1
|
Rotundo S, Tassone MT, Marascio N, Morrone HL, Gigliotti S, Quirino A, Russo A, Matera G, Trecarichi EM, Torti C. A systematic review on antibiotic therapy of cutaneous bacillary angiomatosis not related to major immunocompromising conditions: from pathogenesis to treatment. BMC Infect Dis 2024; 24:380. [PMID: 38589795 PMCID: PMC11000314 DOI: 10.1186/s12879-024-09253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Cutaneous bacillary angiomatosis (cBA) is a vascular proliferative disorder due to Bartonella spp. that mostly affects people living with HIV (PLWH), transplanted patients and those taking immunosuppressive drugs. Since cBA is mostly related to these major immunocompromising conditions (i.e., T-cell count impairment), it is considered rare in relatively immunocompetent patients and could be underdiagnosed in them. Moreover, antimicrobial treatment in this population has not been previously investigated. METHODS We searched the databases PubMed, Google Scholar, Scopus, OpenAIRE and ScienceDirect by screening articles whose title included the keywords "bacillary" AND "angiomatosis" and included case reports about patients not suffering from major immunocompromising conditions to provide insights about antibiotic treatments and their duration. RESULTS Twenty-two cases of cBA not related to major immunocompromising conditions were retrieved. Antibiotic treatment duration was shorter in patients with single cBA lesion than in patients with multiple lesions, including in most cases macrolides and tetracyclines. CONCLUSIONS cBA is an emerging manifestation of Bartonella spp. infection in people not suffering from major immunocompromising 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.
Collapse
Affiliation(s)
- Salvatore Rotundo
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Maria Teresa Tassone
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Nadia Marascio
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Helen Linda Morrone
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Simona Gigliotti
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Angela Quirino
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Alessandro Russo
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
- Unità Operativa Complessa di Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria "R. Dulbecco", Catanzaro, Italy
| | - Giovanni Matera
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
- Unità Operativa Complessa di Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria "R. Dulbecco", Catanzaro, Italy
| | - Carlo Torti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy.
| |
Collapse
|
2
|
Limitations of Serological Diagnosis of Typical Cat Scratch Disease and Recommendations for the Diagnostic Procedure. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4222511. [PMID: 36915870 PMCID: PMC10008113 DOI: 10.1155/2023/4222511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/22/2023] [Accepted: 02/11/2023] [Indexed: 03/07/2023]
Abstract
Introduction Cat scratch disease (CSD) is the most common cause of bacterial infectious lymphadenopathy, especially in children, but its diagnosis still remains challenging. Serological assays are widely applied due to their simplicity and the non-invasive sampling. However, these techniques present several limitations, including not well-defined antigen preparation, assay conditions and cutoff titers, severe cross-reactions with other species and organisms, and the notably ranging seroprevalence in the normal population. The objective of this study is to review the literature in order to determine the best diagnostic procedure for the diagnosis of CSD. Methods Databases including PubMed, Medline, Google Scholar, and Google were searched to determine the best diagnostic procedure for the diagnosis of CSD. A total of 437 papers were identified and screened, and after exclusion of papers that did not fulfill the including criteria, 63 papers were used. Results It was revealed that sensitivities of serological assays varied from 10% to 100%. Indeed, more than half of the studies reported a sensitivity lower than 70%, while 71% of them had a sensitivity lower than 80%. Moreover, specificities of serological assays ranged from 15% to 100%, with 25 assays reporting a specificity lower than 90%. Conclusion It is considered that molecular assays should be the gold standard technique for CSD confirmation, and physicians are reinforced to proceed to lymph node biopsy in suspicious CSD cases.
Collapse
|
3
|
Steed D, Collins J, Farris AB, Guarner J, Yarar D, Friedman-Moraco R, Doane T, Pouch S, Marshall Lyon G, Woodworth MH. Haemophagocytic lymphohistiocytosis associated with bartonella peliosis hepatis following kidney transplantation in a patient with HIV. THE LANCET. INFECTIOUS DISEASES 2022; 22:e303-e309. [PMID: 35500593 PMCID: PMC9942922 DOI: 10.1016/s1473-3099(22)00276-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/28/2021] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
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.
Collapse
Affiliation(s)
- Danielle Steed
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Alton B Farris
- Department of Medicine, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeannette Guarner
- Department of Medicine, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dilek Yarar
- Kidney Specialists of Kentucky, Bowling Green, KY, USA
| | | | - Tristan Doane
- Department of Medicine, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - G Marshall Lyon
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael H Woodworth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Abstract
BACKGROUND/PURPOSE To report a case of serology-negative severe disseminated Bartonella neuroretinitis in an immunocompromised patient in which diagnosis was made by detection of B. henselae DNA by universal polymerase chain reaction of brain tissue. METHODS Case report. RESULTS A 57-year-old man with immunoglobulin A vasculitis on immunosuppressive therapy presented with lethargy, weight loss, and bilateral decreased vision. Fundus examination revealed bilateral mild vitritis, marked optic disc edema, vascular sheathing, and numerous white inner retinal and preretinal lesions. Brain magnetic resonance imaging revealed multiple foci of restricted diffusion and a ring-enhancing focus in the left parietal lobe. Serologies, cerebrospinal fluid, and vitreous biopsies were all negative for Bartonella. A brain biopsy was performed and B. henselae DNA was detected by universal polymerase chain reaction of the specimen. The patient demonstrated resolution of fundus findings with antibiotic treatment. Repeat serological testing demonstrated seroconversion. CONCLUSION In immunocompromised patients, infection by Bartonella henselae can present as severe disseminated disease. Establishing the diagnosis can be challenging as serologic testing is often unrevealing in the setting of a blunted immune response. Polymerase chain reaction has been used in select cases to establish the diagnosis.
Collapse
|
6
|
Maggi R, Breitschwerdt EB, Qurollo B, Miller JC. Development of a Multiplex Droplet Digital PCR Assay for the Detection of Babesia, Bartonella, and Borrelia Species. Pathogens 2021; 10:pathogens10111462. [PMID: 34832618 PMCID: PMC8620149 DOI: 10.3390/pathogens10111462] [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: 10/25/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
We describe the development, optimization, and validation of a multiplex droplet digital PCR (ddPCR) assay for the simultaneous detection of Babesia, Bartonella, and Borrelia spp. DNA from several sample matrices, including clinical blood samples from animals and humans, vectors, in-vitro infected human and animal cell lines, and tissues obtained from animal models (infected with Bartonella and/or B. burgdorferi). The multiplex ddPCR assay was able to detect 31 Bartonella, 13 Borrelia, and 24 Babesia species, including Theileria equi, T. cervi, and Cytauxzoon felis. No amplification of Treponema or Leptospira spp. was observed. Sensitivity of 0.2-5 genome equivalent DNA copies per microliter was achieved for different members of the Bartonella and Borrelia genus, depending on the species or matrix type (water or spiked blood DNA) tested. The ddPCR assay facilitated the simultaneous detection of co-infections with two and three vector-borne pathogens comprising four different genera (Babesia, Bartonella, Borrelia, and Theileria) from clinical and other sample sources.
Collapse
Affiliation(s)
- Ricardo Maggi
- Department of Clinical Sciences, The Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA; (E.B.B.); (B.Q.)
- Galaxy Diagnostics, Inc., 6 Davis Drive, Suite 201, Research Triangle Park, NC 27709, USA;
- Correspondence:
| | - Edward B. Breitschwerdt
- Department of Clinical Sciences, The Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA; (E.B.B.); (B.Q.)
- Galaxy Diagnostics, Inc., 6 Davis Drive, Suite 201, Research Triangle Park, NC 27709, USA;
| | - Barbara Qurollo
- Department of Clinical Sciences, The Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA; (E.B.B.); (B.Q.)
| | - Jennifer C. Miller
- Galaxy Diagnostics, Inc., 6 Davis Drive, Suite 201, Research Triangle Park, NC 27709, USA;
| |
Collapse
|
7
|
Okaro U, George S, Anderson B. What Is in a Cat Scratch? Growth of Bartonella henselae in a Biofilm. Microorganisms 2021; 9:835. [PMID: 33919891 PMCID: PMC8070961 DOI: 10.3390/microorganisms9040835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023] Open
Abstract
Bartonella henselae (B. henselae) is a gram-negative bacterium that causes cat scratch disease, bacteremia, and endocarditis, as well as other clinical presentations. B. henselae has been shown to form a biofilm in vitro that likely plays a role in the establishment and persistence of the bacterium in the host. Biofilms are also known to form in the cat flea vector; hence, the ability of this bacterium to form a biofilm has broad biological significance. The release of B. henselae from a biofilm niche appears to be important in disease persistence and relapse in the vertebrate host but also in transmission by the cat flea vector. It has been shown that the BadA adhesin of B. henselae is critical for adherence and biofilm formation. Thus, the upregulation of badA is important in initiating biofilm formation, and down-regulation is important in the release of the bacterium from the biofilm. We summarize the current knowledge of biofilm formation in Bartonella species and the role of BadA in biofilm formation. We discuss the evidence that defines possible mechanisms for the regulation of the genes required for biofilm formation. We further describe the regulation of those genes in the conditions that mimic both the arthropod vector and the mammalian host for B. henselae. The treatment for persistent B. henselae infection remains a challenge; hence, a better understanding of the mechanisms by which this bacterium persists in its host is critical to inform future efforts to develop drugs to treat such infections.
