Severe Anemia, Panserositis, and Cryptogenic Hepatitis in an HIV Patient Infected withBartonella henselae

Abstract

Bartonella spp. constitute emerging pathogens of worldwide distribution. Bacillary angiomatosis is the most frequent skin manifestation of bartonelloses; nevertheless, B. henselae infection should always be considered systemic, especially in immunodeficient individuals. The authors report the case of an AIDS patient with bacillary angiomatosis, who had concurrent severe anemia, hepatitis, peritonitis, pleuritis, and pericarditis. Clinical manifestation, electronic microscopic examination of erythrocytes, and histopathology of a papule biopsy suggested a Bartonella sp. infection. Multiple genes were target by PCR and B. henselae DNA was amplified and sequenced (GenBank accession number EF196804) from the angiomatous papule. Treatment with clarithromycin resulted in resolution of the bacillary angiomatosis, fever, anemia, panserosites, and hepatitis.

Detection of Bartonella henselae DNA in clinical samples including peripheral blood of immune competent and immune compromised patients by three nested amplifications

“…As an overview, 11 patients were female, ages varied from two to 80 years old, 15 had received antibiotics, 10 had a fever, 10 confirmed they had contact with cats, nine had adenomegaly, eight had underlying diseases, and in two patients the disease led to death. The cases of patients numbered 1 and 3 were reported elsewhere (VELHO et al, 2007;MAGALHÃES et al, 2010).…”

Cryptogenic Hepatitis and Bartonellosis

“…Bartonella henselae can cause chronic hepatitis inflammation in adults or in children [2,3]. These bacteria can be found worldwide.…”

Bartonellosis diagnosis requires careful evaluation

“…2 Nevertheless, false negative results are observed depending on the sensitivity of the technique (single round or nested PCR), serology antigen origin, 3 number of copies of Bartonella sp. on the specimen studied, 1,4 and specimen preservation (fresh tissue or paraffi n), 5 among other factors.…”

“…2 These are fastidious bacteria and their primo-isolation is diffi cult, even using the necessary conditions, such as media enriched with blood, atmosphere of 5% carbon dioxide, temperature between 35 and 37° C for most human pathogenic species, and environment saturated humidity. 1 The falsenegative serology can, amongst other factors, be associated with differences between strains. 3 There are no Brazil-1 strain commercially available antigens.…”

“…1,5 However, negative results of serology, culture, histology, and molecular techniques should be evaluated carefully and, whenever possible, seek the combination of these diagnostic tests. For the authors, the molecular amplifi cation associated with liquid or solid medium isolation should be prioritized.…”