Into the unknown: Diagnosing mysterious brain lesions

Kassab, Ihab; Isada, Carlos M.; Azar, Marwan M.; Sarsam, Nadine; Jiang, Min; Camelo-Piragua, Sandra; Kaul, Daniel R; Malinis, Maricar

doi:10.1111/tid.13829

Cited by 6 publications

(4 citation statements)

References 54 publications

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“…However, granulomatous inflammation of the brain tissue involving meningitis has been demonstrated by some investigators ( 14 , 15 ), and the histopathological features of direct infection by Bartonella henselae were the same as those in the case of our study. Furthermore, there have been some previous reports of brain abscesses and leptomeningitis related to the infection of Bartonella henselae ( 16 – 18 ). Hence, a bacterial invasion may be a continuous process of CSD involving the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

Case report: Intracranial lesions of cat-scratch disease mimicking an atypical meningioma

Fang

Wang²,

Qin³

et al. 2023

Front. Neurol.

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ObjectivesCat-scratch disease (CSD) is an infectious disease caused by Bartonella henselae. The most typical symptom of patients with CSD is regional lymphadenopathy, while central nervous system lesions related to CSD are rare. Here, we present a case of an aged woman with CSD involving the dura mater with a manifestation similar to that of an atypical meningioma.MethodsThe patient was followed up by our neurosurgery and radiology teams. Clinical information was recorded, and the pre- and post-operation CT results and magnetic resonance imaging (MRI) changes were collected. The paraffin-embedded tissue was sampled for the polymerase chain reaction (PCR) test.ResultsIn this study, we present the details of a 54 year-old Chinese woman admitted to our hospital with a paroxysmal headache for 2 years that had worsened in the past 3 months. Brain CT and MRI showed a meningioma-like lesion below the occipital plate. En bloc resection of the sinus junction area was performed. A pathological examination showed granulation tissue and fibrosis with acute and chronic inflammation, granuloma, and central stellate microabscess, which was suspected as the cat-scratch disease. The paraffin-embedded tissue was sampled for a polymerase chain reaction (PCR) test to amplify the corresponding pathogen gene sequence, which was Bartonella henselae.ConclusionThe case in our study underscores the fact that the incubation period of CSD may be very long. On the contrary, CSD can involve the meninges, resulting in tumor-like lesions.

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Section: Discussionmentioning

confidence: 99%

Case report: Intracranial lesions of cat-scratch disease mimicking an atypical meningioma

Fang

Wang²,

Qin³

et al. 2023

Front. Neurol.

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“…Traditionally, and for diagnostic purposes, blood has been the primary target sample type for the detection of Bartonella species in reservoir hosts and incidentally infected patients. 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.…”

Section: Discussionmentioning

confidence: 99%

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

2023

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Pathogen environmental stability is an often-neglected research priority for pathogens that are known to be vector-transmitted. Bartonella henselae, the etiologic agent of Cat Scratch Disease, has become a “pathogen of interest” in several serious human illnesses, which include neoplastic, cardiovascular, neurocognitive, and rheumatologic conditions. Survival in the flea gut and feces as well as the association with a biofilm in culture-negative endocarditis provides insight into this organism’s ability to adjust to environmental extremes. The detection of B. henselae DNA in blood and tissues from marine mammals also raises questions about environmental stability and modes of pathogen transmission. We investigated the ability of B. henselae to survive in fluid matrices chosen to mimic potential environmental sources of infective materials. Feline whole blood, serum and urine, bovine milk, and physiologic saline inoculated with a laboratory strain of B. henselae San Antonio 2 were subsequently evaluated by culture and qPCR at specified time intervals. Bacterial viability was also assessed following desiccation and reconstitution of each inoculated fluid matrix. Bartonella henselae SA2 was cultured from feline urine up to 24 hours after inoculation, and from blood, serum, cow’s milk, and physiologic saline for up to 7 days after inoculation. Of potential medical importance, bacteria were cultured following air-desiccation of all fluid inoculates. The viability and stability of Bartonella within biological and non-biological fluids in the environment may represent a previously unrecognized source of infection for animals and human beings.

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“…Only reports published in English were included. A total of ve studies were found that mention the application of mNGS in the diagnosis of CSD using different types of samples (Table 1), including lymph node tissue, tissue swabs, plasma, peripheral blood and cerebrospinal uid (8)(9)(10)(11)(12) . Although the clinical manifestations, B. henselae-speci c sequences identi ed using mNGS and genome coverage varied considerably among the studies, they all proved that mNGS is an e cient method for establishing a pathogenic diagnosis in cases of complicated general infection.…”

Section: Discussionmentioning

confidence: 99%

Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: A case report and literature review

Qian

Tao

2023

Preprint

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Background: Cat-scratch disease (CSD) is caused by Bartonella henselae infection. In atypical cases of CSD, pathogen determination is challenging. We report a case of Bartonella neuroretinitis with neither a clear history of scratches nor typical general symptoms. The diagnosis was made using metagenomic next-generation sequencing (mNGS), a high-throughput sequencing technology. Case presentation: A female patient presented to the ophthalmologist with complaint of blurred vision in her right eye. Although with history of raising a cat, she reported no clear history of scratches or typical general symptoms, except a fever of unknown origin which resolved spontaneously. The best corrected visual acuity (BCVA) of the right eye was count fingers. Fundus examination showed optic disc oedema, macular exudates and inferior exudative retinal detachment. Laboratory examination results showed increased value of serum C-reactive protein and erythrocyte sedimentation rate. Ocular involvement of toxoplasmosis, syphilis and tuberculosis were excluded. To identify the possible causative pathogen of the disease, mNGS of aqueous humour sample was performed and 521 reads of B. henselae were identified. Serological test results further showed a positive immunoglobulin G (IgG) titre of 1:64. Taking the contact history, clinical manifestations, mNGS and serological results into consideration, the diagnosis of Bartonellaneuroretinitis (ocular CSD) was made. After appropriate treatment, the BCVA of the right eye improved to 20/25 in the last follow-up. Fundus examination showed a normal optic disc and macula, and the exudates had reduced. Conclusions:mNGS, a fast and unbiased method, can be used to detect B. henselae (if present) in intraocular fluid samples.; however, the results should be interpreted together with the clinical symptoms and other auxiliary test results.

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Into the unknown: Diagnosing mysterious brain lesions

Cited by 6 publications

References 54 publications

Case report: Intracranial lesions of cat-scratch disease mimicking an atypical meningioma

Case report: Intracranial lesions of cat-scratch disease mimicking an atypical meningioma

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

Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: A case report and literature review

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