Bartonellosis, One Health and all creatures great and small.

BACKGROUND: Bartonellosis is a zoonotic infectious disease of worldwide distribution, caused by an expanding number of recently discovered Bartonella spp. OBJECTIVES: This review serves as an update on comparative medical aspects of this disease, including the epidemiology, pathogenesis, clinical diagnosis, treatment and challenges. RESULTS: Of comparative medical importance, Bartonella spp. are transmitted by several arthropod vectors, including fleas, keds, lice, sand flies, ticks and, potentially, mites and spiders. Prior to 1990, there was only one named Bartonella species (B. bacilliformis), whereas there are now over 36, of which 17 have been associated with an expanding spectrum of animal and human diseases. Recent advances in diagnostic techniques have facilitated documentation of chronic bloodstream and dermatological infections with Bartonella spp. in healthy and sick animals, in human blood donors, and in immunocompetent and immunocompromised human patients. The field of Bartonella research remains in its infancy and is rich in questions, for which patient relevant answers are badly needed. Directed Bartonella research could substantially reduce a spectrum of chronic and debilitating animal and human diseases, and thereby reduce suffering throughout the world. CONCLUSION: A One Health approach to this emerging infectious disease is clearly needed to define disease manifestations, to establish the comparative infectious disease pathogenesis of this stealth pathogen, to validate effective treatment regimens and to prevent zoonotic disease transmission.

Bartonella henselae prosthetic valve endocarditis in an adult patient with congenital heart disease: favorable outcome after combined medical and surgical management.

Bartonella spp. are a known cause of culture-negative endocarditis. We report a 42-year-old male with underlying surgically corrected congenital heart disease who was diagnosed with Bartonella henselae endocarditis involving the right-ventricle-to-pulmonary-artery conduit.

[Current state of the knowledge of Bartonella infections]. / Wspólczesna wiedza o zakazeniach wywolywanych przez paleczki Bartonella.

Bartonella spp. are gram-negative bacteria localized in erythrocytes of vertebrate hosts. Genus Bartonella contains numerous recently described species, many of them are new and emerging arthropod-borne human pathogens. In addition to humans, Bartonella spp. have also been isolated from a variety of domesticated (cats, dogs) and wild animals (carnivores, ruminants, rodents), which play a key role as reservoir hosts for these pathogens. The infectious process and the pathogenesis of bartonellosis are still poorly understood. The present paper reviews the factors influencing Bartonella infections including a range of reservoir hosts and vectors, mechanism of phatogenesis, diagnostic methods for indentification Bartonella infections in humans and animals as well as the coinfection with Bartonella and other arthropod-borne pathogens.

[Cat scratch disease and other human infections caused by Bartonella species]. / Maladie des griffes du chat et autres bartonelloses.

The different Bartonella species can cause various human infections such as cat scratch disease, chronic bacteremia (homeless patient with nonspecific symptom), endocarditis, bacillary angiomatosis, peliosis, and Carrion's disease. Diagnostic approaches include serology, culture and molecular approaches. PCR is especially useful on lymph nodes biopsies from patients with cat-scratch disease and on valvular samples taken from culture-negative endocarditis. Serology exhibits a very high sensitivity in the latter situation. The treatment should be chosen according to the clinical presentation.

Bartonellosis. New and old.

The number of species that comprise the family of Bartonellaceae, genus Bartonella, has recently increased from one to 11 species, five of which have been associated with different diseases and syndromes in humans. The rapidly growing number of human pathogens has led several investigators to regard bartonellosis and other associated syndromes as important emerging infectious diseases. This article presents the history and epidemiology, clinical features, diagnosis, and treatment of bartonellosis and associated diseases, including Carrión's disease, trench fever, endocarditis and bacteremia, bacillary angiomatosis, and cat-scratch disease.

Bartonellosis and human immunodeficiency disease (AIDS): L-forms as persisters, activating factors, and mechanism of disease.

Bartonella, genus Proteus, can cause immunodepressive disease. The organisms, in parasitized red blood cells, may invade the brain and every other system and space in the human body. Bartonella henselae is proposed to have a role in the pathogenesis of acquired immunodeficiency syndrome (AIDS) encephalopathy. Bartonella bacilliformis produces two known toxins that can induce spasm and angiomatosis, respectively, and manifest as diseases associated with symptomatic AIDS. The skin lesions of bartonellosis may be mistaken clinically and histologically for Kaposi's sarcoma. Bacteria of the genus Proteus produce L-forms: their elementary bodies may be mistaken for what are called the 'human immunodeficiency viruses' (HIV). Antibiotics, especially penicillin, induce bacteria to produce L-forms. Air pollution and high sugar, salt and fat diets are factors that may increase the lipid content of microbes that produce toxins and L-forms that may persist or revert to bacterial form.

