RESUMO
Cutaneous bacillary angiomatosis (cBA) is a vascular proliferative disorder due to Bartonella henselae or Bartonella quintana that has been mostly described in people living with HIV. Since cBA is considered to be rare in hosts not affected by major immunosuppression, it could be underdiagnosed in this population. Moreover, antimicrobial treatment of cBA has been poorly validated, thus reporting experiences on this clinical entity is important. We reported a challenging and well-characterized case of an Italian 67-year-old gentleman without a history of major immunocompromizing conditions, although he was affected by conditions that can be associated with impaired immune function. The patient reported herein was diagnosed after a long time since the initiation of symptoms and was successfully treated with combined antibiotic therapy including macrolides and quinolones under the guidance of molecular test results. Physicians should consider cBA as a possible manifestation of Bartonella spp. Infection in patients not suffering from major immunocompromizing conditions. Until evidence-based guidelines are available, molecular tests together with severity and extension of the disease can be useful to personalize the type of treatment and its duration.
Assuntos
Angiomatose Bacilar , Bartonella henselae , Bartonella quintana , Masculino , Humanos , Idoso , Angiomatose Bacilar/diagnóstico , Angiomatose Bacilar/tratamento farmacológico , Angiomatose Bacilar/complicações , Pele , Antibacterianos/uso terapêutico , Terapia de ImunossupressãoAssuntos
Infecções Oportunistas Relacionadas com a AIDS , Síndrome da Imunodeficiência Adquirida , Angiomatose Bacilar , Neoplasias Cutâneas , Humanos , Angiomatose Bacilar/complicações , Angiomatose Bacilar/diagnóstico , Angiomatose Bacilar/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Infecções Oportunistas Relacionadas com a AIDS/patologia , PacientesRESUMO
Bacillary peliosis hepatis is a well recognised manifestation of disseminated Bartonella henselae infection that can occur in immunocompromised individuals. Haemophagocytic lymphohistiocytosis is an immune-mediated condition with features that can overlap with a severe primary infection such as disseminated Bartonella spp infection. We report a case of bacillary peliosis hepatis and secondary haemophagocytic lymphohistiocytosis due to disseminated Bartonella spp infection in a kidney-transplant recipient with well controlled HIV. The patient reported 2 weeks of fever and abdominal pain and was found to have hepatomegaly. He recalled exposure to a sick dog but reported no cat exposures. Laboratory evaluation was notable for pancytopenia and cholestatic injury. The patient met more than five of eight clinical criteria for haemophagocytic lymphohistiocytosis. Pathology review of a bone marrow core biopsy identified haemophagocytosis. A transjugular liver biopsy was done, and histopathology review identified peliosis hepatis. Warthin-Starry staining of the bone marrow showed pleiomorphic coccobacillary organisms. The B henselae IgG titre was 1:512, and Bartonella-specific DNA targets were detected by peripheral blood PCR. Treatment with doxycycline, increased prednisone, and pausing the mycophenolate component of his transplant immunosuppression regimen resulted in an excellent clinical response. Secondary haemophagocytic lymphohistiocytosis can be difficult to distinguish from severe systemic infection. A high index of suspicion can support the diagnosis of systemic Bartonella spp infection in those who present with haemophagocytic lymphohistiocytosis, especially in patients with hepatomegaly, immunosuppression, and germane animal exposures.
Assuntos
Angiomatose Bacilar , Infecções por Bartonella , Bartonella henselae , Bartonella , Infecções por HIV , Transplante de Rim , Linfo-Histiocitose Hemofagocítica , Peliose Hepática , Angiomatose Bacilar/complicações , Animais , Infecções por Bartonella/complicações , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/patologia , Bartonella henselae/genética , Cães , Doxiciclina/uso terapêutico , Infecções por HIV/complicações , Hepatomegalia/complicações , Imunoglobulina G , Transplante de Rim/efeitos adversos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Masculino , Peliose Hepática/complicações , Peliose Hepática/patologia , Peliose Hepática/veterinária , PrednisonaAssuntos
Angiomatose Bacilar/complicações , Bartonella henselae/imunologia , Infecções Oculares Bacterianas/diagnóstico , Retinite/etiologia , Angiomatose Bacilar/diagnóstico , Angiomatose Bacilar/microbiologia , Anticorpos Antibacterianos/imunologia , Criança , Diagnóstico Diferencial , Infecções Oculares Bacterianas/microbiologia , Humanos , Masculino , Retina/patologia , Retinite/diagnóstico , Retinite/microbiologiaAssuntos
Angiomatose Bacilar/complicações , Hemorragia Gastrointestinal/etiologia , Doenças do Jejuno/complicações , Angiomatose Bacilar/diagnóstico , Angiomatose Bacilar/cirurgia , Biópsia , Endoscopia por Cápsula , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirurgia , Humanos , Imuno-Histoquímica , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos), probably because people have neglected to look. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective (2006-2012), and subsequent prospective study (2012-2013), at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged >1 year admitted with definite or possible endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae endocarditis. CONCLUSIONS/SIGNIFICANCE: We argue that it is likely that Bartonella endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella endocarditis are needed, as it is likely that proven Bartonella endocarditis can be treated with simpler and less expensive regimens than "conventional" endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for Bartonella endocarditis and the importance of vectors and vector control.