Collapse
Affiliation(s)
- Udoka Okaro
- Foundational Sciences Directorate, Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD 21702, USA;
| | - Sierra George
- Department of Molecular Medicine, MDC7, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA;
| | - Burt Anderson
- Department of Molecular Medicine, MDC7, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA;
| |
Collapse
|
8
|
Seguel M, George RC, Maboni G, Sanchez S, Page-Karjian A, Wirth E, McFee W, Gottdenker NL. Pathologic findings and causes of death in bottlenose dolphins Tursiops truncatus stranded along the Georgia coast, USA (2007-2013). DISEASES OF AQUATIC ORGANISMS 2020; 141:25-38. [PMID: 32940248 DOI: 10.3354/dao03509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Between 2007 and 2013, before the 2013 cetacean morbillivirus outbreak, 26 fresh bottlenose dolphin carcasses were necropsied on the coast of Georgia, USA. Here, we present the pathological and microbiological findings associated with their most likely causes of death. The primary cause of death was determined in 25 individuals and included systemic bacterial infection (n = 7), verminous and bacterial bronchopneumonia (n = 5), drowning/entanglement (n = 5), disseminated histoplasmosis (n = 1), intestinal intussusception (n = 1), vegetative endocarditis (n = 1), meningitis (n = 1), necrotizing dermatitis (n = 1), disseminated angiomatosis (n = 1), emaciation (n = 1) and stingray spine trauma (n = 1). Histiocytic and eosinophilic bronchopneumonia associated with Halocerchus sp. infection was observed in 69% of the animals (18/26) and eosinophilic gastritis due to Anisakidae nematodes was found in 36% of the examined stomachs (8/22). Moderate to severe eosinophilic pancreatitis with fibrosis was observed in 4 animals infected with Brachycladiidae trematodes. Proliferative and ulcerative lymphoplasmacytic dermatitis was found in 5 animals and was considered to contribute to deteriorated health status in 2 calves. Pulmonary and lymph node angiomatosis were observed in 15 and 10 animals, respectively. In at least 2 animals, the concentration of polychlorinated biphenyls (PCBs) in the blubber exceeded 1500 µg g-1 of lipid. Bottlenose dolphins stranded on the Georgia coast have a wide range of inflammatory lesions associated with a variety of helminth, bacterial, and fungal pathogens. Some resident animals have also been exposed to high levels of PCB contamination, which could reduce host immunocompetence. Higher exposure to these or other pathogens could result in further decline in the health of resident and migrant dolphin populations in this region.
Collapse
Affiliation(s)
- M Seguel
- Department of Pathology, College of Veterinary Medicine, The University of Georgia, Athens, GA 30602, USA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Maggi RG, Richardson T, Breitschwerdt EB, Miller JC. Development and validation of a droplet digital PCR assay for the detection and quantification of Bartonella species within human clinical samples. J Microbiol Methods 2020; 176:106022. [PMID: 32795640 DOI: 10.1016/j.mimet.2020.106022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/28/2022]
Abstract
This report describes the development, optimization, and validation of a ddPCR assay for the detection of Bartonella spp. DNA within several sample matrices, including clinical blood samples from patients with or without documented Bartonella spp. bacteremia. The Bartonella spp. ddPCR assay was developed based upon previously published TaqMan-based qPCR assays that can amplify DNA of over 25 Bartonella spp. Host DNA (housekeeping gene) amplification serves as a reference target to facilitate quantification. The efficiency, sensitivity, and specificity of the Bartonella spp. ddPCR assay was assessed by direct comparison with the current qPCR methods used by the Intracellular Pathogens Research Laboratory (North Carolina State University, North Carolina, USA), and Galaxy Diagnostics (Research Triangle Park, North Carolina, USA). Bartonella spp. ddPCR assay parameters were successfully optimized to detect Bartonella concentrations equivalent to 0.5 bacterial genome copies per microliter of blood (0.001 pg/ul of bacterial DNA). The number of droplets detected (resolution) for each concentration was consistent across each of four assessed time points. The Bartonella spp. ddPCR assay detected 16 species/strains including B. henselae; B. quintana; B. vinsonii subsp. berkhoffii (genotypes I, II, III and IV); B. vinsonii subsp. vinsonii; B. melophagi; B. volans; B. monaki; B. alsatica; B. bovis; B. elizabethae; B. clarridgeiae; and B. koehlerae. Bartonella DNA was detected in only one previously negative patient sample (119/120 negative; 99% specificity). The ddPCR sensitivity (53/112) was significantly better than qPCR (6/112) when testing patient blood and enrichment blood culture samples. The development of commercial ddPCR systems with integrated technologies has significantly streamlined the DNA detection process, making it more efficient and standardized for clinical diagnostic testing. The assay described in this work is the first step toward the development of a multiplex ddPCR assay (i.e., using the QX One from Bio-Rad) for the simultaneous detection and absolute quantification of multiple vector-borne pathogens (such as Babesia, Bartonella and Borrelia) within clinical samples.
Collapse
Affiliation(s)
- Ricardo G Maggi
- Galaxy Diagnostics, Inc, 7020 Kit Creek Rd #130, Research Triangle Park, NC 27709, USA; Department of Clinical Sciences, The Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Toni Richardson
- Galaxy Diagnostics, Inc, 7020 Kit Creek Rd #130, Research Triangle Park, NC 27709, USA
| | - Edward B Breitschwerdt
- Galaxy Diagnostics, Inc, 7020 Kit Creek Rd #130, Research Triangle Park, NC 27709, USA; Department of Clinical Sciences, The Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Jennifer C Miller
- Galaxy Diagnostics, Inc, 7020 Kit Creek Rd #130, Research Triangle Park, NC 27709, USA.
| |
Collapse
|
10
|
Angulo E, Joyner S, Majeed NK, Nyenhuis S. A rare case of peliosis hepatis in primary immune deficiency. SAGE Open Med Case Rep 2020; 8:2050313X20931996. [PMID: 32595972 PMCID: PMC7301656 DOI: 10.1177/2050313x20931996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/13/2020] [Indexed: 12/02/2022] Open
Abstract
Peliosis hepatis is a rare condition characterized by blackish-blue blood-filled cavities in hepatic parenchyma caused by dilatation of hepatic sinusoids. Peliosis hepatis has been described in secondary immunodeficiencies and certain medications. We present the first case of peliosis hepatis in a patient with a primary immunodeficiency, common variable immunodeficiency. A 44-year-old African-American male presented with gastrointestinal bleeding and elevated liver function tests. His medical history included common variable immunodeficiency and chronic kidney disease. The patient had jaundice, regenerative nodules on liver pathology, and low immunoglobulin levels. A magnetic resonance imaging of the abdomen with contrast revealed a cirrhotic liver, a 5 × 3 cm lesion, and poorly defined nodules which had decreased enhancement. A computed tomography-guided liver biopsy revealed peliosis hepatis, focal nodular hyperplasia, and fibrosis. No other etiology of his liver disease was found. The etiology of peliosis hepatis in patients with primary immunodeficiencies remains unclear. Additional studies are needed to understand the underlying mechanisms.
Collapse
Affiliation(s)
- Evelyn Angulo
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Sydney Joyner
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Nasma K Majeed
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA
| | - Sharmilee Nyenhuis
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
11
|
García MJ, Armiñanzas C, Rivero M, Ramos M. Crohn's Disease and Immunosupressive Treatment: Hepatosplenic Lesions as an Atypical Case of Bartonella henselae. Inflamm Bowel Dis 2020; 26:e17-e18. [PMID: 31909414 DOI: 10.1093/ibd/izz318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Anti–tumor necrosis factor is a frequently used therapy in Crohn’s disease. We describe a patient with Crohn’s disease who presented fever and hepatosplenic lesions due to an opportunistic infection caused by Bartonella henselae.
