Bartonella endocarditis-associated glomerulonephritis: a case report and review of the literature.

Infectious endocarditis is associated with a number of systemic manifestations, including kidney disease. Kidney manifestations, including hematuria, parenchymal infarction, and glomerulonephritis, may affect as many as 40%-50% of patients with infective endocarditis. In a minority of cases of infective endocarditis, routine bacterial cultures do not yield an offending organism. Bartonella species are a known and relatively common cause of culture-negative endocarditis and have been associated with the development of endocarditis-associated glomerulonephritis. We present a case of Bartonella endocarditis-associated glomerulonephritis in which recognition of a characteristic immunofluorescent pattern and thorough investigation of the clinical history led to this uncommon diagnosis.

Mapping the viral genetic determinants of endothelial cell tropism in human cytomegalovirus.

Endothelial cells are natural sites of infection for human cytomegalovirus (HCMV) and are increasingly recognized to play an important role in viral dissemination, as well as provide access to underlying tissues and organs. However, the viral factors required for endothelial cell tropism are poorly defined. The goals of the project were to develop a system to study endothelial cell infectivity factors in HCMV, and map the viral genetic determinants required for these tropism functions. HCMV infection of primary aortic endothelial cells (AEC) was studied as a means to evaluate aspects relevant to both pathogenesis of acute infection and chronic vascular diseases. A series of HCMV virus strains was screened for endothelial tropism by comparing replication efficiencies on AEC. A virus strain that was efficient for replication (AD169varATCC), and a virus strain that was restricted for replication (Toledo), were selected for further analysis and characterization. We present evidence for a novel HCMV endothelial tropism factor that functioned following viral internalization across the endothelial cell plasma membrane and prior to nuclear entry. This factor may be involved in intracellular transport of the virion capsid-tegument structure. Complementation approaches using pseudotype virus infection of AEC demonstrated that the tropism defective strain could be rescued in trans. This supported the existence of a viral encoded tropism determinant. Using a gain of function approach, endothelial cell infectivity of the non-tropic HCMV strain Toledo was rescued with AD169 cosmid sequences. Tropism-specific viral genetic determinant(s) may be mapped to a region of the AD169 viral DNA encompassing UL48-56.

Tobacco smoke induces a persistent, but recoverable state in Chlamydia pneumoniae infection of human endothelial cells.

We investigated the extent to which tobacco smoke could induce persistence of Chlamydia pneumoniae in human endothelial cells. Aortic and coronary artery endothelia were infected in the absence or presence of non-cytotoxic concentrations of tobacco smoke medium. Following exposure to smoke medium, chlamydial inclusions were smaller and demonstrated fewer genome copies as determined by real-time PCR. Enumeration of inclusion-forming units (IFU) established a significant smoke-mediated, dose-dependent inhibition of elementary bodies (EB). Host cell apoptosis did not contribute to the observed restriction of productive infection. Ultrastructure analysis demonstrated an arrest in chlamydial development following smoke-exposure, with a predominance of reticulate bodies (RB) observed inside inclusions. Recovery of viable IFU was achieved with removal of smoke-medium and addition of L-tryptophan. In the presence of smoke, C. pneumoniae infection demonstrated all the characteristics of persistence in human endothelia cells. This is the first time that primary human arterial endothelial cells have been shown to support chlamydial persistence. Tobacco smoke is a well-characterized risk factor for progression of atherosclerosis, but a novel means of inducing chlamydial persistence in vascular cells. Thus, smoking may additionally contribute to atherosclerotic disease by inducing a persistent chlamydial infection in arterial endothelium.

Tobacco smoke induces persistent infection of Chlamydophila pneumoniae in HEp-2 cells.

We examined tobacco smoke exposure and its effect on the life cycle of Chlamydophila pneumoniae (C. pneumoniae) in HEp-2, a human respiratory epithelial cell line. Using noncytotoxic concentrations of smoke medium, chlamydiae were grown in tissue culture and infectious particles were quantitated indirectly by immunocytometry of infected indicator cells. Chlamydial genome copy number was assessed with real-time polymerase chain reaction, and ultrastructure was examined by transmission electron microscopy. There was a significant reduction (56-64%; p<0.05) in the number of infectious elementary bodies following smoke exposure compared to untreated cultures. Under the same conditions, at late time points, smoke-exposed cultures showed significantly fewer chlamydial DNA copies (p<0.04). Moreover, smoke exposure induced large aberrant bodies that predominated within the inclusion. Following in vitro smoke exposure, alterations in the developmental cycle of C. pneumoniae included: inhibition of productive infection, reduced bacterial cell division, and formation of aberrant bodies. Thus, using this novel system, we were able to induce chlamydial persistence. Tobacco smoke exposure may represent a risk for establishment of a chronic reservoir of C. pneumoniae infection within respiratory epithelium.