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Ericson ME, Mozayeni BR, Radovsky L, Bemis LT. Bartonella- and Borrelia-Related Disease Presenting as a Neurological Condition Revealing the Need for Better Diagnostics. Microorganisms 2024; 12:209. [PMID: 38276194 PMCID: PMC10819350 DOI: 10.3390/microorganisms12010209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The diagnostic tests available to identify vector-borne pathogens have major limitations. Clinicians must consider an assortment of often diverse symptoms to decide what pathogen or pathogens to suspect and test for. Even then, there are limitations to the currently available indirect detection methods, such as serology, or direct detection methods such as molecular tests with or without culture enrichment. Bartonella spp., which are considered stealth pathogens, are particularly difficult to detect and diagnose. We present a case report of a patient who experienced a spider bite followed by myalgia, lymphadenopathy, and trouble sleeping. She did not test positive for Bartonella spp. through clinically available testing. Her symptoms progressed and she was told she needed a double hip replacement. Prior to the surgery, her blood was submitted for novel molecular testing, where Bartonella spp. was confirmed, and a spirochete was also detected. Additional testing using novel methods over a period of five years found Bartonella henselae and Borrelia burgdorferi in her blood. This patient's case is an example of why new diagnostic methods for vector-borne pathogens are urgently needed and why new knowledge of the variable manifestations of Bartonellosis need to be provided to the medical community to inform and heighten their index of suspicion.
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Affiliation(s)
| | | | | | - Lynne T. Bemis
- Department of Biomedical Sciences, Medical School Duluth Campus, University of Minnesota, Duluth, MN 55812, USA
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Łysakowska ME, Szybka M, Olga B, Moskwa S, Konieczka M, Makowska J, Pastuszak-Lewandoska D. Cytokine and LL-37 gene expression levels in Bartonella spp. seropositive and seronegative patients of a rheumatology clinic. Adv Med Sci 2022; 67:163-169. [PMID: 35279619 DOI: 10.1016/j.advms.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/07/2022] [Accepted: 02/24/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The variation in the immune response to Bartonella spp. infection in humans remains unclear. The present study compares the expression of selected interleukins, cytokines and cathelicidin (LL-37) in rheumatology clinic patients suffering from musculoskeletal symptoms with healthy blood donors. The patients had previously been tested for the presence of Bartonella henselae antibodies. METHODS Gene expression of LL-37, interleukin (IL)-2, IL-4, IL-6, IL-12, interferon-(IFN)-γ, and tumor necrosis factor (TNF-α)-α was determined in blood samples using quantitative Polymerase Chain Reaction (qPCR). Statistical analysis was prepared with STATISTICA. RESULTS Statistically significant differences in the mRNA levels of the tested cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-12; p<0.0001) were observed between the healthy controls and patients; however, no difference was observed for LL37 mRNA (p = 0.1974). No significant differences in mRNA expression were observed between IgG in anti-Bartonella seropositive and seronegative individuals (p>0.05). The only significant differences between the Bartonella spp. DNA positive and negative patients, indicated by PCR, were observed for TNF-α and IL-12 mRNA (p = 0.0045 and p = 0.0255, respectively). CONCLUSION A broadly similar immune response to the tested cytokines was observed among the participants irrespective of anti-Bartonella spp. IgG seropositivity. However, the Bartonella DNA-positive participants demonstrated significantly lower expression of IL-12 and TNF-α mRNA; this may indicate that these bacteria have a suppressive influence on the immune system.
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Easley F, Taylor L, B. Breitschwerdt E. Suspected Bartonella osteomyelitis in a dog. Clin Case Rep 2021; 9:e04512. [PMID: 34306698 PMCID: PMC8294148 DOI: 10.1002/ccr3.4512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
Bartonella associated osteomyelitis, while described in humans and a cat, has to our knowledge not been described in dogs. Infection with Bartonella spp. should be considered as a potential bacterial cause of osteomyelitis in dogs.