Collapse
Affiliation(s)
- María José García
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de investigación Sanitaria de Cantabria (IDIVAL), Santander, Spain
| | - Carlos Armiñanzas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Montserrat Rivero
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de investigación Sanitaria de Cantabria (IDIVAL), Santander, Spain
| | - Martín Ramos
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de investigación Sanitaria de Cantabria (IDIVAL), Santander, Spain
| |
Collapse
|
12
|
Deng H, Pang Q, Zhao B, Vayssier-Taussat M. Molecular Mechanisms of Bartonella and Mammalian Erythrocyte Interactions: A Review. Front Cell Infect Microbiol 2018; 8:431. [PMID: 30619777 PMCID: PMC6299047 DOI: 10.3389/fcimb.2018.00431] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
Bartonellosis is an infectious disease caused by Bartonella species that are distributed worldwide with animal and public health impact varying according to Bartonella species, infection phase, immunological characteristics, and geographical region. Bartonella is widely present in various mammals including cats, rodents, ruminants, and humans. At least 13 Bartonella species or subspecies are zoonotic. Each species has few reservoir animals in which it is often asymptomatic. Bartonella infection may lead to various clinical symptoms in humans. As described in the B.tribocorum-rat model, when Bartonella was seeded into the blood stream, they could escape immunity, adhered to and invaded host erythrocytes. They then replicated and persisted in the infected erythrocytes for several weeks. This review summarizes the current knowledge of how Bartonella prevent phagocytosis and complement activation, what pathogenesis factors are involved in erythrocyte adhesion and invasion, and how Bartonella could replicate and persist in mammalian erythrocytes. Current advances in research will help us to decipher molecular mechanisms of interactions between Bartonella and mammalian erythrocytes and may help in the development of biological strategies for the prevention and control of bartonellosis.
Collapse
Affiliation(s)
- Hongkuan Deng
- School of Life Sciences, Shandong University of Technology, Zibo, China
| | - Qiuxiang Pang
- School of Life Sciences, Shandong University of Technology, Zibo, China
| | - Bosheng Zhao
- School of Life Sciences, Shandong University of Technology, Zibo, China
| | - Muriel Vayssier-Taussat
- UMR BIPAR, INRA, ANSES, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil Val-de-Marne, Maisons-Alfort, France
| |
Collapse
|
13
|
Mazzitelli M, Lamberti AG, Quirino A, Marascio N, Barreca GS, Costa C, Pisani V, Strazzulla A, Greco G, Liberto MC, Focà A, Torti C. Utility of Molecular Identification and Quantitation of Bartonella Species with Species-Specific Real-Time PCR for Monitoring Treatment Response: A Case Series. Open Microbiol J 2018; 12:148-153. [PMID: 29997699 PMCID: PMC5997851 DOI: 10.2174/1874285801812010148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/01/2018] [Accepted: 05/05/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Bartonella species are intracellular bacteria capable of producing several diseases in humans. The three most common and wellknown diseases are cat scratch disease (CSD), caused by B. henselae, trench fever, caused by B. quintana and Carrion’s Disease, caused by B. bacilliformis. Signs and symptoms are very different and aspecific: Fatigue, fever, headache, lymphadenopathy, malaise, loss of weight. No data exist to support guidelines’ recommendations to decide which drugs should be optimally used and how long they should be administered. Therefore, a marker of treatment response is needed to guide treatment strategies. Methods: We report herein three cases in which a species specific Reverse-Transcriptase Polymerase-Chain-Reaction (RT PCR) developed in-house was performed and compared to serology in order to make diagnosis and to evaluate treatment response. Results: Our species-specific RT PCR seemed to play a fundamental role both in diagnosis and treatment. Moreover, a discrepancy with the serology results was found. Conclusion: Further studies are necessary to validate these results and elucidate what is the best treatment for this pleomorphic disease. However, in absence of clear guidelines, RT PCR may be useful to orientate kind of treatment ad its duration.
Collapse
Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Angelo G Lamberti
- Institute of Microbiology, Department of Health Sciences, "Magna Græcia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Angela Quirino
- Institute of Microbiology, Department of Health Sciences, "Magna Græcia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Nadia Marascio
- Institute of Microbiology, Department of Health Sciences, "Magna Græcia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Giorgio S Barreca
- Institute of Microbiology, Department of Health Sciences, "Magna Græcia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Chiara Costa
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Vincenzo Pisani
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Alessio Strazzulla
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giuseppe Greco
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Maria C Liberto
- Institute of Microbiology, Department of Health Sciences, "Magna Græcia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Alfredo Focà
- Institute of Microbiology, Department of Health Sciences, "Magna Græcia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| |
Collapse
|
14
|
Trefois Q, Marot JC, Yildiz H, Wieers G. Fever, bone pain and erectile dysfunction. Where is the cat? BMJ Case Rep 2017; 2017:bcr-2017-221397. [PMID: 28899872 DOI: 10.1136/bcr-2017-221397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cat-scratch disease is due to Bartonella henselae and commonly presents as a localised papular lesion with regional lymphadenopathy. We report the case of a young man suffering general symptoms and dysautonomy characterised by an erectile dysfunction due to an invasive cat-scratch disease. He was successfully treated by tetracyclines during 3 weeks.
Collapse
Affiliation(s)
- Quentin Trefois
- Department of internal medicine, Clinique Saint-Pierre Ottignies, Ottignies, Belgium
| | - Jean-Christophe Marot
- Department of internal medicine, Clinique Saint-Pierre Ottignies, Ottignies, Belgium
| | - Halil Yildiz
- Department of internal medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Gregoire Wieers
- Department of internal medicine, Clinique Saint-Pierre Ottignies, Ottignies, Belgium
| |
Collapse
|
15
|
Bartonella henselae is usually not viable in lymph nodes of patients with cat scratch disease. Eur J Clin Microbiol Infect Dis 2017; 36:2207-2213. [PMID: 28669017 DOI: 10.1007/s10096-017-3047-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/18/2017] [Indexed: 12/19/2022]
Abstract
Bartonella henselae, the agent of cat scratch disease (CSD), appears to be a common organism responsible for lymphadenitis in both adults and children. There is a very low isolation rate for B. henselae from lymph nodes of patients with CSD. Our objective was to evaluate B. henselae viability in a large series of lymph nodes from patients with CSD. From January to November 2016, we analyzed lymph node biopsy samples from patients diagnosed with CSD. We used reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to detect B. henselae RNA, as well as cultures, histological analyses, and fluorescence in situ hybridization (FISH). We tested 87 lymph nodes positive for B. henselae DNA but only 8 (9%) presented with B. henselae RNA. We did not find a significant difference for the pap threshold cycle (CT) values between RNA-positive and RNA-negative lymph nodes (p = 0.5). Cultures, histological analyses, and FISH were negative for all the tested samples. We provide evidence that B. henselae are not or are rarely viable in most cases in the lymph nodes of patients with CSD.
Collapse
|
16
|
Picascia A, Pagliuca C, Sommese L, Colicchio R, Casamassimi A, Labonia F, Pastore G, Pagliarulo C, Cicatiello AG, Castaldo F, Schiano C, Maiello C, Mezza E, D'Armiento FP, Salvatore P, Napoli C. Seroprevalence of Bartonella henselae in patients awaiting heart transplant in Southern Italy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:239-244. [PMID: 26051222 DOI: 10.1016/j.jmii.2015.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 04/13/2015] [Accepted: 05/05/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bartonella henselae is the etiologic agent of cat-scratch disease. B. henselae infections are responsible for a widening spectrum of human diseases, although often symptomless, ranging from self-limited to life-threatening and show different courses and organ involvement due to the balance between host and pathogen. The role of the host immune response to B. henselae is critical in preventing progression to systemic disease. Indeed in immunocompromised patients, such as solid organ transplant patients, B. henselae results in severe disseminated disease and pathologic vasoproliferation. The purpose of this study was to determine the seroprevalence of B. henselae in patients awaiting heart transplant compared to healthy individuals enrolled in the Regional Reference Laboratory of Transplant Immunology of Second University of Naples. METHODS Serum samples of 38 patients awaiting heart transplant in comparison to 50 healthy donors were examined using immunfluorescence assay. RESULTS We found a B. henselae significant antibody positivity rate of 21% in patients awaiting heart transplant (p = 0.002). There was a positive rate of 8% (p > 0.05) for immunoglobulin (Ig)M and a significant value of 13% (p = 0.02) for IgG, whereas controls were negative both for IgM and IgG antibodies against B. henselae. The differences in comorbidity between cases and controls were statistically different (1.41 ± 0.96 vs 0.42 ± 0.32; p = 0.001). CONCLUSIONS Although this study was conducted in a small number of patients, we suggest that the identification of these bacteria should be included as a routine screening analysis in pretransplant patients.
