“Cat Got Your Wire?”: Bartonella henselae infection of ICD leads

Abstract

Background: Bartonellosis is a worldwide zoonosis, with a broad array of disease presentations, ranging from asymptomatic to severe life-threatening disease. Infectious endocarditis (IE) caused by Bartonella henselae (BH) and associated renal failure (RF) has been well described. However, there is an absence of literature describing the relationship between infection of implantable cardiac device (ICD) and BH. We describe two cases of ICD infections, associated with RF, confirmed to be caused by BH. Case Description: 61-year old female with an ICD presents for recurrent RF. Nine months prior, patient was diagnosed with biopsy-proven glomerulonephritis (GN) and treated with prednisone for presumed post-viral GN. She required temporary hemodialysis for 7 months. Later, the patient presented again with anuric RF necessitating urgent hemodialysis. Blood cultures remained negative. Echocardiography revealed vegetation on ICD lead. Upon extraction, BH was detected by PCR of the lead vegetation. BH IgG serum titer >1:024. Bartonella PCR in serum was negative. Patient confirmed exposure to domestic cats. Treatment with doxycycline and rifampin was associated with cure, but patient remains HD dependent. 59-year old immunocompromised female with ICD admitted for distributive shock and acute renal injury. Blood cultures were negative. Echocardiography revealed vegetation on her ICD lead. Upon extraction, PCR confirmed the presence of BH on the lead. BH IgG serum titer >1:024. Bartonella PCR in serum remains negative. Patient confirmed living with two domesticated cats, and presented with multiple scratches on her extremities. Treatment with doxycycline and rifampin was associated with cure. Renal function recovered. Discussion: These cases show importance of early diagnosis which can result in more favorable patient outcomes. Diagnosis is frequently delayed because of various presentations, as well as BH's unique microbiology, including its fastidious nature and the inability to be isolated by standard culture techniques. With Bartonella's propensity for autoaggregation with biofilm production, in an era of increasing utilization of ICDs, BH infection of ICD has a potential to become an emerging disease. Conclusion: In educating providers on this unusual presentation of a common infection, we hope to raise the index of suspicion and promote early detection with prompt intervention to optimize outcomes.