Amoxicillin for walking pneumonia

Carrion’s disease has, until recently, been restricted in its geographic distribution to the Andes Mountains regions of the South American countries of Colombia, Peru, and Ecuador at elevations of 1000-3000 meters because of the habitat of the sand fly Lutzomyia.

Cases elsewhere in the world are found in travelers, who presumably acquired their infections while visiting one of these countries. Oroya fever was first recognized in the nineteenth century as the cause of acute fever and highly fatal, hemolytic anemia in railroad workers in Peru. Reports suggest that the chronic skin (cutaneous) stage was described earlier. The common bacterial cause of Oroya fever and verruga peruana was confirmed by a Peruvian medical student, Daniel Carrion, in 1885, when he succumbed to acute hemolytic anemia after injecting himself with blood from a verruga peruana skin lesion.

bacilliformis infection as manifested in Oroya fever and verruga peruana has since been named “Carrion’s Disease.”

Trench

Though the true incidence of contemporary (urban) trench fever is unknown, one study of patients in a downtown Seattle clinic for disadvantaged patients found 20% had antibodies to Bartonella spp., though most of these patients were asymptomatic.

Certain features of the following disorders may be similar to those of bartonellosis: Adenitis (Bacterial, Fungal, Pyogenic, and Tuberculous) is an inflammatory disease characterized by lymphadenopathy. Differential diagnosis may be accomplished through skin testing and/or microscopic examination of the involved lymph nodes.

Atypical mycobacterial infections are caused by nontuberculous mycobacteria, but can be very difficult to distinguish from tuberculosis. Lymphadenopathy is caused by nontuberculous mycobacteria, surgical removal and examination (biopsy) of involved tissue may be necessary for diagnosis.

Brucellosis is an infection of livestock that can be transmitted to humans. It is caused by different species of the bacteria Brucella. Initial infection may result in an acute flu-like illness, or may evolve over months.

Untreated cases may take months to resolve, and some cases become chronic. Symptoms may include a gradual onset of fever, weakness, headache, joint pain, and/or night sweats.

Other symptoms may include lymphadenopathy, splenomegaly, and/or hepatomegaly.

(For more information on this disorder, choose “Brucellosis” as your search term in the Rare Disease Database.) Lymphogranuloma venereum is a sexually transmitted infection characterized by a primary skin lesion at the site of infection.

This lesion may be a raised bump (papule) that heals spontaneously or may go unnoticed.

This is followed by lymphadenopathy on one or both sides of the body.

The site of the first infection or

lesion

These tumors are divided into two types, Hodgkin’s and non-Hodgkin’s lymphoma. Symptoms will depend upon the type and location of the tumor. Symptoms may include lymphadenopathy, hoarseness, a high- pitched respiratory sound when inhaling (stridor), and/or difficulty in swallowing (dysphagia).

Sarcoidosis is a rare disorder which affects

many

Symptoms of sarcoidosis depend on the site of involvement and may be absent, slight, or severe. Both enlarged and normal-sized lymph nodes may contain the characteristic sarcoid tubercles. (For more information on this disorder, choose “Sarcoidosis” as your search term in the Rare Disease Database.) Kaposi’s sarcoma is a cancerous tumor that often appears as bluish-red or purple bump on the skin and is often associated with AIDS. Pyogenic granulomas are small, reddish bumps on the skin whose exact cause is unknown but often appear on the hands, arms or face following injury.

Hemangioma is a benign tumor made up of blood vessels that typically occurs as a purplish or reddish slightly elevated area of skin.

The most common initial symptom is an expanding flat or slightly raised red spot skin lesion (“bull’s eye” rash known as erythema migrans) that develops at the site of the bite of a tick.

Within days or weeks after infection, flu-like symptoms can develop.

Later manifestations may include arthritis, the central nervous system, or cardiac involvement.

Most cases of CSD can be diagnosed by the individual’s symptoms and history, such as the development of papules or pustules after vector exposure or a cat scratch or bite.