Collapse
Affiliation(s)
- Antonietta Picascia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University Medical School, Naples, Italy; U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Azienda Ospedaliera Universitaria, Second University of Naples, Naples, Italy.
| | - Chiara Pagliuca
- Department of Molecular Medicine and Medical Biotechnology, Federico II University Medical School, Naples, Italy; Department of Integrated Activities of Laboratory Medicine, Federico II University Medical School, Naples, Italy
| | - Linda Sommese
- U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Azienda Ospedaliera Universitaria, Second University of Naples, Naples, Italy
| | - Roberta Colicchio
- Department of Molecular Medicine and Medical Biotechnology, Federico II University Medical School, Naples, Italy; Institute of Diagnostic and Nuclear Development (SDN), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Naples, Italy
| | - Amelia Casamassimi
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy
| | - Francesco Labonia
- Department of Integrated Activities of Laboratory Medicine, Federico II University Medical School, Naples, Italy
| | - Gabiria Pastore
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy
| | - Caterina Pagliarulo
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy
| | | | - Francesco Castaldo
- Department of Molecular Medicine and Medical Biotechnology, Federico II University Medical School, Naples, Italy
| | - Concetta Schiano
- Institute of Diagnostic and Nuclear Development (SDN), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Naples, Italy
| | - Ciro Maiello
- Department of Cardiothoracic Sciences, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Ernesto Mezza
- Department of Advanced Biomedical Sciences, Section of Pathology, Federico II University Medical School, Naples, Italy
| | - Francesco Paolo D'Armiento
- Department of Advanced Biomedical Sciences, Section of Pathology, Federico II University Medical School, Naples, Italy
| | - Paola Salvatore
- Department of Molecular Medicine and Medical Biotechnology, Federico II University Medical School, Naples, Italy
| | - Claudio Napoli
- U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Azienda Ospedaliera Universitaria, Second University of Naples, Naples, Italy; Institute of Diagnostic and Nuclear Development (SDN), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Naples, Italy
| |
Collapse
|
17
|
Seroprevalence of Bartonella Species in Patients with Ocular Inflammation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1020:33-42. [PMID: 28405890 DOI: 10.1007/5584_2017_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bartonella species, vector-borne etiologic agents of many systemic or self-limited infections, are responsible for a widening spectrum of diseases in humans, including inflammatory conditions of the eye. The aim of this study was to determine whether there is any relationship between uveitis and the evidence of Bartonella spp. infection in the serum, ocular fluid, and cataract mass in patients with intraocular inflammation. Polymerase chain reaction (PCR)-based tests and DNA sequencing were performed on surgery-extracted specimens of intraocular fluid and lens mass of 33 patients. Sera from 51 patients and 101 control subjects were tested for the presence of specific antibodies against Bartonella spp. Neither IgM-class antibodies against Bartonella spp. nor Bartonella spp. DNA were detected. A specific IgG-class antibody was found in 33.3% of the patients with uveitis. The rate of positive Bartonella serology was higher among the uveitis patients than that in control subjects. This high rate may in part result from unrecognized indirect mechanisms rather than the immediate presence and multiplication of Bartonella spp. in the eyeball. Nonetheless we believe that screening for Bartonella spp. should become part of the diagnostic workup in uveitis.
Collapse
|
18
|
Brunt J, Guptill L, Kordick DL, Kudrak S, Lappin MR. American Association of Feline Practitioners 2006 Panel report on diagnosis, treatment, and prevention of Bartonella spp. infections. J Feline Med Surg 2016; 8:213-26. [PMID: 16846781 DOI: 10.1016/j.jfms.2006.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2006] [Indexed: 11/18/2022]
Affiliation(s)
- Jane Brunt
- Cat Hospital At Towson (CHAT), 6701 York Road, Baltimore, MD 21212, USA
| | | | | | | | | |
Collapse
|
19
|
Bettenay SV, Lappin MR, Mueller RS. An Immunohistochemical and Polymerase Chain Reaction Evaluation of Feline Plasmacytic Pododermatitis. Vet Pathol 2016; 44:80-3. [PMID: 17197627 DOI: 10.1354/vp.44-1-80] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sections of 14 skin biopsies of cats with plasmacytic pododermatitis and a clinical follow-up of 12–36 months were stained with a polyclonal anti- Mycobacterium bovis (Bacille Calmette-Guerin = BCG) antibody cross-reactive to a broad spectrum of fungi and bacteria. All sections were negative for organisms within the actual footpad tissue with the anti-BCG antibody stains. Polymerase chain reaction (PCR) assays that amplify the DNA of Bartonella spp., Ehrlichia spp., Anaplasma phagocytophilum, Chlamydophila felis, Mycoplasma spp., Toxoplasma gondii, and feline herpesvirus 1 (FHV-1) were applied to tissue digests. DNA of those pathogens assessed was not amplified from tissue.
Collapse
Affiliation(s)
- S V Bettenay
- Tierdermatologie Oberhaching, Oberhaching, Germany
| | | | | |
Collapse
|
20
|
Chaudhry A, Chaudhry M, Papadimitriou J, Drachenberg C. Bartonella henselaeinfection-associated vasculitis and crescentic glomerulonephritis leading to renal allograft loss. Transpl Infect Dis 2015; 17:411-7. [DOI: 10.1111/tid.12376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/14/2015] [Accepted: 02/16/2015] [Indexed: 01/28/2023]
Affiliation(s)
- A.R. Chaudhry
- Department of General Surgery; Sinai Hospital of Baltimore; Baltimore Maryland USA
| | - M.R. Chaudhry
- Department of Pathology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - J.C. Papadimitriou
- Department of Pathology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - C.B. Drachenberg
- Department of Pathology; University of Maryland School of Medicine; Baltimore Maryland USA
| |
Collapse
|
21
|
Favacho ARM, Roger I, Akemi AK, Pessoa AA, Varon AG, Gomes R, Godoy DT, Pereira S, Lemos ERS. Molecular identification of Bartonella henselae in a seronegative cat scratch disease patient with AIDS in Rio de Janeiro, Brazil. Rev Inst Med Trop Sao Paulo 2014; 56:363-5. [PMID: 25076441 PMCID: PMC4131826 DOI: 10.1590/s0036-46652014000400017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/28/2013] [Indexed: 11/29/2022] Open
Abstract
Bartonella henselae is associated with a wide spectrum of clinical
manifestations, including cat scratch disease, endocarditis and meningoencephalitis,
in immunocompetent and immunocompromised patients. We report the first molecularly
confirmed case of B. henselae infection in an AIDS patient in state
of Rio de Janeiro, Brazil. Although DNA sequence of B. henselae has
been detected by polymerase chain reaction in a lymph node biopsy, acute and
convalescent sera were nonreactive.
Collapse
Affiliation(s)
| | | | - Amanda K Akemi
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos (LAPCLIN-DERMZOO), Instituto de Pesquisa Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Adonai A Pessoa
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC)/FIOCRUZ
| | | | - Raphael Gomes
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC)/FIOCRUZ
| | - Daniela T Godoy
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC)/FIOCRUZ
| | - Sandro Pereira
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos (LAPCLIN-DERMZOO), Instituto de Pesquisa Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Elba R S Lemos
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC)/FIOCRUZ
| |
Collapse
|
22
|
Chmielewski T, Brydak-Godowska J, Fiecek B, Rorot U, Sędrowicz E, Werenowska M, Kopacz D, Hevelke A, Michniewicz M, Kęcik D, Tylewska-Wierzbanowska S. Bacterial tick-borne diseases caused by Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii, and Rickettsia spp. among patients with cataract surgery. Med Sci Monit 2014; 20:927-31. [PMID: 24902636 PMCID: PMC4049946 DOI: 10.12659/msm.890149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, and Rickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks. Material/Methods Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria. Results Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery, respectively. Conclusions Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development.