Bartonellosis.

The role of Bartonella species as pathogens in dogs and cats is being defined. Diagnosis and treatment of Bartonella infections of dogs and cats remain challenging. As new information regarding Bartonella infections of companion animals becomes available, the understanding of the pathogenesis of these infections will improve. Most Bartonella species infecting dogs and cats are zoonotic, with B henselae the most important zoonotic species. B henselae bacteremia is common in domestic cats, and cats transmit B henselae to people. Transmission of Bartonella infections among cats and dogs is believed to occur primarily by way of arthropod vectors. Control of arthropod vectors and avoiding interactions with pets that result in scratches or bites are the most effective means to prevent transmission between animals and people.

[Bartonelloses]. / Bartonelózy.

Bartonellae belong to less known causal agents of many human diseases. They are gram-negative bacteria growing slowly on culture media enriched with hemin or bovine serum. The genus Bartonella, which currently involves more than 15 species, is present worldwide. Bartonellae live in natural foci in dependence on the occurrence of natural host (rodents, felines, canidae, human) and insect vector (flea, tick, louse). By reservoir animals they usually cause permanent intraerythrocytic bacteraemia without system inflammation symptoms. A classical example of a human disease is cat scratch disease (CSD) caused by Bartonella henselae and characterised by regional lymphagoitis and lymphadenitis. Increasing interest is being devoted to the ability of Bartonella sp. (e.i. B. quintana) to cause the opportune infections with diverse clinical manifestation: bacillary angiomatosis, specific liver and spleen vasculitis (peliosis hepatis, splenis), endocarditis and others. The issue of Bartonella infections is relatively new and its importance is still growing with increasing knowledge in this field.

[Bartonellosis: emerging infection]. / Les bartonelloses, maladies infectieuses emergentes.

The spectrum of Bartonella infections in humans shows a constant increase. The number of Bartonella species responsible of zoonoses has increased from one to 7 during the past ten years. In addition numerous orphan clinical manifestations are now associated to Bartonella henselae infections. Animals and particularly domestic cat are the main reservoirs of Bartonella. Cats are healthy carriers of B. henselae and B. clarridgeiae, and can be bacteremic for months to years. Cat-to-cat transmission of the bacteria involves the cat flea in ab-sence of transmission by direct contact. Present knowledge on the etiology, clinical features and epidemiological characteristics of these emerging infections are presented.

Granulomatous inflammation masquerading as an infected urachal cyst.

Errors in urachal obliteration may result in 4 clinical anomalies: patent urachus, urachal cyst, urachal sinus, or vesicourachal diverticulum. Despite the fact that urachal cysts are one of the more common of these anomalies, most go undetected, presenting in the setting of infection. There are reports in the literature of cysts misdiagnosed as other inflammatory processes; however, the converse is reported with less frequency. We present the case of a 3-year-old girl who was admitted to our institution with a suspected urachal cyst. This was subsequently diagnosed as a granulomatous mass caused by the gram negative bacterium Bartonella.

Chronic Bartonellosis in cats: what are the potential implications?

PRACTICAL RELEVANCE: Bartonellae are small, vector-transmitted Gram-negative intracellular bacteria that are well adapted to one or more mammalian reservoir hosts. Cats are the natural reservoir for Bartonella henselae, which is a (re-)emerging bacterial pathogen. It can cause cat scratch disease in humans and, in immunocompromised people, may lead to severe systemic diseases, such as bacillary angiomatosis. Cats bacteraemic with B henselae constitute the main reservoir from which humans become infected. Most cats naturally infected with B henselae show no clinical signs themselves, but other Bartonella species for which cats are accidental hosts appear to have more pathogenicity. GLOBAL IMPORTANCE: Several studies have reported a prevalence of previous or current Bartonella species infection in cats of up to 36%. B henselae is common in cats worldwide, and bacteraemia can be documented by blood culture in about a quarter of healthy cats. The distribution of B henselae to various parts of the world has largely occurred through humans migrating with their pet cats. The pathogen is mainly transmitted from cat to cat by fleas, and the majority of infected cats derive from areas with high flea exposure. No significant difference in B henselae prevalence has been determined between male and female cats. In studies on both naturally and experimentally infected cats, chronic bacteraemia has mainly been found in cats under the age of 2 years, while those over 2 years of age are rarely chronically bacteraemic. EVIDENCE BASE: This article reviews published studies and case reports on bartonellosis to explore the clinical significance of the infection in cats and its impact on humans. The article also discusses possible treatment options for cats and means of minimising the zoonotic potential.