Development of swollen lymph nodes and fever further reinforce a clinical diagnosis.

Blood (serological) testing is available to confirm the diagnosis. PCR and culture tests may also be used in certain

cases

Carrion’s disease may be diagnosed based upon thorough clinical evaluation, detection of characteristic symptoms and physical findings, a complete patient history, including information concerning recent travel to regions where Carrion’s disease is known to occur; and specialized laboratory tests.

For example, during the acute stage, the bacterium may easily be seen within red blood cells on blood smears.

With this diagnostic test, a drop of blood is smeared on a slide, stained with special dyes to make blood cells more visible, and examined under a microscope. During the chronic, cutaneous stage, the bacterium may be isolated from skin lesions.

Blood smears are typically negative during this second stage. However, the bacterium may be cultured from the blood and grown under controlled conditions in the laboratory, enabling identification of the causative microorganism.

In some cases, other laboratory studies may be used to help diagnose Carrion’s disease.

Serological testing is used to diagnose trench fever.

However, it is difficult to diagnose in the laboratory, especially with blood cultures, since results are often negative even when infection is present and growth often takes 20-40 days. Serological testing is the most cost-effective diagnostic tool in laboratory detection of bartonellosis when positive results are found.

However, as previously discussed, false negatives can occur, leading to undiagnosed, untreated patients when further testing is not performed.

Detection of IgG and IgM antibodies in blood serum to Bartonella henselae by Indirect Immunofluorescence Assays (IFA) is an accurate way to identify CSD.

Microscopic examination of

Giemsa-stained

bacilliformis in patients who may have Carrion’s disease. Other Bartonella species are visible only with silver stains (Warthin-Starry, Steiner, Dieterle), although they sometimes resist staining or are present in such low numbers as to not be detectable.

A polymerase chain reaction (PCR) test is a molecular technique used to detect specific genetic material in blood.

Because of the serological cross-reactivity between Bartonella species and other bacteria, PCR analysis of tissue and body fluid is the most specific diagnostic test, especially in identifying distinct genotypes among Bartonella species. Intradermal skin testing, using hypersensitivity reaction to B.

henselae antigen, is a test that is no longer used as more accurate testing is now available. Stains of biopsied tissue from lymph nodes examined microscopically may show small curved Gram-negative rods characteristic of B.

henselae , but this staining method is not a definitive diagnosis of CSD. PCR of lymph nodes and other tissues, when used in conjunction with DNA sequencing, allows for diagnostic confirmation of Bartonella spp.

Complications involving the liver and/or spleen are now identified more frequently with the use of improved serologic, PCR and diagnostic imaging tests. Abdominal imaging is an important diagnostic tool for patients with suspected hepatosplenic disease and who present with prolonged fever. Treatment Cat scratch disease typically subsides without any treatment, usually within 2 to 4 months.

Antipyretics (fever reducers) and analgesics may be administered as needed. Local heat may be applied to the involved lymph nodes. Cat scratch disease usually has a very good prognosis, with no long-term health effects.

If the affected lymph node produces pus (suppurates) and becomes large and/or painful, it may be necessary to drain the node.

Draining the pus through a needle (aspiration) is preferred over making an incision. Usually one aspiration is sufficient to relieve discomfort.

Antibiotics may be considered for severe or systemic disease.

Faster reduction of lymph node size has been demonstrated with a 5-day course of azithromycin. Other antibiotics that have been considered effective include rifampin, ciprofloxacin, gentamicin, and trimethoprim/sulfamethoxazole.

Bartonella henselae is generally resistant to penicillin, amoxicillin, and nafcillin.

Doxycycline and rifampin in combination are the preferred medications for treating neuroretinitis. Effective antibiotic therapy for the complication of endocarditis should include an aminoglycoside prescribed for a minimum of 2 weeks followed by doxycycline or ceftriaxone for 6 weeks.

The treatment of choice for Oroya fever is administration of the antibiotic chloramphenicol (due to frequent, intercurrent infection with Salmonella). Antibiotic therapy may rapidly treat acute febrile illness associated with Oroya fever.