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Affiliation(s)
- Frankie Easley
- Department of Clinical SciencesCollege of Veterinary MedicineNorth Carolina State UniversityRaleighNCUSA
| | | | - Edward B. Breitschwerdt
- Department of Clinical SciencesCollege of Veterinary MedicineNorth Carolina State UniversityRaleighNCUSA
- Intracellular Pathogens Research LaboratoryComparative Medicine InstituteCollege of Veterinary MedicineNorth Carolina State UniversityRaleighNCUSA
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Maluki A, Breitschwerdt E, Bemis L, Greenberg R, Mozayeni BR, Dencklau J, Ericson M. Imaging analysis of Bartonella species in the skin using single-photon and multi-photon (second harmonic generation) laser scanning microscopy. Clin Case Rep 2020; 8:1564-1570. [PMID: 32884796 PMCID: PMC7455430 DOI: 10.1002/ccr3.2939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/14/2020] [Accepted: 04/19/2020] [Indexed: 01/09/2023] Open
Abstract
We demonstrate Bartonella spp are abundant in skin lesions resembling striae distensae. These striae distensae-like lesions, coincidental with sudden onset of neuropsychiatric symptoms, indicate testing for suspected Bartonella spp. infection.
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Affiliation(s)
- Azar Maluki
- DermatologyUniversity of Minnesota Medical School ‐ Twin CitiesMinneapolisMinnesotaUSA
- DermatologyCollege of MedicineUniversity of KufaKufaIraq
| | - Edward Breitschwerdt
- Intracellular Pathogens Research LaboratoryCenter for Comparative Medicine and Translational ResearchCollege of Veterinary MedicineNorth Carolina State University(NCSU)RaleighNorth CarolinaUSA
| | - Lynne Bemis
- Department of Biomedical SciencesUniversity of Minnesota Medical School ‐ Duluth CampusDuluthMinnesotaUSA
| | | | - Bobak Robert Mozayeni
- Founder and General Medical Director Translational Medicine Group PCNorth BethesdaMarylandUSA
| | - Jamie Dencklau
- DermatologyUniversity of Minnesota Medical School ‐ Twin CitiesMinneapolisMinnesotaUSA
| | - Marna Ericson
- DermatologyUniversity of Minnesota Medical School ‐ Twin CitiesMinneapolisMinnesotaUSA
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Łysakowska ME, Brzezińska O, Szybka M, Konieczka M, Moskwa S, Brauncajs M, Makowska J, Pastuszak-Lewandoska D, Grzegorczyk J. The seroprevalence of Bartonella spp. in the blood of patients with musculoskeletal complaints and blood donors, Poland: a pilot study. Clin Rheumatol 2019; 38:2691-2698. [PMID: 31115789 DOI: 10.1007/s10067-019-04591-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bartonella spp. can cause a variety of diseases, such as lymphadenopathies, cat scratch disease, and trench fever, but can also give rise to many non-specific symptoms. No data exists regarding the prevalence of Bartonella spp. in patients with musculoskeletal complaints, nor among blood donors in Poland. METHODS The presence of anti-Bartonella IgM and IgG in the serum of blood donors (n = 65) (Lodz, Poland) and in the patients of the Department of Rheumatology Clinic (n = 40) suffering from musculoskeletal symptoms was tested by immunofluorescence. Blood samples were cultured on enriched media. Epidemiological questionnaires were used to identify key potential risk factors, such as sex, age, contact with companion animals, and bites from insects or animals. RESULTS Altogether, 27 of the 105 tested subjects were seropositive for Bartonella henselae IgG (23%) and three for Bartonella quintana IgG (2.85%); IgMs against B. henselae were found in three individuals (2.85%), and IgMs against B. quintana were found in one (1.54%). No statistically significant difference was found between the prevalence of B. henselae in the blood of donors or patients and the presence of unexplained musculoskeletal complaints (23% vs 30%). Individuals who had kept or been scratched by cats were not more likely to be B. henselae seropositive (p > 0.01). Tick bites were more commonly reported in patients, but insignificantly (p > 0.01). CONCLUSION This is the first report of a high seroprevalence of anti-Bartonella IgG in patients with musculoskeletal symptoms and in blood donors in Poland. The obtained results indicate that such seroprevalence may have a possible significance in the development of musculoskeletal symptoms, although it should be confirmed on a larger group of patients. Asymptomatic bacteremia might occur and pose a threat to recipients of blood from infected donors. Hence, there is a need for more detailed research, including molecular biology methods, to clarify the potential risk of Bartonella spp. being spread to immunocompromised individuals. KEY POINTS • This is the first study presenting high seroprevalence of Bartonella spp. in Poland. • IgG and IgM antibodies against B. quintana were found in blood samples of blood donors.
