

Abstract

The most commonly considered infection with a Bartonella species is cat-scratch disease caused by Bartonella henselae. Here, we discuss a unique case of a 60-year-old man who presented with Bartonella infection complicated by nosocomial COVID-19. He was admitted with a history of chest pain, persistent fever, rash and influenza-like symptoms. Positive Bartonella serology confirmed diagnosis and the patient developed complications of pericardial effusion in addition to COVID-19 infection, requiring non-invasive ventilation and admission to the intensive care unit. We discuss his symptoms, investigations, treatment and outcomes, while also highlighting the challenges of assessing patients presenting with fever of unknown origin during the COVID-19 pandemic.

Pleural and pericardial effusions with fever and altered mental status: an atypical presentation of bartonellosis

“…Although guidelines recommend doxycycline in complicated bartonellosis in combination with gentamicin (preferred with endocarditis) or rifampin (preferred with retinitis or encephalopathy), there is no definitive curative regimen 16. In addition to ours, dual antibiotic therapy was used in two cases,5 8 while two other cases found success with either azithromycin or clarithromycin alone 9 10…”

“…There are only five cases of isolated pericardial effusion associated with bartonellosis seen on echocardiogram 5 8–11. Patients with a pericardial effusion reported prodromal fever, fatigue and flu-like symptoms.…”

“…Patients with a pericardial effusion reported prodromal fever, fatigue and flu-like symptoms. In two cases, patients were found to have pericardial effusions after readmission with persistent or worsening fever, dyspnoea and flu-like symptoms at which time a subsequent diagnosis of bartonellosis was made 5 8. All patients exhibited improvement or resolution of pericardial effusion after antibiotic therapy targeting Bartonella was initiated.…”

Viability and Desiccation Resistance of Bartonella henselae in Biological and Non-Biological Fluids: Evidence for Pathogen Environmental Stability

“…Although few reports describe the detection of Bartonella DNA from other body fluids such as serum [ 56 , 81 ], cerebrospinal fluid (CSF) [ 82 , 83 ], lymph node aspirates [ 84 ], aqueous humor [ 85 ], urine [ 86 ], and saliva [ 64 , 65 , 86 , 87 ], to our knowledge, a systematic assessment of the viability of this or other Bartonella species in these diagnostic patient fluid specimens has not been undertaken. Historically, case reports describing people acquiring CSD from rose thorn injuries [ 88 ], as well as cat or dog salivary transmission from bites and scratches [ 89 , 90 , 91 ], point to this organism’s ability to tolerate a wide range of environmental conditions. The fact that B. henselae can be revived from several fluid matrices following desiccation not only disproved our hypothesis but supports the hypothesis of previously unrecognized infectious sources and alternative modes of transmission.…”

Nyaki tumort utánzó elváltozás egy 13 éves fiúban: post-COVID-bartonellosis

“…Érdemes továbbá rámutatni arra, hogy a COVID-19 és a bartonellosis társulásáról eddig kevés tanulmány született [18,19]. Esetünkben elképzelhetőnek tartjuk, hogy a megelőző COVID-19 az immunrendszer gyengüléséhez vezethetett, és hozzájárulhatott a bartonellosis klinikai képének súlyosbodásához.…”