1
|
Boodman C, Garcia OF, Kabbani D, Villalobos APC, Beeson A, Marx GE, van Griensven J, Doucette K. Donor-Derived Bartonella quintana Infection in Solid Organ Transplantation: An Emerging Public Health Issue With Diagnostic Challenges. Open Forum Infect Dis 2024; 11:ofae381. [PMID: 39192995 PMCID: PMC11348938 DOI: 10.1093/ofid/ofae381] [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: 06/05/2024] [Accepted: 07/04/2024] [Indexed: 08/29/2024] Open
Abstract
Bartonella quintana is a louse-borne intracellular bacterium that remains a neglected cause of bacteremia, bacillary angiomatosis, and infective endocarditis among individuals experiencing poverty. In October 2023, Health Canada notified Canadian organ transplantation programs of an outbreak of donor-derived B quintana infection. From March to August 2023, 5 cases of donor-derived B quintana disease were acquired in Alberta, Canada, from 3 deceased donors who had experienced homelessness. Similar cases recently occurred in the United States. In this article, we discuss strategies to screen organ donors and monitor transplant recipients for B quintana infection using epidemiologic risk factors, physical examination signs, and laboratory diagnostic tests. We review the limitations of existing diagnostic tests for B quintana and describe how these problems may be magnified in the organ transplantation context.
Collapse
Affiliation(s)
- Carl Boodman
- Division of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Unit of Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Oscar Fernandez Garcia
- Department of Infectious Disease, Faculty of Medicine and Dentistry Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dima Kabbani
- Department of Infectious Disease, Faculty of Medicine and Dentistry Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Amy Beeson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Grace E Marx
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Johan van Griensven
- Unit of Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Karen Doucette
- Department of Infectious Disease, Faculty of Medicine and Dentistry Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Aranda-Domene R, Sandoval E, Cuervo G, Fernández-Pittol M, de la María CG, Quintana E. Bartonella quintana pulmonary native valve endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:150-154. [PMID: 38827541 PMCID: PMC11139838 DOI: 10.1007/s12055-024-01727-4] [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: 01/28/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 06/04/2024] Open
Abstract
Bartonella quintana is a well-known cause of blood culture-negative endocarditis; however, pulmonary valve involvement is rare. The case of a 40-year-old African male who presented to the Emergency Department with chest pain, cardiac failure, and a 2-week history of fever is presented. Transoesophageal echocardiography confirmed an atrial septal defect, severe pulmonary insufficiency with large vegetations, severe mitral regurgitation due to anterior leaflet prolapse, and right ventricular dysfunction. Empirical antibiotic therapy was started, and urgent surgical intervention was decided. There were vegetations on the three pulmonary valve leaflets and the mitral valve. Closure of the atrial septal defect, mitral and tricuspid valve repair, pulmonary valve replacement with a biological prosthesis, and infundibuloplasty of the right ventricle were performed. The postoperative course was uneventful. Preoperative blood cultures were negative, and B. quintana was detected through 16S rRNA gene amplification and sequencing in mitral and pulmonary implants. Serology showed positive titers of 1/1260 for both B. quintana and B. henselae. Ceftriaxone and gentamicin were administered for 10 days, followed by oral doxycycline for 12 weeks. A one-year echocardiogram showed normal functioning of the pulmonary prosthesis and the mitral and tricuspid repair. Infection caused by B. quintana is a rare cause of endocarditis with negative blood cultures, and multivalvular and pulmonary valve involvement is exceptional. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-024-01727-4.
Collapse
Affiliation(s)
- Ramón Aranda-Domene
- Cardiovascular Surgery Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Cardiovascular Surgery Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariana Fernández-Pittol
- Department of Microbiology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Aubry A, Corvilain E, Ghelfenstein-Ferreira T, Camelena F, Meignin V, Berçot B, Le Goff J, Salmona M. Unmasking Bartonella henselae infection in the shadows of long COVID thanks to clinical metagenomics. Eur J Clin Microbiol Infect Dis 2024; 43:1025-1029. [PMID: 38472519 DOI: 10.1007/s10096-024-04801-2] [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: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024]
Abstract
The diagnosis of long COVID often relies on symptoms post-COVID-19, occasionally lacking biological evidence. This case study illustrates how investigating long COVID uncovered an underlying bartonellosis through clinical metagenomics. Following mild COVID-19, a 26-year-old woman experienced persistent symptoms during 5 months, including axillary adenopathy. Pathological examination, 16 S rRNA PCR, and clinical metagenomic analysis were done on an adenopathy biopsy. The latter revealed Bartonella henselae DNA and RNA. Treatment with clarithromycin improved symptoms. This case underscores the relevance of clinical metagenomics in diagnosing hidden infections. Post-COVID symptoms warrant thorough investigation, and bartonellosis should be considered in polyadenopathy cases, regardless of a recent history of cat or flea exposures.
Collapse
Affiliation(s)
- Aurélien Aubry
- Virology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Resistant Infectious Agents and Chemotherapy Research Unit, AGIR UR4294, Jules Verne University of Picardie, Amiens, 80000, France.
| | - Emilie Corvilain
- Clinical Immunology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Théo Ghelfenstein-Ferreira
- Parasitology-Mycology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Camelena
- Bacteriology Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- University Paris Cité, INSERM 1137, IAME, Paris, France
| | - Véronique Meignin
- Pathology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Béatrice Berçot
- Bacteriology Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- University Paris Cité, INSERM 1137, IAME, Paris, France
| | - Jérôme Le Goff
- Virology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
- University Paris Cité, Inserm U976, INSIGHT Team, Paris, France
| | - Maud Salmona
- Virology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
- University Paris Cité, Inserm U976, INSIGHT Team, Paris, France
| |
Collapse
|
4
|
Boodman C, Gupta N, Nelson CA, van Griensven J. Bartonella quintana Endocarditis: A Systematic Review of Individual Cases. Clin Infect Dis 2024; 78:554-561. [PMID: 37976173 DOI: 10.1093/cid/ciad706] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Bartonella quintana is a louse-borne bacterium that remains a neglected cause of endocarditis in low-resource settings. Our understanding of risk factors, clinical manifestations, and treatment of B. quintana endocarditis are biased by older studies from high-income countries. METHODS We searched Pubmed Central, Medline, Scopus, Embase, EBSCO (CABI) Global Health, Web of Science and international trial registers for articles published before March 2023 with terms related to Bartonella quintana endocarditis. We included articles containing case-level information on B. quintana endocarditis and extracted data related to patient demographics, clinical features, diagnostic testing, treatment, and outcome. RESULTS A total of 975 records were identified, of which 569 duplicates were removed prior to screening. In total, 84 articles were eligible for inclusion, describing a total of 167 cases. Infections were acquired in 40 different countries; 62 cases (37.1%) were acquired in low- and middle-income countries (LMICs). Disproportionately more female and pediatric patients were from LMICs. More patients presented with heart failure (n = 70/167 [41.9%]) than fever (n = 65/167 [38.9%]). Mean time from symptom onset to presentation was 5.1 months. Also, 25.7% of cases (n = 43/167) were associated with embolization, most commonly to the spleen and brain; 65.5% of antimicrobial regimens included doxycycline. The vast majority of cases underwent valve replacement surgery (n = 154/167, [98.0%]). Overall case fatality rate was 9.6% (n = 16/167). CONCLUSIONS B. quintana endocarditis has a global distribution, and long delays between symptom onset and presentation frequently occur. Improved clinician education and diagnostic capacity are needed to screen at-risk populations and identify infection before endocarditis develops.
