RESUMEN
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.
Asunto(s)
Angiomatosis Bacilar , Bartonella henselae , Bartonella quintana , Masculino , Humanos , Anciano , Angiomatosis Bacilar/diagnóstico , Angiomatosis Bacilar/tratamiento farmacológico , Angiomatosis Bacilar/complicaciones , Piel , Antibacterianos/uso terapéutico , Terapia de InmunosupresiónAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Síndrome de Inmunodeficiencia Adquirida , Angiomatosis Bacilar , Neoplasias Cutáneas , Humanos , Angiomatosis Bacilar/complicaciones , Angiomatosis Bacilar/diagnóstico , Angiomatosis Bacilar/patología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/patología , PacientesRESUMEN
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.
Asunto(s)
Angiomatosis Bacilar , Infecciones por Bartonella , Bartonella henselae , Bartonella , Infecciones por VIH , Trasplante de Riñón , Linfohistiocitosis Hemofagocítica , Peliosis Hepática , Angiomatosis Bacilar/complicaciones , Animales , Infecciones por Bartonella/complicaciones , Infecciones por Bartonella/diagnóstico , Infecciones por Bartonella/patología , Bartonella henselae/genética , Perros , Doxiciclina/uso terapéutico , Infecciones por VIH/complicaciones , Hepatomegalia/complicaciones , Inmunoglobulina G , Trasplante de Riñón/efectos adversos , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Masculino , Peliosis Hepática/complicaciones , Peliosis Hepática/patología , Peliosis Hepática/veterinaria , PrednisonaAsunto(s)
Angiomatosis Bacilar/complicaciones , Bartonella henselae/inmunología , Infecciones Bacterianas del Ojo/diagnóstico , Retinitis/etiología , Angiomatosis Bacilar/diagnóstico , Angiomatosis Bacilar/microbiología , Anticuerpos Antibacterianos/inmunología , Niño , Diagnóstico Diferencial , Infecciones Bacterianas del Ojo/microbiología , Humanos , Masculino , Retina/patología , Retinitis/diagnóstico , Retinitis/microbiologíaAsunto(s)
Angiomatosis Bacilar/complicaciones , Hemorragia Gastrointestinal/etiología , Enfermedades del Yeyuno/complicaciones , Angiomatosis Bacilar/diagnóstico , Angiomatosis Bacilar/cirugía , Biopsia , Endoscopía Capsular , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirugía , Humanos , Inmunohistoquímica , Enfermedades del Yeyuno/diagnóstico , Enfermedades del Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Angiomatosis Bacilar/complicaciones , Endocarditis Bacteriana/etiología , Anciano , Endocarditis Bacteriana/epidemiología , Femenino , Humanos , Laos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
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).
Asunto(s)
Angiomatosis Bacilar/veterinaria , Bartonella henselae , Enfermedades de los Perros/microbiología , Nódulos Pulmonares Múltiples/veterinaria , Angiomatosis Bacilar/complicaciones , Angiomatosis Bacilar/diagnóstico , Angiomatosis Bacilar/diagnóstico por imagen , Angiomatosis Bacilar/microbiología , Angiomatosis Bacilar/patología , Animales , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/patología , Perros , Femenino , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/etiología , Nódulos Pulmonares Múltiples/patología , Tomografía Computarizada por Rayos XAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Angiomatosis Bacilar/diagnóstico , Antibacterianos/uso terapéutico , Bartonella/aislamiento & purificación , Doxiciclina/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Angiomatosis Bacilar/complicaciones , Angiomatosis Bacilar/tratamiento farmacológico , Angiomatosis Bacilar/microbiología , Bartonella/genética , Biopsia , Recuento de Linfocito CD4 , ADN Espaciador Ribosómico/genética , Diagnóstico Diferencial , Cara/patología , Humanos , Masculino , Piel/patología , Resultado del TratamientoAsunto(s)
Angiomatosis Bacilar/complicaciones , Infecciones por VIH/complicaciones , Niño , Femenino , HumanosAsunto(s)
Angiomatosis Bacilar/veterinaria , Bartonella henselae , Colangitis/veterinaria , Hepatitis Animal/microbiología , Enfermedades de los Caballos/microbiología , Hígado/microbiología , Angiomatosis Bacilar/complicaciones , Angiomatosis Bacilar/patología , Animales , Colangitis/etiología , Colangitis/microbiología , Hepatitis Animal/etiología , Hepatitis Animal/patología , Enfermedades de los Caballos/patología , Caballos/microbiología , Hígado/patología , MasculinoAsunto(s)
Adenocarcinoma/patología , Angiomatosis Bacilar/patología , Infecciones por Bartonella/patología , Bartonella , Labio/patología , Neoplasias Pancreáticas/patología , Adenocarcinoma/microbiología , Anciano , Angiomatosis Bacilar/complicaciones , Angiomatosis Bacilar/tratamiento farmacológico , Angiomatosis Bacilar/microbiología , Antibacterianos/administración & dosificación , Infecciones por Bartonella/complicaciones , Infecciones por Bartonella/tratamiento farmacológico , Infecciones por Bartonella/microbiología , Eritromicina/administración & dosificación , Femenino , Humanos , Labio/microbiología , Neoplasias Pancreáticas/microbiologíaRESUMEN
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.
