An unexpected case of Bartonella alsatica prosthetic vascular graft infection

Abstract

Mathilde Puges,1 Armelle Ménard,2,3 Xavier Berard,4 Magalie Geneviève,5 Jean-Baptiste Pinaquy,6 Sophie Edouard,7 Sabine Pereyre,3,8 Charles Cazanave1,81Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Bordeaux, F-33000, France; 2Unité Mixte de Recherche 1053 Bordeaux Research in Translational Oncology, BordeAux Research In Translational Oncology, University Bordeaux, Institut National de la Santé et de la Recherche Médicale, F-33076, France; 3Service de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Bordeaux, F-33000, France; 4Service de Chirurgie Vasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Bordeaux, F-33000, France; 5Service de Néphrologie, Polyclinique Francheville, Périgueux, F-24000, France; 6Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Bordeaux, Hôpital du Haut-Lévêque, Pessac, F-33600, France; 7IHU Méditerranée-Infection, Unité Mixte de Recherche Microbes Evolution Phylogeny and Infections, Aix-Marseille Université, Institut de Recherche et Développement, Assistance Publique - Hôpitaux de Marseille, Marseille, France; 8University Bordeaux, Institut National de la Recherche Agronomique, Unité Sous Contrat Equipe D’accueil 3671, Mycoplasma and Chlamydia Infections in Humans, Bordeaux, F-33000, FranceAbstract: Bartonella alsatica is a wild rabbit pathogen causing bacteremia rarely reported in humans, with only three cases published so far, including one lymphadenitis and two endocarditis cases. Here, we report the case of a 66-year-old man who suffered from acute renal failure due to a membranoproliferative glomerulonephritis. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) showed diffuse FDG uptake around the aortobifemoral graft with no indication of infection. A white blood cell scan showed an accumulation of labeled neutrophils on the left femoral part of the graft. The patient underwent surgery and an abscess around the left iliac part of the graft was found intraoperatively. Intraoperative samples were all negative, but 16S rRNA gene-based PCR was positive, and the sequence was positioned among the Bartonella species cluster. Specific PCRs targeting groEL/hsp60, rpoB and gltA genes were performed and led to the identification of B. alsatica. Accordingly, indirect immunofluorescence serological analyses were positive for Bartonella henselae and Bartonella quintana. The patient had a history of regularly hunting wild rabbits. He was treated with 100 mg of doxycycline twice a day for six months and his renal function significantly improved with no sign of persistent infection. This case highlights the contribution of serology assays and molecular-based methods in prosthetic vascular graft infection diagnosis.Keywords: vascular graft infection, Bartonella alsatica, 16S rRNA PCR, membranoproliferative glomerulonephritis

Keywords

• vascular graft infection
• Bartonella alsatica
• 16S RNA PCR
• membranoproliferative glomerulonephritis