Collapse
Affiliation(s)
- Carl Boodman
- Division of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nitin Gupta
- Department of Infectious Disease, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Christina A Nelson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Johan van Griensven
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
5
|
De Cristofaro J, Sacchi S, Baldetti L, Calvo F, Gramegna M, Pazzanese V, Peveri B, Cianfanelli L, Ajello S, Scandroglio AM. Cat Scratch Endocarditis. JACC Case Rep 2024; 29:102201. [PMID: 38361554 PMCID: PMC10865220 DOI: 10.1016/j.jaccas.2023.102201] [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: 09/21/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 02/17/2024]
Abstract
We reported a case of blood culture-negative infective endocarditis on a native valve, where the clinical presentation was exclusively related to extensive cerebral ischemia secondary to multiple systemic septic cardioembolic events. The cause was ascribed to subacute Bartonella henselae infection, presumably transmitted by cat scratch, documented by positive serologic findings.
Collapse
Affiliation(s)
| | - Stefania Sacchi
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Francesco Calvo
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Mario Gramegna
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Beatrice Peveri
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | | | - Silvia Ajello
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | | |
Collapse
|
6
|
Pizzuti M, Bailey P, Derrick C, Albrecht B, Carr AL, Covington EW, Deri CR, Green SB, Hayes J, Hobbs ALV, Hornback KM, Keil E, Lukas JG, Seddon M, Taylor AD, Torrisi J, Bookstaver PB. Epidemiology and treatment of invasive Bartonella spp. infections in the United States. Infection 2024:10.1007/s15010-024-02177-1. [PMID: 38300353 DOI: 10.1007/s15010-024-02177-1] [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: 10/27/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses. This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes. METHODS Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination. RESULTS Patients were primarily male (n = 25, 61.0%), white (n = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology (n = 34, 82.9%), with Bartonella henselae (n = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin (n = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment (n = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability (n = 5, 31.3%). CONCLUSIONS In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.
Collapse
Affiliation(s)
- Morgan Pizzuti
- Prisma Health Richland, 5 Richland Medical Park Drive, Columbia, SC, 29203, USA.
| | - Pamela Bailey
- Prisma Health Richland, 5 Richland Medical Park Drive, Columbia, SC, 29203, USA.
- University of South Carolina School of Medicine, 2 Richland Medical Park Drive, Suite 205, Columbia, SC, 29203, USA.
| | - Caroline Derrick
- Prisma Health Richland, 5 Richland Medical Park Drive, Columbia, SC, 29203, USA
| | | | | | | | - Connor R Deri
- Duke University Hospital, Durham, NC, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | | | | | | | | | | | | | - Megan Seddon
- Sarasota Memorial Health Care System, Sarasota, FL, USA
| | - Alex D Taylor
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | | |
Collapse
|
7
|
Boodman C, Fongwen N, Pecoraro AJ, Mihret A, Abayneh H, Fournier PE, Gupta N, van Griensven J. Hidden Burden of Bartonella quintana on the African Continent: Should the Bacterial Infection Be Considered a Neglected Tropical Disease? Open Forum Infect Dis 2024; 11:ofad672. [PMID: 38370291 PMCID: PMC10873695 DOI: 10.1093/ofid/ofad672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 02/20/2024] Open
Abstract
Bartonella quintana is a louse-borne gram-negative bacillus that remains a poorly characterized cause of bacteremia, fever, and infective endocarditis. Due to the link with pediculosis, B quintana transmission is tied to poverty, conflict, overcrowding, and inadequate water access to maintain personal hygiene. Although these risk factors may be present globally, we argue that a substantial burden of undocumented B quintana infection occurs in Africa due to the high prevalence of these risk factors. Here, we describe the neglected burden of B quintana infection, endocarditis, and vector positivity in Africa and evaluate whether B quintana meets criteria to be considered a neglected tropical disease according to the World Health Organization.
Collapse
Affiliation(s)
- Carl Boodman
- Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Unit of Neglected Tropical Diseases, Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
| | - Noah Fongwen
- Diagnostics Access, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Alfonso J Pecoraro
- Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Adane Mihret
- Microbiology Department, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Hiwot Abayneh
- Microbiology Department, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Pierre-Edouard Fournier
- French Reference Center for Rickettsioses, Q Fever and Bartonelloses, Institut Hospitalier Universitaire, Marseille, France
| | - Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, India
| | - Johan van Griensven
- Unit of Neglected Tropical Diseases, Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
8
|
Burban A, Słupik D, Reda A, Szczerba E, Grabowski M, Kołodzińska A. Novel Diagnostic Methods for Infective Endocarditis. Int J Mol Sci 2024; 25:1245. [PMID: 38279244 PMCID: PMC10816594 DOI: 10.3390/ijms25021245] [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: 12/15/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Infective endocarditis (IE) remains a dangerous disease and continues to have a high mortality rate. Unfortunately, despite continuous improvements in diagnostic methods, in many cases, blood cultures remain negative, and the pathogen causing endocarditis is unknown. This makes targeted therapy and the selection of appropriate antibiotics impossible. Therefore, we present what methods can be used to identify the pathogen in infective endocarditis. These are mainly molecular methods, including PCR and MGS, as well as imaging methods using radiotracers, which offer more possibilities for diagnosing IE. However, they are still not widely used in the diagnosis of IE. The article summarizes in which cases we should choose them and what we are most hopeful about in further research into the diagnosis of IE. In addition, registered clinical trials that are currently underway for the diagnosis of IE are also presented.
Collapse
Affiliation(s)
- Anna Burban
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dorota Słupik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Reda
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Ewa Szczerba
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Kołodzińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| |
Collapse
|
9
|
Motzer AR, Mudroch S, Schultz S, Sullivan KV, Altneu E. The Brief Case: Bartonella quintana aortic and mitral valve endocarditis identified through 16S rRNA sequencing. J Clin Microbiol 2024; 62:e0040223. [PMID: 38230945 PMCID: PMC10793333 DOI: 10.1128/jcm.00402-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Affiliation(s)
- Andrew R. Motzer
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Steven Mudroch
- Section of Infectious Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Sara Schultz
- Section of Infectious Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Kaede V. Sullivan
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Eric Altneu
- Section of Infectious Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
Kitamura M, Dasgupta A, Henricks J, Parikh SV, Nadasdy T, Clark E, Bazan JA, Satoskar AA. Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis - our experience and a pooled analysis. FRONTIERS IN NEPHROLOGY 2024; 3:1322741. [PMID: 38288381 PMCID: PMC10823370 DOI: 10.3389/fneph.2023.1322741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024]
Abstract
Background Although Staphylococcus aureus is the leading cause of acute infective endocarditis (IE) in adults, Bartonella spp. has concomitantly emerged as the leading cause of "blood culture-negative IE" (BCNE). Pre-disposing factors, clinical presentation and kidney biopsy findings in Bartonella IE-associated glomerulonephritis (GN) show subtle differences and some unique features relative to other bacterial infection-related GNs. We highlight these features along with key diagnostic clues and management approach in Bartonella IE-associated GN. Methods We conducted a pooled analysis of 89 cases of Bartonella IE-associated GN (54 published case reports and case series; 18 published conference abstracts identified using an English literature search of several commonly used literature search modalities); and four unpublished cases from our institution. Results Bartonella henselae and Bartonella quintana are the most commonly implicated species causing IE in humans. Subacute presentation, affecting damaged native and/or prosthetic heart valves, high titer anti-neutrophil cytoplasmic antibodies (ANCA), mainly proteinase-3 (PR-3) specificity, fastidious nature and lack of positive blood cultures of these Gram-negative bacilli, a higher frequency of focal glomerular crescents compared to other bacterial infection-related GNs are some of the salient features of Bartonella IE-associated GN. C3-dominant, but frequent C1q and IgM immunofluorescence staining is seen on biopsy. A "full-house" immunofluorescence staining pattern is also described but can be seen in IE -associated GN due to other bacteria as well. Non-specific generalized symptoms, cytopenia, heart failure and other organ damage due to embolic phenomena are the highlights on clinical presentation needing a multi-disciplinary approach for management. Awareness of the updated modified Duke criteria for IE, a high index of suspicion for underlying infection despite negative microbiologic cultures, history of exposure to animals, particularly infected cats, and use of send-out serologic tests for Bartonella spp. early in the course of management can help in early diagnosis and initiation of appropriate treatment. Conclusion Diagnosis of IE-associated GN can be challenging particularly with BCNE. The number of Bartonella IE-associated GN cases in a single institution tends to be less than IE due to gram positive cocci, however Bartonella is currently the leading cause of BCNE. We provide a much-needed discussion on this topic.
