1887

Abstract

Introduction. Tularaemia is caused by infection with Francisella 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. Bartonella spp.

Case presentation. 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. Since Bartonella infections 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-Bartonella spp. 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. quintana antibodies may have been due to technical issues with the assay, cross-reactivity or both.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005071
2017-02-28
2019-10-21
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/4/2/jmmcr005071.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005071&mimeType=html&fmt=ahah

References

  1. Sjöstedt A. Tularemia: history, epidemiology, pathogen physiology, and clinical manifestations. Ann N Y Acad Sci 2007;1105:1–29 [CrossRef][PubMed]
    [Google Scholar]
  2. Eliasson H, Bäck E. Tularaemia in an emergent area in Sweden: an analysis of 234 cases in five years. Scand J Infect Dis 2007;39:880–889 [CrossRef][PubMed]
    [Google Scholar]
  3. Larson MA, Fey PD, Hinrichs SH, Iwen PC. Francisella tularensis bacteria associated with feline tularemia in the United States. Emerg Infect Dis 2014;20:2068–2071 [CrossRef][PubMed]
    [Google Scholar]
  4. Magee JS, Steele RW, Kelly NR, Jacobs RF. Tularemia transmitted by a squirrel bite. Pediatr Infect Dis J 1989;8:123–125[PubMed]
    [Google Scholar]
  5. Abrahamian FM, Goldstein EJ. Microbiology of animal bite wound infections. Clin Microbiol Rev 2011;24:231–246 [CrossRef][PubMed]
    [Google Scholar]
  6. Eliasson H, Lindbäck J, Nuorti JP, Arneborn M, Giesecke J et al. The 2000 tularemia outbreak: a case-control study of risk factors in disease-endemic and emergent areas, Sweden. Emerg Infect Dis 2002;8:956–960 [CrossRef][PubMed]
    [Google Scholar]
  7. Brouqui P, Lascola B, Roux V, Raoult D. Chronic Bartonella quintana bacteremia in homeless patients. N Engl J Med 1999;340:184–189 [CrossRef][PubMed]
    [Google Scholar]
  8. Fournier PE, Mainardi JL, Raoult D. Value of microimmunofluorescence for diagnosis and follow-up of Bartonella endocarditis. Clin Diagn Lab Immunol 2002;9:795–801 [CrossRef][PubMed]
    [Google Scholar]
  9. La Scola B, Raoult D. Serological cross-reactions between Bartonella quintana, Bartonella henselae, and Coxiella burnetii. J Clin Microbiol 1996;34:2270–2274[PubMed]
    [Google Scholar]
  10. Switaj K, Olszynska-Krowicka M, Zarnowska-Prymek H, Zaborowski P. Tularaemia after tick exposure - typical presentation of rare disease misdiagnosed as atypical presentation of common diseases: a case report. Cases J 2009;2:7954 [CrossRef][PubMed]
    [Google Scholar]
  11. Capellan J, Fong IW. Tularemia from a cat bite: case report and review of feline-associated tularemia. Clin Infect Dis 1993;16:472–475 [CrossRef][PubMed]
    [Google Scholar]
  12. Tärnvik A, Chu MC. New approaches to diagnosis and therapy of tularemia. Ann N Y Acad Sci 2007;1105:378–404 [CrossRef][PubMed]
    [Google Scholar]
  13. Penn RL. Francisella tularensis (tularemia). In Mandell GL, Bennet JE, Dolin R. (editors) Principles and Practice of Infectious Diseases, 6th ed. New York: Churchill Livingstone; 2005; pp.2674–2683
    [Google Scholar]
  14. Eliasson H, Olcén P, Sjöstedt A, Jurstrand M, Bäck E et al. Kinetics of the immune response associated with tularemia: comparison of an enzyme-linked immunosorbent assay, a tube agglutination test, and a novel whole-blood lymphocyte stimulation test. Clin Vaccine Immunol 2008;15:1238–1243 [CrossRef][PubMed]
    [Google Scholar]
