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.

Did Bartonella henselae contribute to the deaths of two veterinarians?

Bartonella henselae, a flea-transmitted bacterium, causes chronic, zoonotic, blood stream infections in immunocompetent and immunocompromised patients throughout the world. As an intra-erythrocytic and endotheliotropic bacterium, B. henselae causes a spectrum of symptomatology ranging from asymptomatic bacteremia to fever, endocarditis and death. Veterinary workers are at occupational risk for acquiring bartonellosis. As an emerging, and incompletely understood, stealth bacterial pathogen, B. henselae may or may not have been responsible for the deaths of two veterinarians; however, recent evidence indicates that this genus is of much greater medical importance than is currently appreciated by the majority of the biomedical community.

Initial diagnosis of HIV/AIDS in a 56-year-old man with non-healing forearm lesion.

A 56-year-old Hispanic man with no significant medical problems presented with a 2-month history of a non-healing right forearm lesion that progressed despite several courses of empiric antibiotics. The patient underwent incision and drainage. Warthin-Starry stain with immunohistochemistry testing diagnosed bacillary angiomatosis secondary to Bartonella quintana. Subsequently, the patient was diagnosed with HIV, with a CD4 count of 68 cells/mm(3), and a HIV viral load of 47, 914 copies/mL. The patient was treated with doxycycline and started on antiretroviral therapy. The lesion has resolved and he has had no recurrence after 16 months of treatment.

Aspectos clínicos, epidemiológicos e laboratoriais das bartoneloses em crianças do Rio de Janeiro / Clinical, epidemiological and laboratory aspects of bartonellosis in children in Rio de Janeiro

As bartoneloses são doenças mundialmente dispersas causadas por bactérias gramnegativas do gênero Bartonella. Com mais de 24 espécies reconhecidas, B. bacilliformis, B.henselae e B. quintana são os principais e mais comuns agentes causadores de doença emhumanos. Na literatura existem relatos de casos isolados e alguns estudos de prevalênciasorológica sobre a doença, a maioria realizados em pacientes adultos, com escassainformação sobre a sua apresentação e a epidemiologia nas crianças. A proposta desseestudo retrospectivo foi analisar uma série casos de bartonelose em pacientes abaixo de 16anos, no estado do Rio de Janeiro, durante o período de 2006 a 2012, a partir dos dadossecundßrios obtidos no banco de dados do Laboratório de Referência Nacional paraRickettsioses, Laboratório de Hantavirose e Rickettsioses do Instituto Oswaldo Cruz, Rio deJaneiro. Dos 36 confirmados por anßlise sorológica utilizando teste de imunofluorescênciacomercial, com títulos de corte de 64, e/ ou por reação em cadeia da polimerase, 19 casos(52,7 por cento) foram do sexo feminino, com uma variação por faixa etßria de zero a 16 anos, 19(52,7 por cento) tinham entre 11 e 16 anos de idade. A maioria dos casos - 22 casos (61,1 por cento) -, foiprocedente do município do Rio de Janeiro, com mais cinco (13,8 por cento ) e três (8,3 por cento) empacientes residentes nos municípios de Duque de Caxias e Nova Iguaçu. A informaçãosobre contato com gato estava disponível em apenas sete (19,4 por cento)...

Bartonelloses are globally dispersed diseases caused by gram-negative bacteria fromBartonella genus. With over 24 recognized species, B. bacilliformis, B. henselae and B.Quintana are the main and most common disease-causing agents in humans. In theliterature, there are reports of isolated cases and some seroprevalence studies about thedisease, most performed in adult patients, with limited information about its presentation andepidemiology in children. The purpose of this retrospective study was to analyze a caseseries of bartonellosis in patients aged less than 16 years, in the State of Rio de Janeiro,during the period 2006-2012. We assessed secondary data from the National ReferenceLaboratory for Rickettsiosis, Laboratory of Hantaviroses and Rickettsioses of Oswaldo CruzInstitute, Rio de Janeiro. Nineteen cases (52,7 percent), from 36 confirmed by serological analysisusing commercial immunofluorescence test, with antibody cut off titers of 64 , and / orpolymerase chain reaction, were female, with an age variation from zero to 16 years old, 19(52.7 percent) were between 11 and 16 years old. Most of cases - 22 (61.1 percent) û were found in thecity of Rio de Janeiro, with another five (13.8 percent) and three (8.3 percent) in patients residing in thecities of Duque de Caxias and Nova Iguaçu. Information about contact with cats wasavailable in just seven (19,4 percent). Clinical manifestations observed in this study were similar tothose described in the literature, in which it was possible to identify cat scratch disease(CSD), fever of unknown origin, and hepatosplenic form...