Collapse
Affiliation(s)
- Mineaki Kitamura
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Alana Dasgupta
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jonathan Henricks
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Samir V. Parikh
- Department of Internal Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tibor Nadasdy
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Edward Clark
- Department of Internal Medicine, St. Vincent Hospital, Erie, PA, United States
| | - Jose A. Bazan
- Department of Internal Medicine, Division of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Anjali A. Satoskar
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
11
|
Sulaiman ZI, Schwade M, Raposa JT, Desai S, Mohan G, Schafer PE, Huggett AL. Paws and Pathogens: A Multidisciplinary Approach Through Bartonella henselae Endocarditis and Hepatosplenic T-Cell Lymphoma. J Investig Med High Impact Case Rep 2024; 12:23247096241262718. [PMID: 39044602 PMCID: PMC11268036 DOI: 10.1177/23247096241262718] [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: 04/17/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 07/25/2024] Open
Abstract
Bartonella species are gram-negative coccobacilli that are globally recognized as significant pathogens causing zoonotic infections. Among Bartonella species, B. henselae, B. quintana, and B. bacilliformis are prominent pathogens causing infections in humans, often manifesting as infective endocarditis. Bartonella endocarditis can pose diagnostic challenges due to its indolent presentation and limitations of standard microbiological culture techniques to identify the organism. We report a case of a 23-year-old male, who initially presented with the manifestations of hepatosplenic T-cell lymphoma, later diagnosed with blood culture-negative endocarditis caused by B. henselae. The patient had a complicated clinical course including pancytopenia, hepatosplenomegaly, and severe aortic valve regurgitation. Despite negative blood cultures, diagnostic clues included persistent fevers and bicuspid aortic valve with abscess. High Bartonella IgG titers (>1:800) supported the diagnosis. This case underscores the importance of considering Bartonella species in patients with suspected endocarditis, particularly in those with predisposing factors and negative blood cultures. Diagnosis relies heavily on serologic assays due to low sensitivity of conventional culture methods. Treatment involves a multidisciplinary approach with antibiotics and surgical intervention for optimal outcomes. Timely recognition and management are crucial to mitigate the high mortality associated with Bartonella endocarditis, and we hope this article offers insight for clinicians.
Collapse
Affiliation(s)
- Zoheb Irshad Sulaiman
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Wellstar MCG Health, Augusta, GA, USA
| | - Mark Schwade
- Department of Medicine, Medical College of Georgia, Wellstar MCG Health, Augusta, GA, USA
| | - Jesse T. Raposa
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Wellstar MCG Health, Augusta, GA, USA
| | - Shreya Desai
- Division of Hematology and Medical Oncology, Department of Medicine, Medical College of Georgia, Wellstar MCG Health, Augusta, GA, USA
| | - Gem Mohan
- Division of Cardiology, Department of Medicine, Medical College of Georgia, Wellstar MCG Health, Augusta, GA, USA
| | - Pascha E. Schafer
- Division of Cardiology, Department of Medicine, Medical College of Georgia, Wellstar MCG Health, Augusta, GA, USA
| | - Ashley L. Huggett
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Wellstar MCG Health, Augusta, GA, USA
| |
Collapse
|
12
|
Sarsiat L, Garrigos T, Houhamdi L, Dauwalder O, Kuli B, Braunberger E, Belmonte O, Fournier PE, Miltgen G. Case series of 12 Bartonella quintana endocarditis from the Southwest Indian Ocean. PLoS Negl Trop Dis 2023; 17:e0011606. [PMID: 37676863 PMCID: PMC10508605 DOI: 10.1371/journal.pntd.0011606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/19/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Bartonella spp. are fastidious bacteria frequently identified as the cause of blood culture-negative (BCN) endocarditis. However, Bartonella infections are difficult to diagnose in routine laboratory testing and their incidence is probably underestimated. We investigated the epidemiological and clinical features of Bartonella endocarditis cases diagnosed between 2009 and 2021 on Reunion Island (Southwest Indian Ocean). METHOD We retrospectively included all patients diagnosed with Bartonella endocarditis at Reunion Island University Hospital during this period. Endocarditis was diagnosed on the basis of microbiological findings, including serological tests (IFA) and PCR on cardiac valves, and the modified Duke criteria. We used then the multispacer typing (MST) method to genotype the available Bartonella strains. FINDINGS We report 12 cases of B. quintana endocarditis on Reunion Island (83.3% in men, median patient age: 32 years). All the patients originated from the Comoros archipelago. The traditional risk factors for B. quintana infection (homelessness, alcoholism, exposure to body lice) were absent in all but two of the patients, who reported head louse infestations in childhood. Previous heart disease leading to valve dysfunction was recorded in 50% of patients. All patients underwent cardiac valve surgery and antimicrobial therapy with a regimen including doxycycline. All patients presented high C-reactive protein concentrations, anemia and negative blood cultures. The titer of IgG antibodies against Bartonella sp. exceeded 1:800 in 42% of patients. Specific PCR on cardiac valves confirmed the diagnosis of B. quintana endocarditis in all patients. Genotyping by the MST method was performed on four strains detected in preserved excised valves and was contributive for three, which displayed the MST6 genotype. CONCLUSIONS Bartonella quintana is an important cause of infective endocarditis in the Comoros archipelago and should be suspected in patients with mitral valve dysfunction and BCN from this area.
Collapse
Affiliation(s)
- Ludivine Sarsiat
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Thomas Garrigos
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France
| | - Linda Houhamdi
- CNR des Rickettsies, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
| | - Olivier Dauwalder
- Plateau de Microbiologie Moléculaire Spécialisé et de Séquençage, Institut des Agents Infectieux, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France
| | - Barbara Kuli
- Service de Maladies Infectieuses, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Eric Braunberger
- Service de Chirurgie Cardio-thoracique, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Olivier Belmonte
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Pierre-Edouard Fournier
- CNR des Rickettsies, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
- UMR Vecteurs—Infections Tropicales et Méditerranéennes (VITROME), Université d’Aix-Marseille, IRD, AP-HM, SSA, IHU-Méditerranée Infection, Marseille, France
| | - Guillaume Miltgen
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France
- Centre Régional en Antibiothérapie (CRAtb) de La Réunion, France
| |
Collapse
|
13
|
McHugh J, Saleh OA. Updates in Culture-Negative Endocarditis. Pathogens 2023; 12:1027. [PMID: 37623987 PMCID: PMC10459830 DOI: 10.3390/pathogens12081027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Blood culture-negative infective endocarditis (BCNE) is a challenging condition associated with significant morbidity and mortality. This review discusses the epidemiology, microbiology, diagnosis, and treatment of BCNE considering advancements in molecular diagnostics and increased access to cardiac surgery. BCNE can be categorized into bacterial endocarditis with sterilized blood cultures due to previous antibiotic treatment, endocarditis caused by fastidious microorganisms, and true BCNE caused by intracellular organisms that cannot be cultured using traditional techniques. Non-infectious causes such as nonbacterial thrombotic endocarditis should also be considered. Diagnostic approaches involve thorough patient history; blood and serum testing, including appropriate handling of blood cultures; serological testing; and molecular techniques such as targeted and shotgun metagenomic sequencing. Where available, evaluation of explanted cardiac tissue through histopathology and molecular techniques is crucial. The therapy for BCNE depends on the likely causative agent and the presence of prosthetic material, with surgical intervention often required.