Asunto(s)
Angiomatosis Bacilar/diagnóstico , Bartonella henselae/aislamiento & purificación , Trastornos del Conocimiento/diagnóstico , Picaduras de Arañas/complicaciones , Angiomatosis Bacilar/complicaciones , Animales , Niño , Preescolar , Trastornos del Conocimiento/etiología , Salud de la Familia , Femenino , Humanos , Masculino , Arañas/microbiologíaAsunto(s)
Aneurisma Infectado/microbiología , Angiomatosis Bacilar/complicaciones , Endocarditis Bacteriana/complicaciones , Glomerulonefritis/microbiología , Anciano , Aneurisma Infectado/sangre , Angiomatosis Bacilar/sangre , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Progresión de la Enfermedad , Endocarditis Bacteriana/sangre , Femenino , Glomerulonefritis/sangre , Humanos , Factores de TiempoAsunto(s)
Angiomatosis Bacilar/microbiología , Bartonella henselae/aislamiento & purificación , Enfermedades del Colon/microbiología , Úlcera Duodenal/microbiología , Enfermedades Gastrointestinales/microbiología , Úlcera/microbiología , Angiomatosis Bacilar/complicaciones , Angiomatosis Bacilar/tratamiento farmacológico , Angiomatosis Bacilar/patología , Antibacterianos/uso terapéutico , Biopsia , Enfermedades del Colon/tratamiento farmacológico , Enfermedades del Colon/patología , Colonoscopía , Úlcera Duodenal/tratamiento farmacológico , Úlcera Duodenal/patología , Femenino , Enfermedades Gastrointestinales/tratamiento farmacológico , Enfermedades Gastrointestinales/patología , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Resultado del Tratamiento , Úlcera/tratamiento farmacológico , Úlcera/patologíaRESUMEN
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.
Asunto(s)
Angiomatosis Bacilar/complicaciones , Bartonella , Enfermedad por Rasguño de Gato/complicaciones , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/patología , Fiebre de las Trincheras/complicaciones , Animales , Bartonella/clasificación , Bartonella/genética , Bartonella/aislamiento & purificación , Bartonella bacilliformis/clasificación , Bartonella bacilliformis/genética , Bartonella bacilliformis/aislamiento & purificación , Bartonella henselae/clasificación , Bartonella henselae/genética , Bartonella henselae/aislamiento & purificación , Bartonella quintana/clasificación , Bartonella quintana/genética , Bartonella quintana/aislamiento & purificación , Gatos , Bovinos , Perros , Humanos , Masculino , Ratones , Conejos , RatasRESUMEN
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.
Asunto(s)
Angiomatosis Bacilar/veterinaria , Bartonella henselae , Enfermedades de los Gatos/etiología , Peliosis Hepática/veterinaria , Angiomatosis Bacilar/complicaciones , Angiomatosis Bacilar/microbiología , Animales , Antígenos Bacterianos/inmunología , Bartonella henselae/genética , Enfermedades de los Gatos/patología , Gatos , ADN Bacteriano/genética , Perros , Humanos , Hígado/patología , Peliosis Hepática/etiología , Peliosis Hepática/patología , Reacción en Cadena de la PolimerasaRESUMEN
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.