Serious and Atypical Presentations of Bartonella henselae Infection in Kidney Transplant Recipients

Abstract

Description of five cases of bartonellosis with fever and atypical clinical presentations in kidney transplant recipients : thrombotic microangiopathies, recurrent haemophagocytosis and immune reconstitution syndrome after treatment. The diagnosis, the pathological lesions, and treatments are described. Bartonellosis must be researched in solid organ transplant recipients with fever of undetermined origin.

Hepatic granulomas in a pediatric liver transplant recipient

“…Ocular disease with partial vision loss and other atypical clinical presentations such as thrombotic microangiopathies and hemophagocytic lymphohistiocytosis have also been described in SOT recipients. 1,2,3 We report the case of a young girl, 2 years and 8 months old, admitted to our institute 2 years and 4 months after liver transplant. She had a 1-year history of relapsing fever and fluctuating liver function tests (LFT) (aspartate aminotransferase 215-495 U/L, alanine aminotransferase 101-588 U/L, alkaline phosphatase 203-295 U/L, total bilirubin 1.1-1.32 mg/dL), anemia (Hb 8.8 g/dL), low grade fever, and increased C-reactive protein (CRP) (46 mg/L, normal value <5).…”

“…Cat fleas (Ctenocefalides felis) can cause cat-tocat or, rarely, cat-to-human, transmission by open wound or mucosal exposure to their contaminated feces. 3,8 Bartonella infection has rarely been reported in SOT recipients; however, compromised cell-mediated immunity is a well-known risk factor for bacillary angiomatosis due to B. henselae. 1 A clear relationship between a particular immunosuppressive drug leading to development of invasive bartonellosis has not been established.…”

“…1 A clear relationship between a particular immunosuppressive drug leading to development of invasive bartonellosis has not been established. 1,3,6 The median time between transplant and diagnosis can vary from a few months to several years. 1,3,6 A diagnosis of bartonellosis in SOT patients is not straightforward: in a recent review of the literature, the predominant symptom of bartonellosis in pediatric SOT recipients was fever (73.3%), followed by lymphadenopathy (46.7%).…”

“…1,3,6 The median time between transplant and diagnosis can vary from a few months to several years. 1,3,6 A diagnosis of bartonellosis in SOT patients is not straightforward: in a recent review of the literature, the predominant symptom of bartonellosis in pediatric SOT recipients was fever (73.3%), followed by lymphadenopathy (46.7%). Only one case report in pediatric SOT reported skin lesions on presentation.…”

“…6 Usually, in cases of invasive bartonellosis complete blood count is unremarkable, CRP is moderately elevated, and LFT can be altered in cases of liver granulomatosis or peliosis. [1][2][3]5,9,10 Regarding diagnosis, isolation of this organism from culture is challenging, and the sensitivity of culture is around 20%. 2 Serology can be a useful tool for diagnosis, and there are two methods: enzymelinked immunosorbent assay (ELISA) and IFA.…”