title: Disseminated Bartonella infection following liver transplantation.
abstract: Bartonella henselae has not only been identified as the causative agent of cat scratch disease, but it is also associated with other significant infectious syndromes in the immunocompromised population. We describe two cases of B. henselae associated diseases in liver transplant recipients who both had contact with cats. The first recipient developed localized skin manifestation of bacillary angiomatosis in association with granulomatous hepatitis. He tested positive for Immunoglobulin G (IgG) antibodies against B. henselae. The second patient developed axillary lymphadenopathy, with biopsy showing necrotizing granulomatous inflammation and polymerase chain reaction studies were positive for B. henselae DNA. Her serology for bartonellosis showed a fourfold rise in antibody titers during her hospitalization. Both patients responded to treatment with Azithromycin in combination with Doxycycline. These were the only cases within a series of 467 consecutive liver transplants performed in 402 patients performed during a 4-year period. Although bartonellosis is a rare infection in liver transplantation recipients, it should always be included in the differential diagnosis of patients presenting with fever, central nervous system (CNS) symptoms, skin lesions, lymphadenopathy, and hepatitis especially if prior contact with cats is reported.
authors.affiliation: Transplant Center, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Hugo
authors.initials: H
authors.lastname: Bonatti
authors.forename: Julio
authors.initials: J
authors.lastname: Mendez
authors.forename: Ivan
authors.initials: I
authors.lastname: Guerrero
authors.forename: Murli
authors.initials: M
authors.lastname: Krishna
authors.forename: Jaime
authors.initials: J
authors.lastname: Ananda-Michel
authors.forename: Joseph
authors.initials: J
authors.lastname: Yao
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Steers
authors.forename: Walter
authors.initials: W
authors.lastname: Hellinger
authors.forename: Rolland C
authors.initials: RC
authors.lastname: Dickson
authors.forename: Salvador
authors.initials: S
authors.lastname: Alvarez
mesh_terms: D016917:Angiomatosis, Bacillary / Q000175:diagnosis / Q000209:etiology; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D001474:Bartonella Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D018416:Bartonella henselae / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D002372:Cat-Scratch Disease / Q000175:diagnosis / Q000209:etiology; D002415:Cats; D005260:Female; D006506:Hepatitis A / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged
chemical_list: D000907:Antibodies, Bacterial