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Pseudoinfectious mononucleosis: a presentation of Bartonella henselae infection
F Massei1, F Messina, M Massimetti
1Dipartimento di Medicina della Procreazione e dell'Età Evolutiva, Università di Pisa, Via Roma 67, 56100 Pisa, Italy.
Insights
Bartonella henselae infections mimic infectious mononucleosis in children. Diagnosis requires specific serology, as common viral tests are negative. All affected children recovered without specific treatment after kitten exposure.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Immunology
Background:
- Infectious mononucleosis is a common childhood illness with characteristic clinical and laboratory findings.
- Differential diagnosis is crucial, especially when atypical laboratory results are observed.
- Several pathogens can cause mononucleosis-like syndromes, necessitating broad diagnostic considerations.
Purpose of the Study:
- To investigate the cause of a mononucleosis-like illness in children with unusual laboratory findings.
- To identify the role of Bartonella henselae in pediatric infectious mononucleosis mimics.
- To evaluate diagnostic approaches for Bartonella henselae infections in children.
Main Methods:
- Retrospective case series of six children presenting with symptoms of infectious mononucleosis over one year.
- Clinical data collection including symptoms, physical examination, and laboratory results (leukocyte count, ESR, immunoglobulin levels).
- Serological testing for common infectious agents including Epstein-Barr virus, cytomegalovirus, adenovirus, Toxoplasma gondii, and Bartonella henselae.
Main Results:
- All six children exhibited leukocytosis with neutrophilia, elevated erythrocyte sedimentation rate, and hypergammaglobulinemia.
- Serology for Epstein-Barr virus, cytomegalovirus, adenovirus, and Toxoplasma gondii was negative in all cases.
- All children tested positive for anti-Bartonella henselae IgM and high IgG titers (>=1/1024) and had a history of contact with kittens.
Conclusions:
- Bartonella henselae infection should be considered in the differential diagnosis of pediatric infectious mononucleosis, especially with atypical laboratory findings.
- Kitten exposure is a significant risk factor for Bartonella henselae infection presenting as a mononucleosis-like illness.
- Children with Bartonella henselae infection mimicking mononucleosis typically recover spontaneously without specific antimicrobial therapy.
Abstract:
Six children presented during one year with clinical features of infectious mononucleosis, but with laboratory findings of leucocytosis with neutrophilia, increased erythrocyte sedimentation rate, and hypergammaglobulinaemia. Serology for Epstein-Barr virus, cytomegalovirus, adenovirus, and Toxoplasma gondii was negative, while anti-Bartonella henselae IgM with high IgG titre (>/=1/1024) was present in all. All children had contact with kittens. No specific treatment was administered and all recovered.