  15. Splettstoesser WD, Tomaso H, Al Dahouk S, Neubauer H, Schuff-Werner P. Diagnostic procedures in tularaemia with special focus on molecular and immunological techniques. J Vet Med B Infect Dis Vet Public Health 2005;52:249–261 [CrossRef][PubMed]
    [Google Scholar]
  16. Tärnvik A. Nature of protective immunity to Francisella tularensis. Rev Infect Dis 1989;11:440–451 [CrossRef][PubMed]
    [Google Scholar]
  17. Ehrenborg C, Byström R, Hjelm E, Friman G, Holmberg M. High Bartonella spp. seroprevalence in a Swedish homeless population but no evidence of trench fever. Scand J Infect Dis 2008;40:208–215 [CrossRef][PubMed]
    [Google Scholar]
  18. Ehrenborg C, Hagberg S, Alden J, Makitalo S, Myrdal G et al. First known case of Bartonella quintana endocarditis in Sweden. Scand J Infect Dis 2009;41:73–75 [CrossRef][PubMed]
    [Google Scholar]
  19. Westling K, Farra A, Cars B, Ekblom AG, Sandstedt K et al. Cat bite wound infections: a prospective clinical and microbiological study at three emergency wards in Stockholm, Sweden. J Infect 2006;53:403–407 [CrossRef][PubMed]
    [Google Scholar]
  20. Westling K, Farra A, Jorup C, Nordenberg A, Settergren B et al. Bartonella henselae antibodies after cat bite. Emerg Infect Dis 2008;14:1943–1944 [CrossRef][PubMed]
    [Google Scholar]
  21. Fournier PE, Ndihokubwayo JB, Guidran J, Kelly PJ, Raoult D. Human pathogens in body and head lice. Emerg Infect Dis 2002;8:1515–1518 [CrossRef][PubMed]
    [Google Scholar]
  22. Mcgill S, Wesslen L, Hjelm E, Holmberg M, Rolf C et al. Serological and epidemiological analysis of the prevalence of Bartonella spp. antibodies in Swedish elite orienteers 1992-93. Scand J Infect Dis 2001;33:423–428[PubMed][CrossRef]
    [Google Scholar]
  23. Mcgill S, Wesslén L, Hjelm E, Holmberg M, Auvinen MK et al. Bartonella spp. seroprevalence in healthy Swedish blood donors. Scand J Infect Dis 2005;37:723–730 [CrossRef][PubMed]
    [Google Scholar]
  24. Hjelm E, Mcgill S, Blomqvist G. Prevalence of antibodies to Bartonella henselae, B. elizabethae and B. quintana in Swedish domestic cats. Scand J Infect Dis 2002;34:192–196 [CrossRef][PubMed]
    [Google Scholar]
  25. da Costa PS, Brigatte ME, Greco DB. Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2005;100:853–859 [CrossRef][PubMed]
    [Google Scholar]
  26. Holmberg M, Mcgill S, Ehrenborg C, Wesslén L, Hjelm E et al. Evaluation of human seroreactivity to Bartonella species in Sweden. J Clin Microbiol 1999;37:1381–1384[PubMed]
    [Google Scholar]
  27. Drancourt M, Mainardi JL, Brouqui P, Vandenesch F, Carta A et al. Bartonella (Rochalimaea) quintana endocarditis in three homeless men. N Engl J Med 1995;332:419–423 [CrossRef][PubMed]
    [Google Scholar]
  28. Maurin M, Eb F, Etienne J, Raoult D. Serological cross-reactions between Bartonella and Chlamydia species: implications for diagnosis. J Clin Microbiol 1997;35:2283–2287[PubMed]
    [Google Scholar]
  29. Savitt AG, Mena-Taboada P, Monsalve G, Benach JL. Francisella tularensis infection-derived monoclonal antibodies provide detection, protection, and therapy. Clin Vaccine Immunol 2009;16:414–422 [CrossRef][PubMed]
    [Google Scholar]
  30. Gilmore RD, Carpio AM, Kosoy MY, Gage KL. Molecular characterization of the sucB gene encoding the immunogenic dihydrolipoamide succinyltransferase protein of Bartonella vinsonii subsp. berkhoffii and Bartonella quintana. Infect Immun 2003;71:4818–4822 [CrossRef][PubMed]
    [Google Scholar]
  31. Litwin CM, Johnson JM, Martins TB. The Bartonella henselae sucB gene encodes a dihydrolipoamide succinyltransferase protein reactive with sera from patients with cat-scratch disease. J Med Microbiol 2004;53:1221–1227 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005071
Loading

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error