Collapse
Affiliation(s)
- Jack McHugh
- Division of Public Health, Infectious Diseases, Occupational Medicine, Mayo Clinic, Rochester, MN 55901, USA;
| | | |
Collapse
|
14
|
Ordaya EE, Abu Saleh OM, Mahmood M. Reply to Boodman et al. Open Forum Infect Dis 2023; 10:ofad437. [PMID: 37663089 PMCID: PMC10468736 DOI: 10.1093/ofid/ofad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Eloy E Ordaya
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
15
|
Ruffier D’Epenoux L, Fayoux E, Guillouzouic A, Lecomte R, Le Tourneau T, Le Lan N, Tessier E, Bémer P, Corvec S. The Brief Case: A Mixed Cutibacterium Species Positive Valve Culture Hiding a Bartonella Infective Endocarditis. J Clin Microbiol 2023; 61:e0076822. [PMID: 37470477 PMCID: PMC10358181 DOI: 10.1128/jcm.00768-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Affiliation(s)
- L. Ruffier D’Epenoux
- Service de Bactériologie et des Contrôles Microbiologiques, CHU de Nantes, Nantes, France
- Université de Nantes, CHU Nantes, INSERM, INCIT U1302, Nantes, France
| | - E. Fayoux
- Service de Bactériologie et des Contrôles Microbiologiques, CHU de Nantes, Nantes, France
| | - A. Guillouzouic
- Service de Bactériologie et des Contrôles Microbiologiques, CHU de Nantes, Nantes, France
| | - R. Lecomte
- Service des Maladies Infectieuses et Tropicales, CHU de Nantes, Nantes, France
| | - T. Le Tourneau
- L’institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | - N. Le Lan
- Laboratoire d'anatomopathologie, CHU de Nantes, Nantes, France
| | - E. Tessier
- Service de Bactériologie et des Contrôles Microbiologiques, CHU de Nantes, Nantes, France
| | - P. Bémer
- Service de Bactériologie et des Contrôles Microbiologiques, CHU de Nantes, Nantes, France
| | - S. Corvec
- Service de Bactériologie et des Contrôles Microbiologiques, CHU de Nantes, Nantes, France
- Université de Nantes, CHU Nantes, INSERM, INCIT U1302, Nantes, France
| |
Collapse
|
16
|
Charles K, Abraham A, Bassi R, Elsadek R, Cockey G. A Rare Case of Bartonella henselae Infective Endocarditis Causing an Embolic Cerebrovascular Accident. Cureus 2023; 15:e41364. [PMID: 37546133 PMCID: PMC10399704 DOI: 10.7759/cureus.41364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Bartonella is a facultative intracellular Gram-negative aerobic rod that is an important cause of culture-negative endocarditis that only accounts for 3% of all infective endocarditis (IE) cases. Throughout the literature, there have been very few documented cases of an embolic stroke caused by Bartonella henselae (B. henselae) IE. Following a comprehensive review of the literature, it appears that only a small number of articles have reported on the correlation between cerebrovascular accidents (CVAs) and Bartonella IE. Here, we present a case of a 42-year-old male with a cerebral embolic event as a complication of B. henselae IE.
Collapse
Affiliation(s)
- Kipson Charles
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - Andrew Abraham
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - Raghav Bassi
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - Rabab Elsadek
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| | - George Cockey
- Internal Medicine, University of Central Florida College of Medicine, Graduate Medical Education/Hospital Corporation of America (HCA) Florida, North Florida Hospital, Gainesville, USA
| |
Collapse
|
17
|
Ordaya EE, Abu Saleh OM, Mahmood M. "Let the Cat Out of the Heart": Clinical Characteristics of Patients Presenting With Blood Culture-Negative Endocarditis Due to Bartonella Species. Open Forum Infect Dis 2023; 10:ofad293. [PMID: 37520412 PMCID: PMC10372712 DOI: 10.1093/ofid/ofad293] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/26/2023] [Indexed: 08/01/2023] Open
Abstract
Patients with blood culture-negative endocarditis due to Bartonella infection frequently presented with fever, cytopenias, kidney failure, and positive PR3-ANCA. Bartonella IgG titers were variable. Patients commonly underwent surgery with overall low mortality.
Collapse
Affiliation(s)
- Eloy E Ordaya
- Correspondence: Eloy E. Ordaya, MD, Mayo Clinic, Division of Public Health, Infectious Diseases, and Occupational Medicine, 200 First Street SW, Rochester, MN 55905 ()
| | - Omar M Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|
18
|
Drummond MR, Dos Santos LS, de Almeida AR, Lins KDA, Barjas-Castro ML, Diniz PPVDP, Velho PENF. Comparison of molecular methods for Bartonella henselae detection in blood donors. PLoS Negl Trop Dis 2023; 17:e0011336. [PMID: 37262044 DOI: 10.1371/journal.pntd.0011336] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/25/2023] [Indexed: 06/03/2023] Open
Abstract
The Bartonella genus consists of neglected pathogens associated with potentially transfusional-transmitted and fatal human diseases. We aimed to evaluate Bartonella sp. prevalence in 500 blood donors and compare the results with the data already published about these samples. We used molecular diagnostic methods to detect Bartonella sp.-DNA from blood and liquid culture samples: (A) conventional PCR for two gene regions, the ITS targeting the genus Bartonella and the specific gltA Bartonella henselae; (B) nested PCR for the ftsZ gene and (C) qualitative real-time PCR for the gltA gene, both B. henselae specific. We obtained 30/500 (6%) DNA detections from the blood samples; 77/500 (15.4%) DNA detections from liquid culture samples and five (1%) samples had DNA detection from both. In total, we detected B. henselae DNA from 102/500 (20.4%) donors. The samples used in this study had already been submitted for Bartonella sp.-DNA detection using only a conventional PCR in liquid culture. Sixteen samples (3.2%) were positive previously, and from these 16 samples, 13 were negative in the new investigation. We concluded that the use of liquid culture combined with different molecular tests increases the possibility of detecting Bartonella sp.-DNA, but the tests do not avoid false-negative results. More than a fifth of blood donors had at least one PCR that detected Bartonella sp.-DNA among the eight molecular reactions performed now (four reactions in whole blood and four in liquid culture). Seven percent had B. henselae-DNA detection for two or more distinct regions. Considering the results obtained previously, the DNA of Bartonella spp. was detected or the agent isolated in 23% of analyzed blood donors. The results establish that the low bacteremia and the fastidious characteristics of the bacterium are challenges to laboratory diagnosis and can make it difficult to confirm the infection in patients with bartonelloses.
Collapse
Affiliation(s)
- Marina Rovani Drummond
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas-UNICAMP; Campinas, Sao Paulo, Brazil
| | - Luciene Silva Dos Santos
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas-UNICAMP; Campinas, Sao Paulo, Brazil
| | - Amanda Roberta de Almeida
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas-UNICAMP; Campinas, Sao Paulo, Brazil
| | - Karina de Almeida Lins
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas-UNICAMP; Campinas, Sao Paulo, Brazil
| | | | | | - Paulo Eduardo Neves Ferreira Velho
- Applied Research in Dermatology and Bartonella Infection Laboratory, University of Campinas-UNICAMP; Campinas, Sao Paulo, Brazil
- Division of Dermatology, Department of Medicine, UNICAMP, Campinas, Sao Paulo, Brazil
| |
Collapse
|
19
|
Drummond MR, Santos LSD, Souza LB, Mitsuushi GN, Cintra ML, França AFEDC, Souza EMD, Velho PENF. Detection of Bartonella henselae DNA in the blood of patients with livedoid vasculopathy. An Bras Dermatol 2023:S0365-0596(23)00066-1. [PMID: 36973097 DOI: 10.1016/j.abd.2022.07.007] [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: 05/18/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Livedoid vasculopathy (LV) manifests as ulcers and atrophic white scars on the lower extremities. The main known etiopathogenesis is hypercoagulability with thrombus formation, followed by inflammation. Thrombophilia, collagen and myeloproliferative diseases may induce LV, but the idiopathic (primary) form predominates. Bartonella sp. may cause intra-endothelial infection and skin manifestations caused by these bacteria may be diverse, including leukocytoclastic vasculitis and ulcers. OBJECTIVE The aim of this study was to investigate the presence of bacteremia by Bartonella spp. in patients with difficult-to-control chronic ulcers diagnosed as primary LV. METHODS Questionnaires and molecular tests (conventional PCR, nested PCR and real-time PCR) were applied and liquid and solid cultures were performed in the blood samples and blood clot of 16 LV patients and 32 healthy volunteers. RESULTS Bartonella henselae DNA was detected in 25% of LV patients and in 12.5% of control subjects but failed to reach statistically significant differences (p = 0.413). STUDY LIMITATIONS Due to the rarity of primary LV, the number of patients studied was small and there was greater exposure of the control group to risk factors for Bartonella spp. INFECTION CONCLUSION Although there was no statistically significant difference between the groups, the DNA of B. henselae was detected in one of every four patients, which reinforces the need to investigate Bartonella spp. in patients with primary LV.
