title: Cat-bite-inducedFrancisella tularensisinfection with a false-positive serological reaction forBartonella quintana.
abstract: Introduction.Tularaemia is caused by infection withFrancisella tularensistransmitted via direct contact with an infected hare carcass or indirectly through the bites of vectors, but may be cat-bite-associated as well. Medical history and reliable diagnostic analysis are important in order to differentiate it from other cat-associated infections, e.g.Bartonellaspp.Casepresentation.A healthy 56-year-old man was examined because of a cat-bite-associated ulceroglandular wound on his right thumb. Nineteen days after the cat bite occurred, a serology test was positive for anti-Bartonella quintana, but negative for anti-F. tularensis. SinceBartonellainfections are rare in Sweden, another serology test was analysed 2 weeks later with a positive result for anti-F. tularensis. The patient was treated with doxycycline for 14 days and recovered. The patient was re-sampled after 18 months to obtain a convalescent sample. The acute and the convalescent samples were both analysed at a reference centre, with negative results for anti-Bartonellaspp. this time.Conclusion.This case is enlightening about the importance of extending the medical history and re-sampling the patient for antibody detection when the clinical suspicion of cat-bite-associated tularaemia is high. The false-positive result for anti-B. quintanaantibodies may have been due to technical issues with the assay, cross-reactivity or both.
authors.affiliation: Department of Medicine, Karlskoga Hospital , Karlskoga , Sweden.
authors.forename: Evelina
authors.initials: E
authors.lastname: Petersson
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University , Örebro SE 701 82 , Sweden.
authors.forename: Simon
authors.initials: S
authors.lastname: Athlin
keywords: Bartonella quintana; Francisella tularensis; cross-reaction; serology; tularaemia