Collapse
Affiliation(s)
- Tomasz Chmielewski
- Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath - National Institute of Hygiene, Warsaw, Poland
| | | | - Beata Fiecek
- Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath - National Institute of Hygiene, Warsaw, Poland
| | - Urszula Rorot
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Sędrowicz
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | - Dorota Kopacz
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Hevelke
- Department of Histology, Medical University of Warsaw, Warsaw, Poland
| | | | - Dariusz Kęcik
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Stanisława Tylewska-Wierzbanowska
- Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath - National Institute of Hygiene, Warsaw, Poland
| |
Collapse
|
23
|
Carrasco SE, Chomel BB, Gill VA, Kasten RW, Maggi RG, Breitschwerdt EB, Byrne BA, Burek-Huntington KA, Miller MA, Goldstein T, Mazet JA. Novel Bartonella infection in northern and southern sea otters (Enhydra lutris kenyoni and Enhydra lutris nereis). Vet Microbiol 2014; 170:325-34. [DOI: 10.1016/j.vetmic.2014.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 11/28/2022]
|
24
|
Guiyedi V, Haddad H, Okome-Nkoumou M, Gire F, Ongali B, Lore P, Gameiro L. Cat-scratch disease in adult hospitalized for prolonged-Fever associated with multiple lymphadenopathies and weight loss. Open Microbiol J 2013; 7:152-5. [PMID: 24403980 PMCID: PMC3882904 DOI: 10.2174/1874285801307010152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/29/2013] [Accepted: 11/30/2013] [Indexed: 11/22/2022] Open
Abstract
We report a 19-year-old patient with a Cat-scratch disease presenting three months continuous alteration of the general condition, including prolonged-fever, anorexia, asthenia, weight loss associated with adenitis and multiple thoracic-abdominal adenopathies, leukocytosis with neutrophil polynuclear predominance, and increased of C-reactive protein. The serologies of toxoplasmosis, infectious mononucleosis, human immunodeficiency virus, Brucellosis, Bartonellosis and the tuberculosis research by tuberculin reaction test and Ziehl acid-alcohol resistant bacilli direct examination were negatives. The cytomegalovirus and Epstein-Barr virus serologies were positives only for immunoglobulin-G. The Bartonella henselae diagnosis was made with the analysis of histopathological specimens. The clinical and biological symptoms regressed following eight weeks of azithromycin's treatment. According to this observation, the cat-scratch disease should be considered in differential diagnosis of patients presenting prolonged-fever associated with multiple lymphadenopathies and weight loss. The azithromycin would be an alternative therapeutic issue for this pathology in case of confirmed efficacy by studies in a large patient population.
Collapse
Affiliation(s)
- Vincent Guiyedi
- Service de Médecine B-Hepato-Gastro-Enterologie, Centre Hospitalier de Tulle, France ; Département de Maladies Infectieuses et Tropicales, Faculté de Médecine de Libreville, Université des Sciences de la Santé, Gabon ; Service de Médecine Interne-Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire International Albert Schweitzer de Lambaréné, Université des Sciences de la Santé, Libreville, Gabon
| | - Hanna Haddad
- Service de Chirurgie Orthopédique, Centre Hospitalier de Tulle, France
| | - Madeleine Okome-Nkoumou
- Département de Maladies Infectieuses et Tropicales, Faculté de Médecine de Libreville, Université des Sciences de la Santé, Gabon ; Service de Médecine Interne-Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire International Albert Schweitzer de Lambaréné, Université des Sciences de la Santé, Libreville, Gabon
| | - Fabien Gire
- Service de Médecine B-Hepato-Gastro-Enterologie, Centre Hospitalier de Tulle, France
| | - Brice Ongali
- Service de Médecine Interne-Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire International Albert Schweitzer de Lambaréné, Université des Sciences de la Santé, Libreville, Gabon
| | - Philippes Lore
- Service de Médecine Interne-Rhumatologie-Neurologie, Centre Hospitalier de Tulle, France
| | - Luis Gameiro
- Service de Médecine B-Hepato-Gastro-Enterologie, Centre Hospitalier de Tulle, France
| |
Collapse
|
25
|
Prutsky G, Domecq JP, Mori L, Bebko S, Matzumura M, Sabouni A, Shahrour A, Erwin PJ, Boyce TG, Montori VM, Malaga G, Murad MH. Treatment outcomes of human bartonellosis: a systematic review and meta-analysis. Int J Infect Dis 2013; 17:e811-9. [DOI: 10.1016/j.ijid.2013.02.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 11/27/2022] Open
|
26
|
Berghoff W. Chronic Lyme Disease and Co-infections: Differential Diagnosis. Open Neurol J 2012; 6:158-78. [PMID: 23400696 PMCID: PMC3565243 DOI: 10.2174/1874205x01206010158] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 12/22/2022] Open
Abstract
In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th, i.e. approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with Borrelia burgdorferi by tick bite resulting in multiple infections but a fraction of co-infections occur independently of tick bite. Clinically relevant co-infections are caused by Bartonella species, Yersinia enterocolitica, Chlamydophila pneumoniae, Chlamydia trachomatis, and Mycoplasma pneumoniae. In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in patients not infected by Borrelia burgdorferi can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by Bartonella henselae, Yersinia enterocolitica, and Mycoplasma pneumoniae. Chlamydia trachomatis primarily causes polyarthritis. Chlamydophila pneumoniae not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by Yersinia enterocolitica. For the remaining infections predominantly tetracyclines and macrolides are used. Quinolones are for alternative treatment, particularly gemifloxacin. For Bartonella henselae, Chlamydia trachomatis, and Chlamydophila pneumoniae the combination with rifampicin is recommended. Erythromycin is the drug of choice for Campylobacter jejuni.
Collapse
|
27
|
Rostad CA, McElroy AK, Hilinski JA, Thompson MP, Drew CP, Denison AM, Zaki SR, Mahle WT, Rogers J, Abramowsky CR, Shehata B. Bartonella henselae-mediated disease in solid organ transplant recipients: two pediatric cases and a literature review. Transpl Infect Dis 2012; 14:E71-81. [PMID: 22862881 DOI: 10.1111/j.1399-3062.2012.00774.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/15/2012] [Accepted: 03/19/2012] [Indexed: 01/27/2023]
Abstract
Bartonella henselae, the etiologic agent of cat-scratch disease, causes a well-defined, self-limited syndrome of fever and regional lymphadenopathy in immunocompetent hosts. In immunocompromised hosts, however, B. henselae can cause severe disseminated disease and pathologic vasoproliferation known as bacillary angiomatosis (BA) or bacillary peliosis. BA was first recognized in patients infected with human immunodeficiency virus. It has become more frequently recognized in solid organ transplant (SOT) recipients, but reports of pediatric cases remain rare. Our review of the literature revealed only one previously reported case of BA in a pediatric SOT recipient. We herein present 2 pediatric cases, one of which is the first reported case of BA in a pediatric cardiac transplant recipient, to our knowledge. In addition, we review and summarize the literature pertaining to all cases of B. henselae-mediated disease in SOT recipients.
Collapse
Affiliation(s)
- C A Rostad
- Department of Pediatrics, Emory University, Atlanta, Georgia 30322, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Whittemore J, Hawley J, Radecki S, Steinberg J, Lappin M. Bartonella Species Antibodies and Hyperglobulinemia in Privately Owned Cats. J Vet Intern Med 2012; 26:639-44. [DOI: 10.1111/j.1939-1676.2012.00925.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/02/2012] [Accepted: 03/05/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- J.C. Whittemore
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville; TN
| | - J.R. Hawley
- Veterinary Medical Center; Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins; CO
| | | | | | - M.R. Lappin
- Veterinary Medical Center; Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins; CO
| |
Collapse
|
29
|
Palmero J, Pusterla N, Cherry NA, Kasten RW, Mapes S, Boulouis HJ, Breitschwerdt EB, Chomel BB. Experimental infection of horses with Bartonella henselae and Bartonella bovis. J Vet Intern Med 2012; 26:377-83. [PMID: 22356473 DOI: 10.1111/j.1939-1676.2012.00890.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/11/2011] [Accepted: 01/09/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Experimental infection of horses with Bartonella species is not documented. OBJECTIVES Determine clinical signs, hematologic changes, duration of bacteremia, and pattern of seroconversion in Bartonella henselae or Bartonella bovis-inoculated horses. ANIMALS Twelve (2 groups of 6) randomly selected healthy adult horses seronegative and culture negative for Bartonella spp. METHODS Experimental/observational study: Group I: B. henselae or saline control was inoculated intradermally into 4 naïve and 2 sentinel horses, respectively. Group II: same design was followed by means of B. bovis. Daily physical examinations, once weekly CBC, immunofluorescent antibody assay serology, real-time polymerase chain reaction (PCR), and twice weekly blood cultures were performed for 6 weeks and at postinoculation day 80 and 139. Bartonella alpha-Proteobacteria growth medium (BAPGM) enrichment blood culture was performed for horses that seroconverted to B. henselae antigens. RESULTS Transient clinical signs consistent with bartonellosis occurred in some Bartonella-inoculated horses, but hematological alterations did not occur. Three B. henselae-inoculated horses seroconverted, whereas 1 B. bovis-inoculated horse was weakly seropositive. In Group I, B. henselae was amplified and sequenced from BAPGM blood culture as well as a subculture isolate from 1 horse, blood from a 2nd horse, and BAPGM blood culture from a 3rd horse although a subculture isolate was not obtained. All sentinels remained PCR, culture, and serology negative. CONCLUSIONS Detection of Bartonella sp. in blood after experimental inoculation supports bacteremia and seroconversion. Culture with BAPGM may be required to detect Bartonella sp. Although mild clinical signs followed acute infection, no long-term effects were noted for 2 years postinoculation.
