1 - Unidade de Infeciologia, Área da Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
2 - Departamento de doenças infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Águas de Moura, Portugal
- Publicação de E-poster e sob a forma de resumo na 42nd ESPID, Copenhagen, May 2024
Resumo:
AIM To characterise bone and joint Bartonella spp. infections requiring hospitalization
METHODS Longitudinal observational retrospective data analysis of children and adolescents admitted with bone and joint bartonellosis (BJB) at a paediatric tertiary hospital from 2010 to 2023.
RESULTS We identified 21 patients, 17 with atypical presentation, of which 10 with BJB. Overall, the mean age was 8,6±4,5 years old and 19 had contact with cats. Patients with BJB presented with pain (n=10), fever (n=9), lymphadenopathy (n=7) and torticollis (n=2). The affected areas were vertebral spine (n=6), sacroiliac joint (n=3), sternoclavicular joint (n=1) and tibiotarsal joint (n=1). One patient had multifocal involvement. Two children had concomitant hepatosplenic microabscesses. Clinical diagnosis was confirmed by serology in all BJB patients (n=10) and additionally Bartonella DNA detection in one patient´s lymph node/hepatic lesion (n=1) specimen. All patients were treated with different antibiotic schemes: azithromycin (n=1); cotrimoxazole plus gentamicin (n=1); rifampicin plus azithromycin (n=2), cefuroxime (n=1), ciprofloxacin (n=3) or doxycycline (n=2). The median duration of treatment was 42 days [5,70]. At follow-up clinical remission was observed in all patients with radiologic improvement. Three patients’ cats were screened for Bartonella and treated when infected (n=2).
TAKE HOME MESSAGES BJB is rare but should be considered when bone pain and fever are present in patients with cat exposure, hepatosplenic abscesses or lymphadenopathy. Serological and/or molecular methods is essential to confirm diagnosis. Doxycycline plus rifampicin is an acceptable treatment regimen in severe bone disease. Favourable outcome plus seroconversion allows for conservative approach without the need for bone biopsy.
Palavras Chave: Bartonella infection; bartonellosis; bone and joint infection; fever of unknown origin; osteomyelitis;