Collapse
Affiliation(s)
- Marina Rovani Drummond
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil.
| | - Luciene Silva Dos Santos
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Lais Bomediano Souza
- Department of Medicine, Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, SP, Brazil
| | - Gabriela Nero Mitsuushi
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Maria Letícia Cintra
- Department of Pathological Anatomy, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | | | - Elemir Macedo de Souza
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| |
Collapse
|
20
|
McCormick DW, Rassoulian-Barrett SL, Hoogestraat DR, Salipante SJ, SenGupta D, Dietrich EA, Cookson BT, Marx GE, Lieberman JA. Bartonella spp. Infections Identified by Molecular Methods, United States. Emerg Infect Dis 2023; 29:467-476. [PMID: 36823096 PMCID: PMC9973681 DOI: 10.3201/eid2903.221223] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Molecular methods can enable rapid identification of Bartonella spp. infections, which are difficult to diagnose by using culture or serology. We analyzed clinical test results of PCR that targeted bacterial 16S rRNA hypervariable V1-V2 regions only or in parallel with PCR of Bartonella-specific ribC gene. We identified 430 clinical specimens infected with Bartonella spp. from 420 patients in the United States. Median patient age was 37 (range 1-79) years; 62% were male. We identified B. henselae in 77%, B. quintana in 13%, B. clarridgeiae in 1%, B. vinsonii in 1%, and B. washoensis in 1% of specimens. B. quintana was detected in 83% of cardiac specimens; B. henselae was detected in 34% of lymph node specimens. We detected novel or uncommon Bartonella spp. in 9 patients. Molecular diagnostic testing can identify Bartonella spp. infections, including uncommon and undescribed species, and might be particularly useful for patients who have culture-negative endocarditis or lymphadenitis.
Collapse
Affiliation(s)
- David W. McCormick
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)
- University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
| | - Sara L. Rassoulian-Barrett
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)
- University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
| | - Daniel R. Hoogestraat
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)
- University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
| | - Stephen J. Salipante
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)
- University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
| | - Dhruba SenGupta
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)
- University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
| | - Elizabeth A. Dietrich
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)
- University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
| | - Brad T. Cookson
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)
- University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
| | | | | |
Collapse
|
21
|
Lin KP, Yeh TK, Chuang YC, Wang LA, Fu YC, Liu PY. Blood Culture Negative Endocarditis: A Review of Laboratory Diagnostic Approaches. Int J Gen Med 2023; 16:317-327. [PMID: 36718144 PMCID: PMC9884005 DOI: 10.2147/ijgm.s393329] [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: 10/18/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Infective endocarditis is a potentially fatal condition, and identifying the pathogen is crucial to optimizing antibiotic treatment. While a blood culture takes time and may yield negative results, it remains the gold standard for diagnosis, blood culture-negative endocarditis, which accounts for up to 20% of infective endocarditis cases, poses a clinical challenge with increasing mortality. To better understand the etiology of blood culture-negative infective endocarditis, we reviewed non-culture-based strategies and compared the results. Serology tests work best in limited pathogens, such as Coxiella burnetii and Bartonella infections. Most of the pathogens identified by broad-range PCR tests are Streptococcus spp, Staphylococcus spp and Propionibacterium spp. adding specific real-time PCR assays to the systematic PCR testing of patients with blood culture-negative endocarditis will increase the efficiency of diagnosis. Recently, metagenomic next-generation sequencing has also shown promising results.
Collapse
Affiliation(s)
- Kuan-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Kuang Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Genomic Center for Infectious Diseases, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chuan Chuang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-An Wang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Ching Fu
- Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Correspondence: Yun-Ching Fu; Po-Yu Liu, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Blvd, Xitun District, Taichung City, 40705, Taiwan, Tel +886-4-2359-2525 ext.3110, Fax +886-4-2359-5046, Email ;
| | - Po-Yu Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| |
Collapse
|
22
|
Mullins K, Canal E, Ouch P, Prasetyo D, Tagoe J, Attram N, Yeboah C, Kumordjie S, Fox A, Letizia AG, Rachlin A, Nguyen HM, Robinson MT, Vongsouvath M, Davong V, Maxay M, Simons MP, Caranci A, Newton PN, Richards AL, Farris CM. Bartonella Species in Cambodia, Ghana, Laos, and Peru: Results from Vector and Serosurveys. Vector Borne Zoonotic Dis 2023; 23:9-17. [PMID: 36633562 PMCID: PMC7614129 DOI: 10.1089/vbz.2021.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Bartonella species are fastidious gram-negative vector-borne bacteria with a wide range of mammalian reservoirs. While it is understood that some species of Bartonella are human pathogens, the extent of human exposure to Bartonella species (both pathogenic and nonpathogenic) is yet to be fully understood. Materials and Methods: To this end, residual sera from participants enrolled in undifferentiated fever studies in Cambodia, Ghana, Laos, and Peru were screened for the presence of IgG antibodies against Bartonella quintana and Bartonella henselae, using the FOCUS diagnostics Dual Spot- Bartonella IgG Immunofluorescence assay. Forty-eight patients with suspected or confirmed Bartonella bacilliformis exposure or infection in Peru were screened to assess cross-reactivity of the FOCUS assay for IgG against other Bartonella species. Results: Ten of 13 patients with confirmed B. bacilliformis infection were Bartonella-specific IgG positive, and overall, 36/48 of the samples were positive. In addition, 79/206, 44/200, 101/180, and 57/100 of the samples from Peru, Laos, Cambodia, and Ghana, respectively, were Bartonella-specific IgG positive. Furthermore, ectoparasite pools from Cambodia, Laos, and Peru were tested using quantitative real-time PCR (qPCR) for the presence of Bartonella DNA. Of the sand fly pools collected in Peru, 0/196 were qPCR positive; 15/140 flea pools collected in Cambodia were qPCR positive; while 0/105 ticks, 0/22 fleas, and 0/3 louse pools collected in Laos tested positive for Bartonella DNA. Conclusion: Evidence of Bartonella in fleas from Cambodia supports the possibility that humans are exposed to Bartonella through this traditional vector. However, Bartonella species were not found in fleas, ticks, or lice from Laos, or sand flies from Peru. This could account for the lower positive serology among the population in Laos and the strictly localized nature of B. bacilliformis infections in Peru. Human exposure to the Bartonella species and Bartonella as a human pathogen warrants further investigation.