Collapse
Affiliation(s)
- J Palmero
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Cañas-Ventura A, Esteve E, Horcajada JP, Andreu M, Knobel H, Márquez L. Systemic Bartonella henselae infection and Crohn's disease treatment with infliximab. Inflamm Bowel Dis 2012; 18:E197-8. [PMID: 21928372 DOI: 10.1002/ibd.21858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/18/2011] [Indexed: 12/09/2022]
|
31
|
Huarcaya E, Best I, Rodriguez-Tafur J, Maguiña C, Solórzano N, Menacho J, Lopez De Guimaraes D, Chauca J, Ventosilla P. Cytokines and T-Lymphocute count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study. Rev Inst Med Trop Sao Paulo 2011; 53:149-54. [PMID: 21755237 DOI: 10.1590/s0036-46652011000300006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 03/11/2011] [Indexed: 11/22/2022] Open
Abstract
Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities of CD4(+) and CD8(+) T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the elevated levels of IFN-γ and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in animal models.
Collapse
Affiliation(s)
- Erick Huarcaya
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Bartonella infection in immunocompromised hosts: immunology of vascular infection and vasoproliferation. Clin Dev Immunol 2011; 2012:612809. [PMID: 22162717 PMCID: PMC3227422 DOI: 10.1155/2012/612809] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/27/2011] [Accepted: 09/29/2011] [Indexed: 01/07/2023]
Abstract
Most infections by genus Bartonella in immunocompromised patients are caused by B. henselae and B. quintana. Unlike immunocompetent hosts who usually develop milder diseases such as cat scratch disease and trench fever, immunocompromised patients, including those living with HIV/AIDS and posttransplant patients, are more likely to develop different and severe life-threatening disease. This paper will discuss Bartonella's manifestations in immunosuppressed patients and will examine Bartonella's interaction with the immune system including its mechanisms of establishing infection and immune escape. Gaps in current understanding of the immunology of Bartonella infection in immunocompromised hosts will be highlighted.
Collapse
|
33
|
Ficociello J, Bradbury C, Morris A, Lappin MR. Detection of Bartonella henselae IgM in serum of experimentally infected and naturally exposed cats. J Vet Intern Med 2011; 25:1264-9. [PMID: 22092615 DOI: 10.1111/j.1939-1676.2011.00820.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/01/2011] [Accepted: 09/01/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Results of Bartonella henselae blood culture, polymerase chain reaction (PCR) assay on blood, or IgG antibody assays do not always correlate with the presence or absence of clinical disease in cats, and B. henselae IgG antibodies in serum do not always correlate with bacteremia. However, little is known concerning Bartonella spp. IgM antibodies in naturally exposed cats. HYPOTHESIS Bartonella spp. IgM antibodies in serum are associated with fever, stomatitis, and bacteremia based on PCR assay results in experimentally infected or client-owned cats. ANIMALS Stored sera from cats experimentally infected with B. henselae by exposure to Ctenocephalides felis, client-owned cats with and without fever, and client-owned cats with and without stomatitis were studied. METHODS A Bartonella spp. IgM ELISA was titrated with samples from experimentally infected cats and then test sera from client-owned cats were assayed. Associations among IgM ELISA results, clinical findings, and bacteremia as defined by Bartonella spp. PCR assay were assessed. RESULTS All experimentally infected cats developed Bartonella spp. IgM antibodies. Bartonella spp. IgM antibody assay results were not always in agreement with PCR assay results in client-owned cats (60%). Bartonella spp. DNA in blood, IgM antibodies, and IgG antibodies were not associated with the presence of fever or stomatitis. CONCLUSIONS AND CLINICAL IMPORTANCE Because Bartonella spp. IgM antibodies as measured by this assay were not associated with fever or stomatitis and were not always in agreement with PCR assay results, there appears to be little need for assessing individual client-owned cats for this antibody class alone.
Collapse
Affiliation(s)
- J Ficociello
- Department of Clinical Sciences, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO 80523, USA
| | | | | | | |
Collapse
|
34
|
Karris MY, Litwin CM, Dong HS, Vinetz J. Bartonella henselae infection of prosthetic aortic valve associated with colitis. Vector Borne Zoonotic Dis 2011; 11:1503-5. [PMID: 21702667 DOI: 10.1089/vbz.2010.0169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The diagnosis of infective endocarditis can be difficult, particularly with atypical presentation and negative blood cultures. A 61-year-old man with a porcine aortic valve presented with fever, intermittent confusion, diarrhea, and fatigue. In the community clinic setting, a colonoscopy performed for anemia demonstrated colitis. Symptoms progressed for months; elicitation of a history of significant kitten exposure and the finding of an axillary lymph node prompted testing for Bartonella henselae antibodies. High titer antibodies by indirect immunofluorescence assay indicated chronic B. henselae infection. Surgical valve replacement followed by prolonged doxycycline and rifampin led to cure. This case illustrates the complexities of infective endocarditis and is the first description B. henselae endocarditis associated with colitis in an immunocompetent adult.
Collapse
Affiliation(s)
- Maile Young Karris
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | | |
Collapse
|
35
|
Angelakis E, Edouard S, La Scola B, Raoult D. Bartonella henselae in skin biopsy specimens of patients with cat-scratch disease. Emerg Infect Dis 2011; 16:1963-5. [PMID: 21122232 PMCID: PMC3294597 DOI: 10.3201/eid1612.100647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During the past 2 years, we identified live Bartonella henselae in the primary inoculation sites of 3 patients after a cat scratch. Although our data are preliminary, we report that a cutaneous swab of the skin lesion from a patient in the early stage of cat-scratch disease can be useful for diagnosis of the infection.
Collapse
|
36
|
Sidiq T, Khajuria A, Suden P, Sharma R, Singh S, Suri KA, Satti NK, Johri RK. Possible role of macrophages induced by an irridoid glycoside (RLJ-NE-299A) in host defense mechanism. Int Immunopharmacol 2010; 11:128-35. [PMID: 21074614 DOI: 10.1016/j.intimp.2010.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 10/06/2010] [Accepted: 10/26/2010] [Indexed: 01/10/2023]
Abstract
In order to explore the possible role of macrophages and other necessary immune competent (T and B) cells in the modulation of immune responses, an attempt was made to study the immunomodulatory effect of an irridoid glycoside (RLJ-NE-299A) isolated from the roots of Picrorhiza kurroa. Both in vitro and in vivo studies were used to evaluate the effect of RLJ-NE-299A on humoral, cellular, and phagocytic activity of macrophages. The data obtained in the present study showed that RLJ-NE-299A significantly increased sheep red blood cell (SRBC) and induced antibody (IgM and IgG) titer and delayed type hypersensitivity (DTH) reaction in mice. Besides augmenting the humoral and cell-mediated immune response, it induced macrophage phagocytosis and stimulated cytokine-induced macrophage activation and nitric oxide (NO) production, which resulted in a high degree of protection against Candida albicans and Salmonella typhimurium infections. Flow cytometric analysis indicated the enhanced expression of co-stimulatory surface molecules CD80 and CD86. The ability of RLJ-NE-299A to upregulate these cell surface antigens involved in antigen presentation may provide an explanation for the increased T-cell mediated immunity involving macrophages. Taken together this in vitro and in vivo preclinical data suggests that RLJ-NE-299A acts as an effective immunomodulator specifically to improve macrophage function during infections. The effects of this agent on these cells at concentrations relevant to in vivo therapy support its immunopharmacologic application to modify cellular immunity.