Assuntos
Angiomatose Bacilar/complicações , Endocardite Bacteriana/etiologia , Idoso , Endocardite Bacteriana/epidemiologia , Feminino , Humanos , Laos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
This report describes a 2-year-old collie dog with pulmonary nodules, visualized by computed tomographic (CT) scan, with evidence of Bartonella henselae bacteremia and pyogranulomatous lymphadenitis. Clinical signs resolved with antimicrobial therapy.
Lymphadénite pyogranulomateuse mandibulaire latérale et nodules pulmonaires chez un chien atteint de bactériémie àBartonella henselae. Ce rapport décrit un chien Collie âgé de 2 ans atteint de nodules pulmonaires, visualisés par tomodensitométrie, avec des signes de bactériémie à Bartonella henselae et de lymphadénite pyogranulomateuse. Les signes cliniques se sont résorbés avec un traitement antimicrobien.(Traduit par Isabelle Vallières).
Assuntos
Angiomatose Bacilar/veterinária , Bartonella henselae , Doenças do Cão/microbiologia , Nódulos Pulmonares Múltiplos/veterinária , Angiomatose Bacilar/complicações , Angiomatose Bacilar/diagnóstico , Angiomatose Bacilar/diagnóstico por imagem , Angiomatose Bacilar/microbiologia , Angiomatose Bacilar/patologia , Animais , Doenças do Cão/diagnóstico , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/patologia , Cães , Feminino , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulos Pulmonares Múltiplos/etiologia , Nódulos Pulmonares Múltiplos/patologia , Tomografia Computadorizada por Raios XAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Angiomatose Bacilar/diagnóstico , Antibacterianos/uso terapêutico , Bartonella/isolamento & purificação , Doxiciclina/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Angiomatose Bacilar/complicações , Angiomatose Bacilar/tratamento farmacológico , Angiomatose Bacilar/microbiologia , Bartonella/genética , Biópsia , Contagem de Linfócito CD4 , DNA Espaçador Ribossômico/genética , Diagnóstico Diferencial , Face/patologia , Humanos , Masculino , Pele/patologia , Resultado do TratamentoAssuntos
Angiomatose Bacilar/complicações , Infecções por HIV/complicações , Criança , Feminino , HumanosAssuntos
Angiomatose Bacilar/veterinária , Bartonella henselae , Colangite/veterinária , Hepatite Animal/microbiologia , Doenças dos Cavalos/microbiologia , Fígado/microbiologia , Angiomatose Bacilar/complicações , Angiomatose Bacilar/patologia , Animais , Colangite/etiologia , Colangite/microbiologia , Hepatite Animal/etiologia , Hepatite Animal/patologia , Doenças dos Cavalos/patologia , Cavalos/microbiologia , Fígado/patologia , MasculinoAssuntos
Adenocarcinoma/patologia , Angiomatose Bacilar/patologia , Infecções por Bartonella/patologia , Bartonella , Lábio/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma/microbiologia , Idoso , Angiomatose Bacilar/complicações , Angiomatose Bacilar/tratamento farmacológico , Angiomatose Bacilar/microbiologia , Antibacterianos/administração & dosagem , Infecções por Bartonella/complicações , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/microbiologia , Eritromicina/administração & dosagem , Feminino , Humanos , Lábio/microbiologia , Neoplasias Pancreáticas/microbiologiaRESUMO
BACKGROUND: Bartonella species comprise a group of zoonotic pathogens that are usually acquired by vector transmission or by animal bites or scratches. METHODS: PCR targeting the Bartonella 16S-23S intergenic spacer (ITS) region was used in conjunction with BAPGM (Bartonella alpha Proteobacteria growth medium) enrichment blood culture to determine the infection status of the family members and to amplify DNA from spiders and woodlice. Antibody titers to B. vinsonii subsp. berkhoffii (Bvb) genotypes I-III, B. henselae (Bh) and B. koehlerae (Bk) were determined using an IFA test. Management of the medical problems reported by these patients was provided by their respective physicians. RESULTS: In this investigation, immediately prior to the onset of symptoms two children in a family experienced puncture-like skin lesions after exposure to and presumptive bites from woodlouse hunter spiders. Shortly thereafter, the mother and both children developed hive-like lesions. Over the ensuing months, the youngest son was diagnosed with Guillain-Barre (GBS) syndrome followed by Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). The older son developed intermittent disorientation and irritability, and the mother experienced fatigue, headaches, joint pain and memory loss. When tested approximately three years after the woodlouse hunter spider infestation, all three family members were Bartonella henselae seroreactive and B. henselae DNA was amplified and sequenced from blood, serum or Bartonella alpha-proteobacteria (BAPGM) enrichment blood cultures from the mother and oldest son. Also, B. henselae DNA was PCR amplified and sequenced from a woodlouse and from woodlouse hunter spiders collected adjacent to the family's home. CONCLUSIONS: Although it was not possible to determine whether the family's B. henselae infections were acquired by spider bites or whether the spiders and woodlice were merely accidental hosts, physicians should consider the possibility that B. henselae represents an antecedent infection for GBS, CIDP, and non-specific neurocognitive abnormalities.
