Hempel Amanda, Manzoor Fizza, Petrescu Dan
Department of Medicine, University of Toronto, RM 13EN, 300 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
Division of Infectious Diseases, University Health Network, Toronto, ON, Canada.
Trop Dis Travel Med Vaccines. 2023 Sep 25;9(1):14. doi: 10.1186/s40794-023-00200-1.
Bartonella henselae is a species of intracellular bacteria transmitted to humans through animal bites and scratches contaminated with the feces of arthropod vectors, and are most commonly associated with cat exposure although transmission from other mammals has been reported. Bartonella henselae infection has a spectrum of clinical manifestations and has rarely been reported as cause of hemophagocytic lymphohistiocytosis (HLH) in immunocompromised hosts.
We present a report of Bartonella henselae infection progressing to HLH in an immunocompetent patient. The patient initially presented with regional lymphadenopathy but the diagnosis was not suspected as the patient reported no exposure to cats. On further history, he did report a scratch from a dog prior to development of symptoms. The patient was treated with methylprednisolone, intravenous immunoglobulin and anakinra for the HLH and three months of Doxycycline for Bartonella infection, with complete resolution of symptoms.
Although commonly associated with cat exposure, Bartonella henselae transmission can occur after exposure to other animals and vectors including dogs and clinicians need to maintain an index of suspicion for timely diagnosis. Bartonella henselae is associated with a spectrum of clinical manifestations which can include disseminated infection with severe complications such as hemophagocytic lymphohistiocytosis. Prompt initiation of Bartonella treatment is essential when thought to be the trigger for hemophagocytic lymphohistiocytosis although the optimal treatment regimen is unclear.
亨氏巴尔通体是一种细胞内细菌，可通过被节肢动物媒介粪便污染的动物咬伤和抓伤传播给人类，虽然有报道称可从其他哺乳动物传播，但最常与接触猫有关。亨氏巴尔通体感染有一系列临床表现，在免疫功能低下宿主中作为噬血细胞性淋巴组织细胞增生症（HLH）的病因鲜有报道。
我们报告一例免疫功能正常患者的亨氏巴尔通体感染进展为HLH的病例。患者最初表现为局部淋巴结病，但由于患者报告未接触过猫，故未怀疑该诊断。进一步询问病史时，他确实报告在症状出现前被一只狗抓伤过。患者接受了甲基强的松龙、静脉注射免疫球蛋白和阿那白滞素治疗HLH，并接受了三个月的强力霉素治疗巴尔通体感染，症状完全缓解。
虽然亨氏巴尔通体通常与接触猫有关，但接触包括狗在内的其他动物和媒介后也可发生传播，临床医生需要保持怀疑指数以便及时诊断。亨氏巴尔通体与一系列临床表现有关，其中可能包括播散性感染及噬血细胞性淋巴组织细胞增生症等严重并发症。当认为亨氏巴尔通体是噬血细胞性淋巴组织细胞增生症的触发因素时，及时开始治疗至关重要，尽管最佳治疗方案尚不清楚。