Collapse
Affiliation(s)
- Tabasum Sidiq
- Division of Pharmacology, Indian Institute of Integrative Medicine (CSIR), Jammu-180001, India
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Piérard-Franchimont C, Quatresooz P, Piérard GE. Skin diseases associated with Bartonella infection: facts and controversies. Clin Dermatol 2010; 28:483-8. [PMID: 20797506 DOI: 10.1016/j.clindermatol.2010.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
Collapse
|
38
|
Colton L, Zeidner N, Lynch T, Kosoy MY. Human isolates of Bartonella tamiae induce pathology in experimentally inoculated immunocompetent mice. BMC Infect Dis 2010; 10:229. [PMID: 20673363 PMCID: PMC2920874 DOI: 10.1186/1471-2334-10-229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 07/30/2010] [Indexed: 11/30/2022] Open
Abstract
Background Bartonella tamiae, a newly described bacterial species, was isolated from the blood of three hospitalized patients in Thailand. These patients presented with headache, myalgia, anemia, and mild liver function abnormalities. Since B. tamiae was presumed to be the cause of their illness, these isolates were inoculated into immunocompetent mice to determine their relative pathogenicity in inducing manifestations of disease and pathology similar to that observed in humans. Methods Three groups of four Swiss Webster female mice aged 15-18 months were each inoculated with 106-7 colony forming units of one of three B. tamiae isolates [Th239, Th307, and Th339]. A mouse from each experimental group was sampled at 3, 4, 5 and 6 weeks post-inoculation. Two saline inoculated age-matched controls were included in the study. Samples collected at necropsy were evaluated for the presence of B. tamiae DNA, and tissues were formalin-fixed, stained with hematoxylin and eosin, and examined for histopathology. Results Following inoculation with B. tamiae, mice developed ulcerative skin lesions and subcutaneous masses on the lateral thorax, as well as axillary and inguinal lymphadenopathy. B. tamiae DNA was found in subcutaneous masses, lymph node, and liver of inoculated mice. Histopathological changes were observed in tissues of inoculated mice, and severity of lesions correlated with the isolate inoculated, with the most severe pathology induced by B. tamiae Th239. Mice inoculated with Th239 and Th339 demonstrated myocarditis, lymphadenitis with associated vascular necrosis, and granulomatous hepatitis and nephritis with associated hepatocellular and renal necrosis. Mice inoculated with Th307 developed a deep dermatitis and granulomas within the kidneys. Conclusions The three isolates of B. tamiae evaluated in this study induce disease in immunocompetent Swiss Webster mice up to 6 weeks after inoculation. The human patients from whom these isolates were obtained had clinical presentations consistent with the multi-organ pathology observed in mice in this study. This mouse model for B. tamiae induced disease not only strengthens the causal link between this pathogen and clinical illness in humans, but provides a model to further study the pathological processes induced by these bacteria.
Collapse
Affiliation(s)
- Leah Colton
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.
| | | | | | | |
Collapse
|
39
|
Lamas CC, Mares-Guia MA, Rozental T, Moreira N, Favacho ARM, Barreira J, Guterres A, Bóia MN, de Lemos ERS. Bartonella spp. infection in HIV positive individuals, their pets and ectoparasites in Rio de Janeiro, Brazil: serological and molecular study. Acta Trop 2010; 115:137-41. [PMID: 20206113 DOI: 10.1016/j.actatropica.2010.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 02/20/2010] [Accepted: 02/22/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bartonella is the agent of cat-scratch disease, but is also responsible for more severe conditions such as retinitis, meningoencephalitis, endocarditis and bacillary angiomatosis. Its seroprevalence is unknown in Brazil. METHODS Patients in an AIDS clinic, asymptomatic at the time of the study, were enrolled prospectively. They answered a structured questionnaire and had blood taken for serological and molecular assays. Cat breeder's pets were tested serologically and collected ectoparasites were tested by molecular biology techniques. Blood donors, paired by age and sex, were tested for Bartonella IgG antibodies. RESULTS 125 HIV positive patients with a median age of 34 were studied; 61 were male and 75% were on HAART. Mean most recent CD4 count was 351-500 cells/mm(3). A high rate of contact with ticks, fleas and lice was observed. Bartonella IgG seroreactivity rate was 38.4% in HIV positive individuals and breeding cats was closely associated with infection (OR 3.6, CI 1.1-11.9, p<0.05). No difference was found between the sexes. Titers were 1:32 in 39 patients, 1:64 in seven, 1:128 in one and 1:256 in one. In the control group, IgG seroreactivity to Bartonella spp. was 34%, and female sex was correlated to seropositivity. Fourteen of 61 (23%) males vs 29/64 (45.3%) females were seroreactive to Bartonella (OR 2.8, CI 1.2-6.5, p<0.01). Titers were 1:32 in 29 patients, 1:64 in ten and 1:128 in four. CONCLUSIONS Bartonella spp. seroprevalence is high in HIV positive and in blood donors in Rio de Janeiro. This may be of public health relevance.
Collapse
Affiliation(s)
- Cristiane C Lamas
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Disseminated bartonellosis presenting as neuroretinitis in a young adult with human immunodeficiency virus infection. Pediatr Infect Dis J 2010; 29:675-7. [PMID: 20216243 DOI: 10.1097/inf.0b013e3181d60a6d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rapidly declining visual acuity from neuroretinitis should prompt aggressive diagnostic intervention to preserve eyesight. We present a young adult with human immunodeficiency virus (HIV) infection in whom neuroretinitis was the presenting feature of disseminated bartonellosis. Tissue biopsy was required to establish the diagnosis and directed therapy was associated with restored vision.
Collapse
|
41
|
Dowers KL, Hawley JR, Brewer MM, Morris AK, Radecki SV, Lappin MR. Association of Bartonella species, feline calicivirus, and feline herpesvirus 1 infection with gingivostomatitis in cats. J Feline Med Surg 2010; 12:314-21. [DOI: 10.1016/j.jfms.2009.10.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2009] [Indexed: 11/27/2022]
Abstract
Feline gingivostomatitis (FGS) is a common syndrome in cats; feline calicivirus (FCV), feline herpesvirus 1 (FHV-1), and Bartonella species are common differential diagnoses. In this study, blood from 70 cats with FGS and 61 healthy control cats was tested for Bartonella species antibodies in serum by enzyme-linked immunosorbent assay and Western blot immunoassay and DNA in blood using a conventional polymerase chain reaction assay. Additionally, fresh oral biopsies from cats with FGS ( n=42) and 19 healthy controls were tested for FCV RNA, FHV-1 DNA and Bartonella species DNA. The prevalence rates for Bartonella species antibodies and DNA in the blood and the tissues did not differ between the two groups. FHV-1 DNA was also not significantly different between groups. Only FCV RNA was present in significantly more cats with FGS (40.5%) than control cats (0%). The results suggest that FCV was associated with FGS in some of the cats.
Collapse
Affiliation(s)
- Kristy L. Dowers
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Jennifer R. Hawley
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Melissa M. Brewer
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Arianne K. Morris
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Michael R. Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| |
Collapse
|
42
|
Disseminated Infection With Bartonella henselae in a Lung Transplant Recipient. J Heart Lung Transplant 2009; 28:736-9. [PMID: 19560704 DOI: 10.1016/j.healun.2009.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 03/05/2009] [Accepted: 03/09/2009] [Indexed: 11/21/2022] Open
|
43
|
Glass GE, Gardner-Santana LC, Holt RD, Chen J, Shields TM, Roy M, Schachterle S, Klein SL. Trophic garnishes: cat-rat interactions in an urban environment. PLoS One 2009; 4:e5794. [PMID: 19492061 PMCID: PMC2686234 DOI: 10.1371/journal.pone.0005794] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 05/08/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Community interactions can produce complex dynamics with counterintuitive responses. Synanthropic community members are of increasing practical interest for their effects on biodiversity and public health. Most studies incorporating introduced species have been performed on islands where they may pose a risk to the native fauna. Few have examined their interactions in urban environments where they represent the majority of species. We characterized house cat (Felis catus) predation on wild Norway rats (Rattus norvegicus), and its population effects in an urban area as a model system. Three aspects of predation likely to influence population dynamics were examined; the stratum of the prey population killed by predators, the intensity of the predation, and the size of the predator population. METHODOLOGY/PRINCIPAL FINDINGS Predation pressure was estimated from the sizes of the rat and cat populations, and the characteristics of rats killed in 20 alleys. Short and long term responses of rat population to perturbations were examined by removal trapping. Perturbations removed an average of 56% of the rats/alley but had no negative long-term impact on the size of the rat population (49.6+/-12.5 rats/alley and 123.8+/-42.2 rats/alley over two years). The sizes of the cat population during two years (3.5 animals/alley and 2.7 animals/alley) also were unaffected by rat population perturbations. Predation by cats occurred in 9/20 alleys. Predated rats were predominantly juveniles and significantly smaller (144.6 g+/-17.8 g) than the trapped rats (385.0 g+/-135.6 g). Cats rarely preyed on the larger, older portion of the rat population. CONCLUSIONS/SIGNIFICANCE The rat population appears resilient to perturbation from even substantial population reduction using targeted removal. In this area there is a relatively low population density of cats and they only occasionally prey on the rat population. This occasional predation primarily removes the juvenile proportion of the rat population. The top predator in this urban ecosystem appears to have little impact on the size of the prey population, and similarly, reduction in rat populations doesn't impact the size of the cat population. However, the selected targeting of small rats may locally influence the size structure of the population which may have consequences for patterns of pathogen transmission.
