Bartonella henselae: Clinical Manifestations and Diagnostic Workup Challenges in Patient with Fever of Unknown Origin | Chapter 9 | Medicine and Medical Research: New Perspectives Vol. 9

Bartonella henselae is a zoonotic Gram-negative Bacillus associated with self-limited regional lymphadenopathy caused by close animal contact. In recent decades, a vast spectrum of clinical manifestations has been described, from mild self-limiting lymphadenopathy to disseminated disease involving multiple organs. About 30 species have been identified, and 12 have been linked to human infection, among which three are most commonly encountered clinically- Bartonella bacilliformis, which causes Oroya fever endemic to regions in Peru, Bartonella quintana that causes Trench Fever, and Bartonella henselae that causes Cat scratch disease (CSD). Trench fever was seen in World War I amongst soldiers living in trenches or closed spaces, who developed symptoms of recurrent febrile illness associated with headache, body aches, and rash that were transmitted by lice. More recently, trench fever outbreaks have been seen in densely populated spaces such as in the homeless population and refugee camps. Transmission of B. henselae is associated with cats and cat fleas. Weeks after a scratch or bite, a pustule will form at the inoculation site with associated localized lymphadenopathy. Commonly, this is a self-limiting disease. However, in immunocompromised patients and patients with predisposing factors, patients' lymphadenopathy will progress and become bacteremic, leading to endocarditis as well as aseptic meningitis. Bartonella spp. is the second most common cause of culture-negative endocarditis after Coxiella burnetii. Definitive diagnosis of Bartonella infection is often challenging due to its insidious nature and variable presentation based on the body's immune status.

A clinical diagnostic challenge was encountered when a 25-year-old male presented to our hospital with a Fever of unknown origin (FUO). Initially, there was no clear etiology of the fever until a timely diagnosis of Bartonella infection was made. This case report highlights the importance of considering Bartonella as a potential etiology in patients with prolonged Fever of unknown origin (FUO), especially in endemic regions.

 

Author (s) Details

Neeladri Misra
Sutter Roseville Medical Center, Medical Plaza Dr, Roseville, CA-95661, USA.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v9/2478

Sensorineural Hearing Loss: A Rare Manifestation of Scrub Typhus | Chapter 3 | Achievements and Challenges of Medicine and Medical Science Vol. 2

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging infectious disease prevalent in countries like China, India, Indonesia, Japan, Korea, the Philippines, Sri Lanka, Taiwan, and Thailand and is an often underestimated public health problem in the Asia Pacific area. The "tsutsugamushi triangle" refers to a geographical region in the Asia-Pacific area where scrub typhus is highly endemic. This triangle spans from northern Japan and far-eastern Russia in the north, to northern Australia in the south, and to Pakistan and Afghanistan in the west. As an underestimated disease, there is still a substantial lack of knowledge about scrub typhus, reflected by the limited epidemiological data and insufficient public health information in its endemic regions. Without appropriate treatment, scrub typhus can lead to severe multiorgan failure, with a case fatality rate of up to 70%.  While fever and systemic complications are common in scrub typhus, neurological manifestations, such as sudden bilateral sensorineural hearing loss (SNHL), are rare but increasingly recognized.

A case of 64-year-old female presented who experienced fever, myalgia, and bilateral sensorineural hearing loss (SNHL), eventually diagnosed as scrub typhus. The diagnostic process was challenging due to the wide clinical spectrum and nonspecific symptoms of the disease. Proposed mechanisms for hearing loss include direct invasion of the central nervous system or vasculitis involving the cochlear nerve. Increased awareness among healthcare providers is essential for prompt diagnosis and treatment. In endemic areas, empirical treatment with doxycycline is advised for suspected cases. This case highlights the need to consider scrub typhus in patients with acute febrile illness and ear-related symptoms, which can lead to early intervention and better patient outcomes.

 

Author (s) Details

Athulya Asokan
Department of General Medicine, Government Medical College, Kottayam, India.

 

Athira V R
Department of General Medicine, Pushpagiri Institute of Medical Sciences, India.

 

Sanal K Thomas
Department of Neurology, Jubilee Mission Medical College, India.

 

Ajeesh Koshy
Department of General Medicine, Pushpagiri Institute of Medical Sciences, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v2/2931