Collapse
Affiliation(s)
- Kristin Mullins
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | | | - Pidor Ouch
- Naval Medical Research Unit-2, Phnom Penh, Cambodia
| | | | - Janice Tagoe
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Naiki Attram
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Clara Yeboah
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | | | - Anne Fox
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | | | - Audrey Rachlin
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Hung Manh Nguyen
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Matthew T Robinson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Center for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Microbiology Laboratory, Mahosot Hospital, Qua Fa Ngum, Vientiane, Lao PDR
| | - Viengmon Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Microbiology Laboratory, Mahosot Hospital, Qua Fa Ngum, Vientiane, Lao PDR
| | - Mayfong Maxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Center for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Mark P Simons
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Angela Caranci
- Northwest Mosquito and Vector Control District, Corona, California, USA
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Center for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Allen L Richards
- Naval Medical Research Center, Silver Spring, Maryland, USA
- Uniformed Services University, Bethesda, Maryland, USA
| | | |
Collapse
|
23
|
Kagatani J, Asakura T, Sekine K, Watanabe H, Kawada M, Ohkusu K, Koyama T. Clinical utility of whole body diffusion-weighted imaging in an immunocompetent adult with atypical cat scratch disease. J Infect Chemother 2022; 28:1558-1561. [PMID: 35921966 DOI: 10.1016/j.jiac.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/25/2022] [Accepted: 07/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cat scratch disease (CSD) is an infectious disease caused by Bartonella henselae. CSD follows a typical course, characterized by regional lymphadenopathy. In atypical CSD, the lesions spread to systemic organs and can cause fever of unknown origin (FUO). A previous study showed the usefulness of whole-body magnetic resonance imaging (WB-MRI) with diffusion-weighted imaging (DWI) for limited areas in the diagnosis of FUO, but there are no studies on the clinical utility of whole-body DWI (WB-DWI). We herein report the case of an immunocompetent young man in whom contrast-enhanced CT-unidentifiable multiple liver abscess and osteomyelitis were successfully detected by WB-DWI. Follow-up with a liver biopsy helped confirm an atypical CSD diagnosis. CASE PRESENTATION A 23-year-old previously healthy man was admitted for a 19-day history of high fever despite 3-day treatment by azithromycin. His physical examination was unremarkable and contrast-enhanced CT showed only a low attenuated area in the right lobe of the liver, indicating a cyst. WB-DWI revealed multiple nodular lesions of hypo-diffusion in the liver, spine, and pelvic region. The biopsy specimens of the liver abscess showed no evidence of tuberculosis/malignancy and the polymerase chain reaction (PCR) test of liver abscess aspirate showed positive findings for Bartonellahenselae, confirming the diagnosis of CSD. He completed minocycline monotherapy for a total of 60 days without any deterioration. CONCLUSIONS WB-DWI can be useful for the diagnosis of atypical CSD with hepatic and bone involvement, which can cause FUO in young immunocompetent adults.
Collapse
Affiliation(s)
- Jin Kagatani
- Department of Internal Medicine, Saitama City Hospital, Saitama, Japan.
| | - Takanori Asakura
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan; Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsutoshi Sekine
- Department of Internal Medicine, Saitama City Hospital, Saitama, Japan
| | - Hiromi Watanabe
- Department of Diagnostic Radiology, Saitama City Hospital, Saitama, Japan
| | - Miki Kawada
- Department of Infectious Diseases, Saitama City Hospital, Saitama, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Koyama
- Department of Internal Medicine, Saitama City Hospital, Saitama, Japan
| |
Collapse
|
24
|
Flurin L, Wolf MJ, Fisher CR, Cano Cevallos EJ, Vaillant JJ, Pritt BS, DeSimone DC, Patel R. Pathogen Detection in Infective Endocarditis Using Targeted Metagenomics on Whole Blood and Plasma: a Prospective Pilot Study. J Clin Microbiol 2022; 60:e0062122. [PMID: 36040200 PMCID: PMC9491191 DOI: 10.1128/jcm.00621-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022] Open
Abstract
Initial microbiologic diagnosis of infective endocarditis (IE) relies on blood cultures and Bartonella and Coxiella burnetii serology. Small case series and one prospective study have preliminarily reported application of metagenomic sequencing on blood or plasma for IE diagnosis. Here, results of a prospective pilot study evaluating targeted metagenomic sequencing (tMGS) for blood-based early pathogen detection and identification in IE are reported. Subjects diagnosed with possible or definite IE at a single institution were prospectively enrolled with informed consent from October 2020 to July 2021. Blood was drawn and separated into whole blood and plasma. Both specimen types were subjected to nucleic acid extraction and PCR targeting the V1-V3 region of the 16S ribosomal RNA gene, followed by next-generation sequencing on an Illumina MiSeqTM platform. 35 subjects, 28 (80%) with definite and 7 (20%) with possible IE were enrolled, including 6 (17%) with blood culture-negative endocarditis (BCNE). Overall, 20 whole blood (59%) and 16 plasma (47%) samples tested positive (P = 0.47). When results of whole blood and plasma testing were combined, a positive tMGS result was found in 23 subjects (66%). tMGS identified a potential pathogen in 5 of 6 culture-negative IE cases. Although further study is needed, the results of this pilot study suggest that blood-based tMGS may provide pathogen identification in subjects with IE, including in culture-negative cases.
Collapse
Affiliation(s)
- Laure Flurin
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, France
| | - Matthew J. Wolf
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cody R. Fisher
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Edison J. Cano Cevallos
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Memorial Healthcare System, Hollywood, Florida, USA
| | - James J. Vaillant
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bobbi S. Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C. DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
25
|
Guo S, Pottanat ND, Herrmann JL, Schamberger MS. Bartonella endocarditis and diffuse crescentic proliferative glomerulonephritis with a full-house pattern of immune complex deposition. BMC Nephrol 2022; 23:181. [PMID: 35549887 PMCID: PMC9097344 DOI: 10.1186/s12882-022-02811-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Abstract
Background Bartonella endocarditis is often a diagnostic challenge due to its variable clinical manifestations, especially when it is first presented with involvement of organs other than skin and lymph nodes, such as the kidney. Case presentation This was a 13-year-old girl presenting with fever, chest and abdominal pain, acute kidney injury, nephrotic-range proteinuria and low complement levels. Her kidney biopsy showed diffuse crescentic proliferative glomerulonephritis with a full-house pattern of immune complex deposition shown by immunofluorescence, which was initially considered consistent with systemic lupus erythematous-associated glomerulonephritis (lupus nephritis). After extensive workup, Bartonella endocarditis was diagnosed. Antibiotic treatment and valvular replacement surgery were undertaken with subsequent return of kidney function to normal range. Conclusion This case demonstrates the importance of considering the full clinical picture when interpreting clinical, laboratory and biopsy findings, because the treatment strategy for infective endocarditis versus lupus nephritis is drastically different.
Collapse
Affiliation(s)
- Shunhua Guo
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 W. 11th street, Indianapolis, IN, 46202, USA.
| | - Neha D Pottanat
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeremy L Herrmann
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marcus S Schamberger
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
26
|
Bartonella Endocarditis in Spain: Case Reports of 21 Cases. Pathogens 2022; 11:pathogens11050561. [PMID: 35631082 PMCID: PMC9143151 DOI: 10.3390/pathogens11050561] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Blood culture negative endocarditis (BCNE) is frequent in infective endocarditis (IE). One of the causes of BCNE is fastidious microorganisms, such as Bartonella spp. The aim of this study was to describe the epidemiologic, clinical characteristics, management and outcomes of patients with Bartonella IE from the “Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)”cohort. Here we presented 21 cases of Bartonella IE. This represents 0.3% of a total of 5590 cases and 2% of the BCNE from the GAMES cohort. 62% were due to Bartonella henselae and 38% to Bartonella quintana. Cardiac failure was the main presenting form (61.5% in B. hensalae, 87.5% in B. quintana IE) and the aortic valve was affected in 85% of the cases (76% in B. henselae, 100% in B. quintana IE). Typical signs such as fever were recorded in less than 40% of patients. Echocardiography showed vegetations in 92% and 100% of the patients with B. henselae and B. quintana, respectively. Culture was positive only in one patient and the remaining were diagnosed by serology and PCR. PCR was the most useful tool allowing for diagnosis in 16 patients (100% of the studied valves). Serology, at titers recommended by guidelines, only coincided with PCR in 52.4%. Antimicrobial therapy, in different combinations, was used in all cases. Surgery was performed in 76% of the patients. No in-hospital mortality was observed. One-year mortality was 9.4%. This article remarks the importance for investigating the presence of Bartonella infection as causative agent in all BCNE since the diagnosis needs specific microbiological tools and patients could benefit of a specific treatment.