Collapse
Affiliation(s)
- Gregory E Glass
- The W Harry Feinstone Department of Molecular Microbiology & Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Scheidegger F, Ellner Y, Guye P, Rhomberg TA, Weber H, Augustin HG, Dehio C. Distinct activities of Bartonella henselae type IV secretion effector proteins modulate capillary-like sprout formation. Cell Microbiol 2009; 11:1088-101. [PMID: 19416269 DOI: 10.1111/j.1462-5822.2009.01313.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The zoonotic pathogen Bartonella henselae (Bh) can lead to vasoproliferative tumour lesions in the skin and inner organs known as bacillary angiomatosis and bacillary peliosis. The knowledge on the molecular and cellular mechanisms involved in this pathogen-triggered angiogenic process is confined by the lack of a suitable animal model and a physiologically relevant cell culture model of angiogenesis. Here we employed a three-dimensional in vitro angiogenesis assay of collagen gel-embedded endothelial cell (EC) spheroids to study the angiogenic properties of Bh. Spheroids generated from Bh-infected ECs displayed a high capacity to form sprouts, which represent capillary-like projections into the collagen gel. The VirB/VirD4 type IV secretion system and a subset of its translocated Bartonella effector proteins (Beps) were found to profoundly modulate this Bh-induced sprouting activity. BepA, known to protect ECs from apoptosis, strongly promoted sprout formation. In contrast, BepG, triggering cytoskeletal rearrangements, potently inhibited sprouting. Hence, the here established in vitro model of Bartonella- induced angiogenesis revealed distinct and opposing activities of type IV secretion system effector proteins, which together with a VirB/VirD4-independent effect may control the angiogenic activity of Bh during chronic infection of the vasculature.
Collapse
Affiliation(s)
- F Scheidegger
- Focal Area Infection Biology Biozentrum, University of Basel, Switzerland
| | | | | | | | | | | | | |
Collapse
|
45
|
Prevalence of Bartonella species antibodies and Bartonella species DNA in the blood of cats with and without fever. J Feline Med Surg 2009; 11:141-8. [DOI: 10.1016/j.jfms.2008.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2008] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to determine whether there are associations between Bartonella species antibody (enzyme-linked immunosorbent assay (ELISA) and Western blot (WB)) and polymerase chain reaction assay results in cats with and without fever. Afebrile control cats (39/93; 42.0%) were more likely to have Bartonella species antibodies than cats with fever (29/93; 31.2%). The difference in prevalence of Bartonella species deoxyribonucleic acid (DNA) in blood of cats with fever (14/81; 17.3%) as compared to afebrile control cats (6/81; 7.4%) approached statistical significance ( P=0.0571). Bartonella species ELISA or WB results frequently did not correlate to the presence or absence of Bartonella species DNA in blood. The results of this study indicate that in cats, Bartonella species antibody tests cannot predict whether fever is due to Bartonella species infection and should not be used to determine the Bartonella species infection status.
Collapse
|
46
|
Parasite interactions in natural populations: insights from longitudinal data. Parasitology 2008; 135:767-81. [PMID: 18474121 DOI: 10.1017/s0031182008000395] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The physiological and immunological state of an animal can be influenced by current infections and infection history. Consequently, both ongoing and previous infections can affect host susceptibility to another parasite, the biology of the subsequent infection (e.g. infection length) and the impact of infection on host morbidity (pathology). In natural populations, most animals will be infected by a succession of different parasites throughout the course of their lives, with probably frequent concomitant infections. The relative timing of different infections experienced by a host (i.e. the sequence of infection events), and the effects on factors such as host susceptibility and host survival, can only be derived from longitudinal data on individual hosts. Here we review some of the evidence for the impact of co-infection on host susceptibility, infection biology and pathology focusing on insights obtained from both longitudinal studies in humans and experiments that explicitly consider the sequence of infection. We then consider the challenges posed by longitudinal infection data collected from natural populations of animals. We illustrate their usefulness using our data of microparasite infections associated with field vole (Microtus agrestis) populations to examine impacts on susceptibility and infection length. Our primary aim is to describe an analytical approach that can be used on such data to identify interactions among the parasites. The preliminary analyses presented here indicate both synergistic and antagonistic interactions between microparasites within this community and emphasise that such interactions could have significant impacts on host-parasite fitness and dynamics.
Collapse
|
47
|
Florin TA, Zaoutis TE, Zaoutis LB. Beyond cat scratch disease: widening spectrum of Bartonella henselae infection. Pediatrics 2008; 121:e1413-25. [PMID: 18443019 DOI: 10.1542/peds.2007-1897] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bartonella henselae was discovered a quarter of a century ago as the causative agent of cat scratch disease, a clinical entity described in the literature for more than half a century. As diagnostic techniques improve, our knowledge of the spectrum of clinical disease resulting from infection with Bartonella is expanding. This review summarizes current knowledge regarding the microbiology, clinical manifestations, diagnostic techniques, and treatment of B. henselae infection.
Collapse
Affiliation(s)
- Todd A Florin
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | | | | |
Collapse
|
48
|
Lamas C, Curi A, Bóia MN, Lemos ERS. Human bartonellosis: seroepidemiological and clinical features with an emphasis on data from Brazil - A review. Mem Inst Oswaldo Cruz 2008; 103:221-35. [DOI: 10.1590/s0074-02762008000300001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Accepted: 05/06/2008] [Indexed: 11/21/2022] Open
Affiliation(s)
- C Lamas
- Laboratório de Hantaviroses e Rickettsioses; Fiocruz, Brasil
| | | | | | - ERS Lemos
- Laboratório de Hantaviroses e Rickettsioses
| |
Collapse
|
49
|
Kunz S, Oberle K, Sander A, Bogdan C, Schleicher U. Lymphadenopathy in a novel mouse model of Bartonella-induced cat scratch disease results from lymphocyte immigration and proliferation and is regulated by interferon-alpha/beta. THE AMERICAN JOURNAL OF PATHOLOGY 2008; 172:1005-18. [PMID: 18292236 DOI: 10.2353/ajpath.2008.070591] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In immunocompetent humans, cat scratch disease (CSD) is elicited by the Gram-negative bacterium Bartonella henselae and is characterized by a benign regional lymphadenopathy, the pathogenesis of which is poorly understood. Here, we describe a novel mouse model of Bartonella-induced CSD-like disease that allowed us to investigate the mechanisms leading to lymphadenopathy in vivo. In wild-type mice, a subcutaneous inoculation of either viable or inactivated B. henselae led to a strong swelling of the draining lymph node, which was long-lasting despite the rapid elimination of the bacteria. Carboxyfluorescein- and bromodesoxyuridine-labeling experiments showed that lymph node enlargement resulted from modified immigration and enhanced proliferation of lymphocytes, preferentially of B cells. A comparative analysis of B. henselae and the rodent pathogen B. grahamii in wild-type versus interferon-alpha/beta-receptor I chain-deficient mice revealed that interferon-alpha/beta is not only differentially induced by these two Bartonella species but also exerts an inhibitory effect on the development of lymphadenopathy both in vitro and in vivo. These data demonstrate that the lymphadenopathy of human CSD can be reproduced and studied in a mouse model and provide the first insights into the underlying immunological mechanisms.
Collapse
Affiliation(s)
- Stefanie Kunz
- Immunologie und Hygiene, Universitätsklinikum Erlangen, Wasserturmstrasse 3-5, Erlangen, Germany
| | | | | | | | | |
Collapse
|
50
|
Fontenelle JP, Powell CC, Hill AE, Radecki SV, Lappin MR. Prevalence of serum antibodies against Bartonella species in the serum of cats with or without uveitis. J Feline Med Surg 2007; 10:41-6. [PMID: 17719256 PMCID: PMC7129676 DOI: 10.1016/j.jfms.2007.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2007] [Indexed: 11/18/2022]
Abstract
Bartonella henselae has been implicated as a causative agent of chronic uveitis in people and in some cats. The objective of this study was to determine whether Bartonella species seroprevalence or titer magnitude varies among cats with uveitis, cats without ocular diseases recorded and healthy cats, while controlling for age and risk of flea exposure based on state of residence. There was no difference in seroprevalence rates or titer magnitude between cats with uveitis and cats with non-ocular diseases. Healthy cats were more likely to be seropositive for Bartonella species than cats with uveitis. The median Bartonella species titer was 1:64 for all groups, although healthy cats were more likely to have higher titers than cats with uveitis and cats with non-ocular disease. The results suggest that serum antibody tests alone cannot be used to document clinical uveitis associated with Bartonella species infection.
Collapse
|