SHM Converge Scientific Abstract ePoster Gallery-Cognitive Bias Behind "Flu-Like" Symptoms: Bartonella Quintana Bacteremia Case Report

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This case report describes a 35-year-old man with homelessness and methamphetamine use who repeatedly presented to the ED with vague “flu-like” symptoms, including chills, headache, congestion, abdominal pain, nausea, vomiting, and later fever/hallucinations. Because his labs were often unremarkable and he had a positive influenza B test during one visit, his symptoms were initially attributed to viral illness, nonspecific syndromes, or sympathomimetic toxicity. However, chart review later revealed a prior untreated history of Bartonella quintana infection, which was not consistently recognized across encounters.<br /><br />The report emphasizes how cognitive bias and premature closure can delay diagnosis of serious infection, especially when symptoms are nonspecific. Bartonella quintana is a fastidious gram-negative rod transmitted by lice and is associated with homelessness and alcoholism. It can cause bacteremia, endocarditis, or bacillary angiomatosis. Diagnosis is difficult because culture is slow and requires prolonged incubation; serology and PCR may help, but results can be variable.<br /><br />In this patient, blood cultures eventually grew B. quintana one month after collection, confirming bacteremia. Serology later showed negative IgG but strongly positive IgM, supporting recent or active infection. He was treated with gentamicin and doxycycline, with plans for extended doxycycline therapy, and underwent echocardiographic evaluation for endocarditis, which was negative. Unfortunately, he was lost to follow-up.<br /><br />The key lesson is that clinicians should maintain high suspicion for B. quintana in patients with relevant risk factors and recurrent nonspecific symptoms. Thorough chart review and electronic medical record awareness can reduce missed diagnoses, prevent repeated ED visits, and improve care.

Asset Subtitle

Cortland C. Vis

Meta Tag

Author List Cortland C. Vis

Category Clinical Vignettes

Concept Bartonella quintana infection

Concept Diagnosis

Concept Premature Closure

Concept Bacteremia

Concept Prolonged incubation

Distinguished Non-Finalist

Presenter Organization University of Colorado Hospital

Presenting Author Cortland C. Vis

Track Adult

Keywords

Bartonella quintana

homelessness

methamphetamine use

flu-like symptoms

bacteremia

endocarditis

cognitive bias

premature closure

blood cultures

doxycycline gentamicin

Bartonella quintana infection

Diagnosis

Premature Closure

Bacteremia

Prolonged incubation