Adhesins of Bartonella spp.

Adhesion to host cells represents the first step in the infection process and one of the decisive features in the pathogenicity of Bartonella spp. B. henselae and B. quintana are considered to be the most important human pathogenic species, responsible for cat scratch disease, bacillary angiomatosis, trench fever and other diseases. The ability to cause vasculoproliferative disorders and intraerythrocytic bacteraemia are unique features of the genus Bartonella. Consequently, the interaction with endothelial cells and erythrocytes is a focus in Bartonella research. The genus harbours a variety of trimeric autotransporter adhesins (TAAs) such as the Bartonella adhesin A (BadA) of B. henselae and the variably expressed outer-membrane proteins (Vomps) of B. quintana, which display remarkable variations in length and modular construction. These adhesins mediate many of the biologically-important properties of Bartonella spp. such as adherence to endothelial cells and extracellular matrix proteins and induction of angiogenic gene programming. There is also significant evidence that the laterally acquired Trw-conjugation systems of Bartonella spp. mediate host-specific adherence to erythrocytes. Other potential adhesins are the filamentous haemagglutinins and several outer membrane proteins. The exact molecular functions of these adhesins and their interplay with other pathogenicity factors (e.g., the VirB/D4 type 4 secretion system) need to be analysed in detail to understand how these pathogens adapt to their mammalian hosts.

Bartonellosis as cause of death after red blood cell unit transfusion.

The authors present the case of a young man with aplastic anemia who went into shock and died after several red blood cell unit transfusions. Immunohematological studies did not show any abnormality and blood cultures from patients and blood bags were negative. The ultrastructural findings, allied with current scientific knowledge, permitted the diagnosis of Bartonella sp. infection. In face of this diagnosis, two possibilities should be considered: the first one is that the patient was already infected by the bacteria before the last RBC unit transfusion. The pathogen could be involved in aplastic anemia etiology and in the failure to recover hemoglobin levels, in spite of the transfusions. The second possibility is that the RBC unit was contaminated with a Bartonella sp., which would have led to a state of shock, causing the death of the patient.

[Risk of infections among orienteers]. / Infeksjonsrisiko hos orienteringsløpere.

BACKGROUND: Research on orienteers is useful for assessing the risk of infections associated with physical activity in the forest. In this paper four types of infections are reviewed, and the efficacy of preventive initiatives is discussed. MATERIAL AND METHODS: The paper is based on literature retrieved from a non-systemic search in PubMed. RESULTS: Hepatitis B infection was more prevalent among orienteers before they were obliged to use protective clothing. In the 1980s, there was an increase of sudden unexpected death among young Swedish orienteers. Bartonella infection was later suggested as an underlying cause. No unexpected deaths have occurred among young orienteers after 1992 when specific advice was given regarding training and competitions. Orienteers do not seem to be affected by lyme borreliosis or tick-borne encephalitis (TBE) more often than others, but only two old studies have been performed. INTERPRETATION: Orienteers may be at risk of acquiring infection from lyme borreliosis and TBE in Norway in the future, as the incidence of these contagions is increasing. Norwegian medical personnel should consider TBE vaccination of orienteers and others who wander in areas with a high prevalence of infected ticks.

Bartonella quintana and Bartonella pediococcus Infection after Aortic Valve Replacement.

Bartonella quintana and Bartonella pediococcus infections are very rare causes of endocarditis. Urban trench fever with relapsing febrile illness, headache, leg pain, and endocarditis has now begun to be a more important cause of disease in socially disadvantaged persons. The diagnosis is difficult because the growth of B. quintana in blood culture takes 20-40 days. B. pediococcus may be an opportunistic pathogen in severely compromised hosts, although it has been described as a harmless bacterium. We describe a patient who developed bioprosthetic valve infection with B. quintana and B. pediococcus after valve replacement.