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Affiliation(s)
- Monika E Łysakowska
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, Pomorska 251, 92-231, Lodz, Poland.
| | - Olga Brzezińska
- Department of Rheumatology, Medical University of Lodz, Pieniny 30, 92-115, Lodz, Poland
| | - Małgorzata Szybka
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, Pomorska 251, 92-231, Lodz, Poland
| | - Magdalena Konieczka
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, Pomorska 251, 92-231, Lodz, Poland
| | - Sylwia Moskwa
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, Pomorska 251, 92-231, Lodz, Poland
| | - Małgorzata Brauncajs
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, Pomorska 251, 92-231, Lodz, Poland
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, Pieniny 30, 92-115, Lodz, Poland
| | - Dorota Pastuszak-Lewandoska
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, Pomorska 251, 92-231, Lodz, Poland
| | - Janina Grzegorczyk
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, Pomorska 251, 92-231, Lodz, Poland
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Breitschwerdt EB, Greenberg R, Maggi RG, Mozayeni BR, Lewis A, Bradley JM. Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome. J Cent Nerv Syst Dis 2019; 11:1179573519832014. [PMID: 30911227 PMCID: PMC6423671 DOI: 10.1177/1179573519832014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background: With the advent of more sensitive culture and molecular diagnostic testing
modalities, Bartonella spp. infections have been documented
in blood and/or cerebrospinal fluid specimens from patients with diverse
neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome
(PANS) is characterized by an unusually abrupt onset of cognitive,
behavioral, or neurological symptoms. Between October 2015 and January 2017,
a 14-year-old boy underwent evaluation by multiple specialists for
sudden-onset psychotic behavior (hallucinations, delusions, suicidal and
homicidal ideation). Methods: In March 2017, Bartonella spp. serology (indirect
fluorescent antibody assays) and polymerase chain reaction (PCR)
amplification, DNA sequencing, and Bartonella enrichment
blood culture were used on a research basis to assess
Bartonella spp. exposure and bloodstream infection,
respectively. PCR assays targeting other vector-borne infections were
performed to assess potential co-infections. Results: For 18 months, the boy remained psychotic despite 4 hospitalizations,
therapeutic trials involving multiple psychiatric medication combinations,
and immunosuppressive treatment for autoimmune encephalitis.
Neurobartonellosis was diagnosed after cutaneous lesions developed.
Subsequently, despite nearly 2 consecutive months of doxycycline
administration, Bartonella henselae DNA was PCR amplified
and sequenced from the patient’s blood, and from Bartonella
alphaproteobacteria growth medium enrichment blood cultures. B
henselae serology was negative. During treatment with
combination antimicrobial chemotherapy, he experienced a gradual progressive
decrease in neuropsychiatric symptoms, cessation of psychiatric drugs,
resolution of Bartonella-associated cutaneous lesions, and
a return to all pre-illness activities. Conclusions: This case report suggests that B henselae bloodstream
infection may contribute to progressive, recalcitrant neuropsychiatric
symptoms consistent with PANS in a subset of patients.