Aortic valve endocarditis with Bartonella quintana - a rare entity.

Endocarditis caused by Bartonella species is difficult to diagnose and still remains a rare entity. Therefore, a young male patient undergoing aortic valve replacement for culture-negative endocarditis is reported in whom the diagnosis of a Bartonella quintana infection was made with a great delay postoperatively.

Granulomatous hepatitis and necrotizing splenitis due to Bartonella henselae in a patient with cancer: case report and review of hepatosplenic manifestations of bartonella infection.

Bacillary angiomatosis and the related disorders of bacillary peliosis hepatis and bacillary splenitis are manifestations of infection with Bartonella henselae and Bartonella quintana in immunocompromised persons. B. henselae infection, but not B. quintana infection, is linked to contact with cats and is presumed to cause visceral cat-scratch disease. We reports a case of visceral infection by B. henselae in an adult patient with cancer who was receiving chemotherapy and had had no contact with a cat or dog. The patient--whose illness was eventually diagnosed on the basis of findings of histologic, polymerase chain reaction, and serological studies--was treated with doxycycline and rifampin, and the infection resolved. In addition, 41 cases of documented or suspected bartonella infection of the liver, spleen, or both in immunocompetent or immunocompromised hosts are reviewed.

Esquemas de tratamiento para la enfermedad de Carrión no complicada en la ciudad de Caraz, Perú / Treatment outlines for non-complicated Carrion's Disease, in Caraz, Peru

Objetivos: Describir el tratamiento para infección por Bartonella bacilliformis, en Caraz, Ancash. Diseño: Estudio observacional, transversal y retrospectivo. Lugar: Caraz, Ancash, Perú. Pacientes: Quinientos dieciocho pacientes. Intervenciones: Recolección de datos, entre enero 2004 y marzo 2005, por medio de historias clínicas realizadas en el Hospital de Caraz. Principales medidas de resultados: Esquemas de tratamiento para infección por Bartonella bacilliformis. Resultados: Se registró 248 pacientes en fase aguda. En 215 (86,7 por ciento), se indicó cloramfenicol para su tratamiento y en todos ellos no se registró la dosis de carga de 50 mg/kg, por 3 días; 164 (66,1 por ciento) pacientes necesitaron una dosis de cloramfenicol superior a 25 mg/kg. En fase eruptiva, se registró 270 pacientes; en 260 (96,3 por ciento) se indicó rifampicina y 222 (82,2 por ciento) sobrepasaron los 21 días de duración de tratamiento con dicho antibiótico. Cloramfenicol obtuvoun 89 por ciento de eficacia en curación clínica y rifampicina, 93,1 por ciento. Conclusiones: En la población estudiada, existió una marcada tendencia a aumentar la dosis de cloramfenicol e incrementar el número de días de tratamiento con rifampicina, en fase aguda y eruptiva, respectivamente, de la Enfermedad de Carrión.

Objectives: To describe Bartonella bacilliformis' infection treatment, in Caraz, Ancash. Design: Observational, transverse and retrospective study. Setting: Caraz, Ancash, Peru. Patients: Five hundred and eighteen patients. Interventions: Study of clinical histories data from January 2004 through March 2005 at Caraz Hospital. Main outcome measures: Treatment outlines for Bartonella bacilliformis infection. Results: In the acute phase, 248 patients were registered; in 215 (86,7 per cent) chloramphenicol treatment was indicated but the 50 mg/kg loading dose by 3 days was not prescribed; 164 (66,1 per cent) patients needed a higher chloramphenicol dose of 25 mg/kg. In the eruptive phase, 270 patients were registered; in 260 (96,3 per cent) rifampicin was indicated and 222 (82,2 per cent) for more than the 21 treatment days suggested for this antibiotic. Clinical cure was obtained with chloramphenicol in 89 per cent and 93,1 per cent with rifampicin. Conclusions: In the population studied there was a tendency to increase both chloramphenicol dose and rifampicin number of treatment days respectively in the acute and eruptive phases of Carrion's disease.