Disseminated Bartonella infection following liver transplantation.

Bartonella henselae has not only been identified as the causative agent of cat scratch disease, but it is also associated with other significant infectious syndromes in the immunocompromised population. We describe two cases of B. henselae associated diseases in liver transplant recipients who both had contact with cats. The first recipient developed localized skin manifestation of bacillary angiomatosis in association with granulomatous hepatitis. He tested positive for Immunoglobulin G (IgG) antibodies against B. henselae. The second patient developed axillary lymphadenopathy, with biopsy showing necrotizing granulomatous inflammation and polymerase chain reaction studies were positive for B. henselae DNA. Her serology for bartonellosis showed a fourfold rise in antibody titers during her hospitalization. Both patients responded to treatment with Azithromycin in combination with Doxycycline. These were the only cases within a series of 467 consecutive liver transplants performed in 402 patients performed during a 4-year period. Although bartonellosis is a rare infection in liver transplantation recipients, it should always be included in the differential diagnosis of patients presenting with fever, central nervous system (CNS) symptoms, skin lesions, lymphadenopathy, and hepatitis especially if prior contact with cats is reported.

[Detection of the Bartonella DNA by the method of nested PCR in patients after tick bites in Novosibirsk region].

Arthropod-borne bacterial pathogen Bartonella DNA was detected in human blood cells after tick bites in summer 2003 and 2004 in Novosibirsk region by nested PCR with primers specific to groEL gene of HSP60 protein. Comparative assay of 190 p.b. of long PCR fragment revealed that the nucleotide sequences might belong to Bartonella henselae and Bartonella quintana.

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.

[Bartonella and bartonellosis--emerging and re-emerging infections: epidemiology, clinical course, diagnosis].

Information on the epidemiology, clinic and diagnostics of bartonellosis is updated. The importance of bartonellosis lies in the fact that its main risk group embraces patients with immunodeficiencies of different origin, the number of such patients constantly growing. The diagnostics of bartonellosis is insufficiently developed and the research on Bartonella organisms, except for the trunch (Volynia) fever causative agent, is insufficient in our country.

Seroprevalence of and risk factors for Bartonella henselae and Bartonella quintana infections among pet cats in Jordan.

To determine the seroprevalences of Bartonella henselae and Bartonella quintana antibodies in Jordanian pet cats, serum samples from 153 cats from three geographical regions were analyzed. Seroprevalences were determined by indirect immunofluorescence. The true seroprevalences to B. henselae and B. quintana were 32 and 1.5%, respectively. The seroprevalence of B. henselae-specific antibodies in cats from northern Jordan was significantly higher than in cats from the central or southern parts of Jordan. The seroprevalence to B. henselae increased to age 2 years. Odds of seropositivity were higher in cats living outdoors, showing hunting behavior, having a flea infestation and of a mixed breed. No association was detected with sex.

Spatial analysis of Yersinia pestis and Bartonella vinsonii subsp. berkhoffii seroprevalence in California coyotes (Canis latrans).

Zoonotic transmission of sylvatic plague caused by Yersinia pestis occurs in California, USA. Human infections with various Bartonella species have been reported recently. Coyotes (Canis latrans) are ubiquitous throughout California and can become infected with both bacterial agents, making the species useful for surveillance purposes. This study examined the geographic distribution of 863 coyotes tested for Y. pestis and Bartonella vinsonii subsp. berkhoffii serologic status to gain insight into the natural history of B. vinsonii subsp. berkhoffii and to characterize the spatial distribution of the two agents. We found 11.7% of specimens positive to Y. pestis and 35.5% positive to B. vinsonii subsp. berkhoffii. The two pathogens had distinct spatial clusters: Y. pestis was more prevalent in eastern portions of the state and B. vinsonii subsp. berkhoffii in coastal regions. Prevalence of Y. pestis increased with increasing elevation, whereas prevalence of B. vinsonii subsp. berkhoffii decreased with increasing elevation. There were differences in the proportions of positive animals on a yearly basis to both pathogens.