Collapse
|
27
|
Villasmil RJ, Sia J, Motie I, Rodriguez L, Kraitman N. Not Your Usual Case of Culture-Negative Endocarditis: A Case Report of Bartonella Endocarditis. Cureus 2022; 14:e24947. [PMID: 35698666 PMCID: PMC9188445 DOI: 10.7759/cureus.24947] [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] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
Advancements in transcatheter interventions have revolutionized the treatment of adult congenital heart disease. We present a case of a 32-year-old male with a history of tetralogy of Fallot with pulmonary atresia diagnosed with Bartonella spp. culture-negative infective endocarditis (IE) of his Melody valve, necessitating Melody valve replacement.
Collapse
Affiliation(s)
- Ricardo J Villasmil
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - John Sia
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - Ian Motie
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - Lisette Rodriguez
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - Natan Kraitman
- Infectious Disease, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| |
Collapse
|
28
|
Boodman C, MacDougall W, Hawkes M, Tyrrell G, Fanella S. Bartonella quintana endocarditis in a child from Northern Manitoba, Canada. PLoS Negl Trop Dis 2022; 16:e0010399. [PMID: 35617170 PMCID: PMC9135198 DOI: 10.1371/journal.pntd.0010399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe a case of Bartonella quintana endocarditis in an 11-year-old child from Northern Manitoba, Canada. This case demonstrates the neglected endemicity of B. quintana in Northern Canada and highlights the need for improved case finding and elucidation of specific risk factors for B. quintana infection in the Canadian North. Considering B. quintana's predominant transmission via body lice ectoparasitosis, we hypothesize that B. quintana's endemicity in Northern Canada is linked to inadequate access to suitable housing and running water among remote communities in the Canadian North.
Collapse
Affiliation(s)
- Carl Boodman
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | |
Collapse
|
29
|
Boodman C, Wuerz T, Lagacé-Wiens P, Lindsay R, Dibernardo A, Bullard J, Stein DR, Keynan Y. Serologic testing for Bartonella in Manitoba, Canada, 2010-2020: a retrospective case series. CMAJ Open 2022; 10:E476-E482. [PMID: 35640989 PMCID: PMC9177198 DOI: 10.9778/cmajo.20210180] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bartonella are gram-negative bacilli not identified by routine bacterial culture. The objectives of this study were to review the results of all serologic testing for Bartonella ordered in Manitoba, Canada, and to review cases with positive test results among adults to assess species identification, risk factors, clinical manifestations and outcomes. METHODS This retrospective study included all Bartonella serologic tests ordered in Manitoba and performed at the National Microbiology Laboratory, Winnipeg, from Jan. 1, 2010, until Dec. 31, 2020. We analyzed the aggregate data for all serologic tests for Bartonella for patients of all ages. We reviewed the charts of adult (age ≥ 18 yr) patients with serologic positivity for Bartonella who had a medical chart at 1 of Winnipeg's 2 largest hospitals (Health Sciences Centre and St. Boniface Hospital) to extract clinical and demographic data and create a case series. Descriptive statistics were performed. RESULTS During the study period, 1014 Bartonella serologic tests were ordered in adult and pediatric patients, of which 24 (2.4%) gave a positive result. Sixteen adults (12 men and 4 women; mean age 48 yr) seen at a participating hospital had a positive result. Molecular species-level identification occurred on explanted cardiac valves in 5 (31%) of the 16 cases; B. quintana was identified in all 5. Six patients (38%) were diagnosed with probable B. quintana infection, for a total of 11 B. quintana cases (69%); 8 (73%) of the 11 had endocarditis. Four cases of B. quintana infection (36%) were associated with rural residence. Four cases (25%) of probable B. henselae were identified; 2 patients had fever and lymphadenopathy, and 2 had endocarditis. The remaining patient was deemed to have a false-positive result as his B. henselae titre was at the threshold for positivity, his B. quintana serologic test gave a negative result, and his clinical syndrome was not suggestive of Bartonella infection. Two patients died; both had multivalvular B. quintana endocarditis with ruptured intracranial mycotic aneurysms. INTERPRETATION Bartonella quintana was a common cause of Bartonella serologic positivity among adults in Manitoba in 2010-2020 and was associated with endocarditis and systemic embolization. As B. quintana is transmitted by body lice, active case finding for people who lack suitable housing, both in urban and rural settings, should prioritize those with elevated Bartonella titres to receive echocardiography and detect endocarditis before systemic embolization occurs.
Collapse
Affiliation(s)
- Carl Boodman
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man.
| | - Terence Wuerz
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Philippe Lagacé-Wiens
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Robbin Lindsay
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Antonia Dibernardo
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Jared Bullard
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Derek R Stein
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Yoav Keynan
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man.
| |
Collapse
|
30
|
Krügel M, Król N, Kempf VAJ, Pfeffer M, Obiegala A. Emerging rodent-associated Bartonella: a threat for human health? Parasit Vectors 2022; 15:113. [PMID: 35361285 PMCID: PMC8969336 DOI: 10.1186/s13071-022-05162-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/11/2022] [Indexed: 01/20/2023] Open
Abstract
Background Species of the genus Bartonella are facultative intracellular alphaproteobacteria with zoonotic potential. Bartonella infections in humans range from mild with unspecific symptoms to life threatening, and can be transmitted via arthropod vectors or through direct contact with infected hosts, although the latter mode of transmission is rare. Among the small mammals that harbour Bartonella spp., rodents are the most speciose group and harbour the highest diversity of these parasites. Human–rodent interactions are not unlikely as many rodent species live in proximity to humans. However, a surprisingly low number of clinical cases of bartonellosis related to rodent-associated Bartonella spp. have thus far been recorded in humans. Methods The main purpose of this review is to determine explanatory factors for this unexpected finding, by taking a closer look at published clinical cases of bartonellosis connected with rodent-associated Bartonella species, some of which have been newly described in recent years. Thus, another focus of this review are these recently proposed species. Conclusions Worldwide, only 24 cases of bartonellosis caused by rodent-associated bartonellae have been reported in humans. Possible reasons for this low number of cases in comparison to the high prevalences of Bartonella in small mammal species are (i) a lack of awareness amongst physicians of Bartonella infections in humans in general, and especially those caused by rodent-associated bartonellae; and (ii) a frequent lack of the sophisticated equipment required for the confirmation of Bartonella infections in laboratories that undertake routine diagnostic testing. As regards recently described Bartonella spp., there are presently 14 rodent-associated Candidatus taxa. In contrast to species which have been taxonomically classified, there is no official process for the review of proposed Candidatus species and their names before they are published. This had led to the use of malformed names that are not based on the International Code of Nomenclature of Prokaryotes. Researchers are thus encouraged to propose Candidatus names to the International Committee on Systematics of Prokaryotes for approval before publishing them, and only to propose new species of Bartonella when the relevant datasets allow them to be clearly differentiated from known species and subspecies. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05162-5.
