Culture, PCR, DNA sequencing, and second harmonic generation (SHG) visualization of Bartonella henselae from a surgically excised human femoral head
63-year-old veterinarian was diagnosed at age 8 with Cat Scratch Disease (CSD; acute #Bartonella henselae infection). Over the course of her life, in which she had a lot of exposure to cats, she developed a bull's eye rash twice, cardiac arrhythmias and palpitations, muscle and skeletal pain, uterine (endometrial) cancer, hyperparathyroidism, osteoarthritis in wrist and hip, emergency appendectomy, and hip joint pain.
Galaxy Diagnostic's testing and enriched cultures (BAPGM ePCR) of her blood revealed antibodies and the presence of Bartonella bacteria DNA.
Due to severe, end stage degenerative osteoarthritis, she had hip replacement surgery. After the operation, part of the excised hip joint was examined for infection- it was Bartonella henselae PCR positive. Microscopy revealed that B. henselae was more abundant in the spongy vs. the compact bone. "Assuming that her B. henselae infection persisted between the timing of her blood culture, surgery, and femoral head cultures, she remained infected for at least 108 days."
"B. henselae has been implicated as a cause of osteomyelitis [bone infection] of the hip joint acetabulum in two adult males and localized or generalized osteolytic lesions [areas of bone loss] in children, which are considered atypical or systemic manifestations of CSD." One study found that years following CSD diagnosis, a subset of patients develop arthritis or other musculoskeletal abnormalities.
Authors of this study, including Galaxy employees, suggest that patients with asymmetrical or atypical osteoarthritis should have their history examined for risk factors for Bartonella species (such as cat exposure) and be considered for diagnostic testing.
https://www.ncbi.nlm.nih.gov/pubmed/28028681