Donor-Derived Disseminated Bartonella Infection After Renal Transplant
Bibliographic record
Abstract
Introduction: Bacillary angiomatosis is a manifestation of the rare infection caused by Bartonella quintana, with disseminated or chronic relapsing infection occurring most often in the immunocompromised. This organism is usually transmitted between hosts via the human body louse. Donor related infection is rare and screening is not routine. Those infected commonly complain of fever, headache, joint pain or weakness. Diagnosis is challenging as typical serologic testing may be negative in the immunocompromised. Case Description: A 59 year-old male with CKD secondary to biopsy proven lambda light chain AL amyloidosis underwent a deceased donor renal transplant. He received induction immunosuppression with Basiliximab and continued on standard immunosuppression, achieving good graft function, with creatinine 1800mg/dL. The patient did not encounter clinical rejection. His background medical history was significant for amyloidosis, with disease quiescence confirmed on bone marrow aspirate and trephine biopsy pre-transplant. He had travelled extensively, had secure housing and owned a dog and chickens with no other animal exposures. Over the next several months, the patient presented with recurrent episodes of profound fatigue, weakness, headaches and occasional fever with a septic appearance on clinical examination and associated leukocytosis. Broad microbiological work-up was negative. This included serology for Bartonella species. Six months after his original presentation, the patient described small cherry red lesions on his thigh, arm and buccal mucosa. Biopsy identified bacillary angiomatosis. Warthin-Starry stains were negative, but B. quintana was confirmed on PCR. Serology later returned a positive result. He was treated for disseminated infection with doxycycline 100mg BID. Rifampicin was not used due to interaction with immunosuppressants. Subsequent testing of donor serum confirmed the presence of B.quintana antibodies. On follow-up, the patient demonstrated improvement with resolving symptoms and lesions. Discussion: This case highlights the challenges inherent in atypical donor derived infections. Patient serology was uninformative, being initially negative after several months of symptoms and became positive much later. Given the prolonged period of infection and the inherent difficulties in diagnosis, reviewing risk factors for infection in the donor may have been useful.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".