Blood transfusions may be required to treat severe anemia. For antibiotic treatment of verruga peruana, rifampin and streptomycin are typically recommended. Other treatment for this disorder is symptomatic and supportive. Carrion’s disease may be prevented by avoiding the sandflies that transmit the bacterium to humans.

Insect repellents, bed nets, and long-acting insecticides can help prevent exposure to these insects.

Tetracycline-group antibiotics (doxycycline, tetracycline) are commonly used to treat trench fever.

Uncomplicated disease responds to doxycycline and gentamicin. Chloramphenicol is an amoxicillin throwing up alternative medication recommended when tetracycline usage is undesirable, such as in severe liver malfunction, kidney deficiency, in children under nine years and pregnant women.

Macrolides and ceftriaxone have also been effective.

A longer duration of treatment is recommended for immunocompromised patients and when the liver or other organs are involved.

In patients with AIDS and bacillary angiomatosis, the primary choices of antibiotics are erythromycin or doxycycline.

Doxycycline combined with rifampin is effective in patients with severe disease.

An extended treatment if often required in these cases. Though the course of the disease can be far more severe and potentially life-threatening for immunocompromised patients, these patients typically experience full resolution of disease with appropriate antibiotic use and management of complications. The response of immunocompromised patients to antibiotics is significantly more dramatic than immunocompetent patients. Some researchers believe that less virulent strains tend to infect immunocompromised patients and are perhaps more antibiotic responsive.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov.

government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office: Toll-free: (800) 411-1222 TTY: (866) 411-1010 Email: [email protected] For information about clinical trials sponsored by private sources, in the main,

contact

For more information about clinical trials conducted in Europe, contact: https://www.clinicaltrialsregister.eu/ Supporting Organizations.

Centers for Disease Control and Prevention 1600 Clifton Road NE Atlanta, GA 30333 Phone: (404) 639-3534 Toll-free: (800) 232-4636 Email: [email protected] Website: http://www.cdc.gov/ Genetic and Rare Diseases (GARD) Information Center PO Box 8126 Gaithersburg, MD 20898-8126 Phone: (301) 251-4925 Toll-free: (888) 205-2311 Website: http://rarediseases.info.nih.gov/GARD/ World Health Organization (WHO) Avenue Appia 20 Geneva 27, 1211 Switzerland Phone: 41227912111 Website: http://www.who.int/en/ References.

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Bartonella infection in immunocompromised hosts: immunology of vascular infection and vasoproliferation.

Development of a novel genus-specific real-time PCR assay for detection and differentiation of Bartonella species and genotypes.

Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient.

Bartonella henselae infection of prosthetic aortic valve associated with colitis.

Graveleau J, Grossi O, Lefebvre M, et al.Vertebral osteomyelitis: an unusual presentation of Bartonella henselae infection. Vector competence of the tick Ixodes ricinus for transmission of Bartonella birtlesii.

Mascarelli PE, Iredell JR, Maggi RG, Weinberg G, Breitschwerdt EB. Bartonella species bacteremia in two patients with epithelioid hemangioendothelioma. Billeter SA, Caceres AG, Gonzales-Hidalgo J, Luna-Caypo D, Kosoy MY. Molecular detection of Bartonella species in ticks from Peru. Bartonellosis: an emerging infectious disease of zoonotic importance to animals and human beings. Human coinfection with Bartonella henselae and two hemotropic mycoplasma variants resembling Mycoplasma ovis. Beyond cat scratch disease: widening spectrum of Bartonella henselae infection.

Vermeulen MJ, Herremans M, Verbakel H, Serological testing for Bartonella henselae infections in The Netherlands: clinical evaluation of immunofluorescence assay and ELISA. Vikram HR, Bacani AK, DeValeria PA, Cunningham SA, Cockerill FR 3rd. Bivalvular Bartonella henselae prosthetic valve endocarditis.

Brunt J, Guptill L, Kordick DL, Kudrak S, Lappin MR.