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Affiliation(s)
- Edward B Breitschwerdt
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - Ricardo G Maggi
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - Allen Lewis
- Sancta Familia Center for Integrative Medicine, Columbus, OH, USA
| | - Julie M Bradley
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Horowitz RI, Freeman PR. Precision medicine: retrospective chart review and data analysis of 200 patients on dapsone combination therapy for chronic Lyme disease/post-treatment Lyme disease syndrome: part 1. Int J Gen Med 2019; 12:101-119. [PMID: 30863136 PMCID: PMC6388746 DOI: 10.2147/ijgm.s193608] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We collected data from an online survey of 200 of our patients, which evaluated the efficacy of dapsone (diaminodiphenyl sulfone, ie, DDS) combined with other antibiotics and agents that disrupt biofilms for the treatment of chronic Lyme disease/post-treatment Lyme disease syndrome (PTLDS). We also collected aggregate data from direct retrospective chart review, including laboratory testing for Lyme, other infections, and associated tick-borne coinfections. This helped us to determine the frequency of exposure to other infections/coinfections among a cohort of chronically ill Lyme patients, evaluate the efficacy of newer "persister" drug regimens like DDS, and determine how other infections and tick-borne coinfections may be contributing to the burden of chronic illness leading to resistant symptomatology. PATIENTS AND METHODS A total of 200 adult patients recruited from a specialized Lyme disease medical practice had been ill for at least 1 year. We regularly monitored laboratory values and participants' symptom severity, and the patients completed the online symptom questionnaire both before beginning treatment and after 6 months on DDS combination therapy (DDS CT). Paired-samples t-tests and Wilcoxon signed-rank nonparametric test were performed on each of eight major Lyme symptoms, both before DDS CT and after 6 months of therapy. RESULTS DDS CT statistically improved the eight major Lyme symptoms. We found multiple species of intracellular bacteria including rickettsia, Bartonella, Mycoplasma, Chlamydia, Tularemia, and Brucella contributing to the burden of illness and a high prevalence of Babesia complicating management with probable geographic spread of Babesia WA1/duncani to the Northeast. Borrelia, Bartonella, and Mycoplasma species, as well as Babesia microti had variable manifestations and diverse seroreactivity, with evidence of persistence despite commonly prescribed courses of anti-infective therapies. Occasional reactivation of viral infections including human herpes virus 6 was also seen in immunocompromised individuals. CONCLUSION DDS CT decreased eight major Lyme symptoms severity and improved treatment outcomes among patients with chronic Lyme disease/PTLDS and associated coinfections.
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Affiliation(s)
- Richard I Horowitz
- Health and Human Services, Tick-Borne Disease Working Group, Washington, DC 20201 USA,
- Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA,
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Mozayeni BR, Maggi RG, Bradley JM, Breitschwerdt EB. Rheumatological presentation of Bartonella koehlerae and Bartonella henselae bacteremias: A case report. Medicine (Baltimore) 2018; 97:e0465. [PMID: 29703000 PMCID: PMC5944489 DOI: 10.1097/md.0000000000010465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Systemic Bartonella spp. infections are being increasingly reported in association with complex medical presentations. Individuals with frequent arthropod exposures or animal contact appear to be at risk for acquiring long standing infections with Bartonella spp. CASE REPORT This case report describes infections with Bartonella koehlerae and Bartonella henselae in a female veterinarian whose symptoms were predominantly rheumatologic in nature. Infection was confirmed by serology, polymerase chain reaction (PCR), enrichment blood culture, and DNA sequencing of amplified B koehlerae and B henselae DNA. Long-term medical management with antibiotics was required to achieve elimination of these infections and was accompanied by resolution of the patient's symptoms. Interestingly, the patient experienced substantial improvement in the acquired joint hypermobility mimicking Ehlers-Danlos Syndrome (EDS) type III. CONCLUSION To facilitate early and directed medical interventions, systemic bartonellosis should potentially be considered as a differential diagnosis in patients with incalcitrant rheumatological symptoms and frequent arthropod exposures or extensive animal contact.
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Affiliation(s)
| | - Ricardo Guillermo Maggi
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Julie Meredith Bradley
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Edward Bealmear Breitschwerdt
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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