Assuntos
Angiomatose Bacilar/diagnóstico , Bartonella henselae/isolamento & purificação , Transtornos Cognitivos/diagnóstico , Picada de Aranha/complicações , Angiomatose Bacilar/complicações , Animais , Criança , Pré-Escolar , Transtornos Cognitivos/etiologia , Saúde da Família , Feminino , Humanos , Masculino , Aranhas/microbiologiaAssuntos
Aneurisma Infectado/microbiologia , Angiomatose Bacilar/complicações , Endocardite Bacteriana/complicações , Glomerulonefrite/microbiologia , Idoso , Aneurisma Infectado/sangue , Angiomatose Bacilar/sangue , Anticorpos Anticitoplasma de Neutrófilos/sangue , Progressão da Doença , Endocardite Bacteriana/sangue , Feminino , Glomerulonefrite/sangue , Humanos , Fatores de TempoAssuntos
Angiomatose Bacilar/microbiologia , Bartonella henselae/isolamento & purificação , Doenças do Colo/microbiologia , Úlcera Duodenal/microbiologia , Gastroenteropatias/microbiologia , Úlcera/microbiologia , Angiomatose Bacilar/complicações , Angiomatose Bacilar/tratamento farmacológico , Angiomatose Bacilar/patologia , Antibacterianos/uso terapêutico , Biópsia , Doenças do Colo/tratamento farmacológico , Doenças do Colo/patologia , Colonoscopia , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/patologia , Feminino , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/patologia , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Resultado do Tratamento , Úlcera/tratamento farmacológico , Úlcera/patologiaRESUMO
The genus Bartonella is composed of a series of species and subspecies. Ten of them are responsible for human infections. The best-identified diseases are cat scratch disease (B henselae and possibly B clarridgeiae), trench fever (B quintana), bacillary angiomatosis (B quintana and B henselae), and the spectrum of verruga peruana, Carrion disease, and Oroya fever (B bacilliformis). Controversies exist about the implication of a few other microorganisms being involved in these diseases. Several other conditions have been associated with the presence of Bartonella spp, but these observations await confirmation.
Assuntos
Angiomatose Bacilar/complicações , Bartonella , Doença da Arranhadura de Gato/complicações , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/patologia , Febre das Trincheiras/complicações , Animais , Bartonella/classificação , Bartonella/genética , Bartonella/isolamento & purificação , Bartonella bacilliformis/classificação , Bartonella bacilliformis/genética , Bartonella bacilliformis/isolamento & purificação , Bartonella henselae/classificação , Bartonella henselae/genética , Bartonella henselae/isolamento & purificação , Bartonella quintana/classificação , Bartonella quintana/genética , Bartonella quintana/isolamento & purificação , Gatos , Bovinos , Cães , Humanos , Masculino , Camundongos , Coelhos , RatosRESUMO
Peliosis hepatis is a vasculoproliferative disorder of the liver with infectious and noninfectious causes. In humans and dogs, Bartonella henselae has been linked to peliosis hepatis. Although domestic cats are the natural reservoir of B. henselae and although peliosis hepatis is common in this species, an association between this condition and infection with B. henselae has never been investigated in cats. In this study, 26 cases of peliosis hepatis in cats were tested for B. henselae infection by nested polymerase chain reaction and immunohistochemistry. The authors failed to detect B. henselae nucleic acid or antigen in any of the affected liver specimens. These findings suggest that, unlike in humans and dogs, peliosis hepatis in cats may not be significantly associated with a B. henselae infection.
Assuntos
Angiomatose Bacilar/veterinária , Bartonella henselae , Doenças do Gato/etiologia , Peliose Hepática/veterinária , Angiomatose Bacilar/complicações , Angiomatose Bacilar/microbiologia , Animais , Antígenos de Bactérias/imunologia , Bartonella henselae/genética , Doenças do Gato/patologia , Gatos , DNA Bacteriano/genética , Cães , Humanos , Fígado/patologia , Peliose Hepática/etiologia , Peliose Hepática/patologia , Reação em Cadeia da PolimeraseRESUMO
We report a case of severe aortic bicuspid valve endocarditis, revealed by global cardiac failure without fever, in a 38-year-old man who had developed cerebral mycotic aneurysms nine months earlier. PCR analysis of the excised aortic valve and serological tests (even 9 months earlier) were positive for Bartonella henselae. A combination of intravenous then oral doxycyclin at 200mg/day and intravenous gentamycin at 90mg/day was given for 6 and 2 weeks respectively. The evolution was favorable on follow-up, 12 months after completion of the therapy. Only 49 cases of B. henselae endocarditis have been reported to date, none with associated mycotic aneurysm but most often located on the bicuspid aortic valve, and usually with severe valvular damage due to late diagnosis.