Collapse
Affiliation(s)
- Maria Krügel
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103, Leipzig, Germany
| | - Nina Król
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103, Leipzig, Germany
| | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University, Frankfurt am Main, Germany.,National Consiliary Laboratory for Bartonella, Frankfurt am Main, Germany
| | - Martin Pfeffer
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103, Leipzig, Germany
| | - Anna Obiegala
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103, Leipzig, Germany.
| |
Collapse
|
31
|
Solanky D, Ahmed AA, Fierer J, Golts E, Jones M, Mehta SR. Utility of Plasma Microbial Cell-Free DNA Decay Kinetics After Aortic Valve Replacement for Bartonella Endocarditis: Case Report. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.842100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundDetection and sequencing of circulating microbial cell-free DNA (mcfDNA) in plasma is an increasingly popular tool for diagnosing many infectious diseases, but could also be used to monitor the progress of infection. However, the decay of this microbial cell-free DNA in blood following treatment has not been previously characterized.Case PresentationA 53 year-old male was diagnosed with Bartonella quintana bioprosthetic aortic valve endocarditis by sequencing of the mcfDNA in the blood (Karius, Redwood City, CA). We then monitored the kinetics of decay of mcfDNA after parenteral antibiotics and valve resection in this individual. We measured plasma mcfDNA (Karius) in serial samples obtained in the operating room to calculate mcfDNA half-life after valve resection. After four weeks of parenteral antibiotics, Bartonella mcfDNA signal decreased by 78%. The signal subsequently rose during operative manipulation of the infected valve but dropped 81-fold over four hours following valve resection. The half-life of mcfDNA between the time shortly following resection of the infected valve and 24 to 48 hours post-operatively was between 35 and 115 minutes. The trend in mcfDNA signal was characterized by rapid and then slower phases of decay within 24 hours, and little change between 24 and 48 hours.ConclusionsThis study is one of the first to characterize decay kinetics of mcfDNA and highlights the potential of monitoring mcfDNA in addressing major challenges in infective endocarditis management, including monitoring the response to therapy, and as an early screen for recurrence.
Collapse
|
32
|
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
|
33
|
Robert M, Lecomte R, Michel M, Guimbretiere G, Croizier G, Corvec S, Leroy A. Bartonella quintana infective endocarditis in a homeless man with unexpected positive blood culture. IDCases 2022; 30:e01647. [DOI: 10.1016/j.idcr.2022.e01647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
|
34
|
Saengsawang P, Pangjai D, Kaewmongkol G, Inpankaew T. Detection of antibodies against three zoonotic Bartonella spp. and cross-reactivity among species and Coxiella burnetii in dogs and cats from Central Thailand. Comp Immunol Microbiol Infect Dis 2021; 81:101743. [PMID: 34942506 DOI: 10.1016/j.cimid.2021.101743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
Dogs and cats are important reservoir hosts of bacterial zoonotic pathogens, especially the Proteobacteria, Bartonella spp., and Coxiella burnetii. Bartonella spp. and C. burnetii are Gram-negative intracellular bacteria causing cat-scratch disease and query fever, respectively. Despite these two pathogens being dangerous, studies of their seroprevalence and cross-reactivity are limited in Thailand. The objectives of this study were to detect the seroprevalence of three zoonotic species of Bartonella and to evaluate cross-reactivity among Bartonella spp. and with C. burnetii. In total, 570 dog and cat serum samples were detected for antibodies against Bartonella spp. and C. burnetii using an indirect immunofluorescence antibody (IFA) test. At titer ≥ 1:64, tested serum that had a fluorescent intensity score ≥ 2 was interpreted as positive. Additionally, possible factors related to the seroprevalence were analyzed consisting of sex, breed, age, residing area, and ectoparasite control. Overall, the seroprevalence levels of Bartonella spp. and C. burnetii were 13.16% and 1.23%, respectively. All antigens of Bartonella were reacted to sera (1.23-7.72%), furthermore, both phases of C. burnetii were revealed in sera (0.35-1.05%). Interestingly, there was a poor agreement of cross-reactivity among Bartonella spp. at 5.56-8.70%, while cross-reactivity between Bartonella spp. and C. burnetii also showed poor agreement (2.80%). It is suggested that dogs and cats are important reservoirs of Bartonella spp., even in animals with ectoparasite control. The Bartonella seroprevalence was high in pure-breed animals with ectoparasite control, reflecting that Bartonella spp. infections can occur in owned, well-cared-for, and asymptomatic dogs and cats.
Collapse
Affiliation(s)
- Phirabhat Saengsawang
- Center for Agricultural Biotechnology, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom 73140, Thailand; Center of Excellence on Agricultural Biotechnology: (AG-BIO/MHESI), Bangkok 10900, Thailand; Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80161, Thailand
| | - Decha Pangjai
- National Institute of Health, Department of Medical Science, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Gunn Kaewmongkol
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand
| | - Tawin Inpankaew
- Center for Agricultural Biotechnology, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom 73140, Thailand; Center of Excellence on Agricultural Biotechnology: (AG-BIO/MHESI), Bangkok 10900, Thailand; Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand.
| |
Collapse
|
35
|
Zhang Y, Verdecia J, Mgbemena O, Ravi M, Sands M. Bartonella Endocarditis: A Missed Diagnosis in Medical Practice. Cureus 2021; 13:e19309. [PMID: 34900484 PMCID: PMC8647862 DOI: 10.7759/cureus.19309] [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] [Accepted: 11/06/2021] [Indexed: 11/17/2022] Open
Abstract
Here, we present the case of a 52-year-old patient who presented with fever, chills, and weight loss. Further workup revealed Bartonella endocarditis of the aortic valve. After six weeks of antibiotics, a follow-up transthoracic echocardiogram showed a decrease in the size of vegetation. Serologic testing based on epidemiologic history should be obtained for the workup of blood culture-negative endocarditis.
Collapse
Affiliation(s)
- Yixin Zhang
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jorge Verdecia
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Okechukwu Mgbemena
- Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Malleswari Ravi
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Michael Sands
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| |
Collapse
|
36
|
Pecoraro AJK, Pienaar C, Herbst PG, Poerstamper S, Joubert L, Taljaard J, Prozesky H, Janson J, Newton-Foot M, Doubell AF. Causes of infective endocarditis in the Western Cape, South Africa: a prospective cohort study using a set protocol for organism detection and central decision making by an endocarditis team. BMJ Open 2021; 11:e053169. [PMID: 34873007 PMCID: PMC8650472 DOI: 10.1136/bmjopen-2021-053169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Blood culture negative infective endocarditis (BCNIE) poses both a diagnostic and therapeutic challenge. High rates of BCNIE reported in South Africa have been attributed to antibiotic use prior to blood culture sampling. OBJECTIVES To assess the impact of a systematic approach to organism detection and identify the causes of infective endocarditis (IE), in particular causes of BCNIE. DESIGN Prospective cohort study. METHODS The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and February 2021. A set protocol for organism detection with management of patients by an endocarditis team was employed. This prospective cohort was compared with a retrospective cohort of patients with IE admitted between January 2017 and December 2018. RESULTS One hundred and forty patients with IE were included, with 75 and 65 patients in the retrospective and prospective cohorts, respectively. Baseline demographic characteristics were similar with a mean age of 39.6 years and male predominance (male sex=67.1%). The rate of BCNIE was lower in the prospective group (28/65 or 43.1%) compared with the retrospective group (47/75 or 62.7%; p=0.039). The BCNIE in-hospital mortality rate in the retrospective cohort was 23.4% compared with 14.2% in the prospective cohort (p=0.35). A cause was identified (including non-culture techniques) in 86.2% of patients in the prospective cohort, with Staphylococcus aureus (26.2%), Bartonella species (20%) and the viridans streptococci (15.3%) being most common. CONCLUSION The introduction of a set protocol for organism detection, managed by an endocarditis team, has identified Staphylococcusaureus as the most common cause of IE and identified non-culturable organisms, in particular Bartonella quintana, as an important cause of BCNIE. A reduction in in-hospital mortality in patients with BCNIE was observed, but did not reach statistical significance.
Collapse
Affiliation(s)
- Alfonso Jan Kemp Pecoraro
- Medicine, Division of Cardiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Colette Pienaar
- Microbiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Philippus George Herbst
- Medicine, Division of Cardiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Simon Poerstamper
- Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Lloyd Joubert
- Medicine, Division of Cardiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Jantjie Taljaard
- Medicine, Division of Cardiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Hans Prozesky
- Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Jacques Janson
- Surgery, Division of Cardiothoracic Surgery, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Mae Newton-Foot
- Microbiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Anton Frans Doubell
- Medicine, Division of Cardiology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| |
Collapse
|
37
|
Amerstorfer F, Igrec J, Valentin T, Leithner A, Leitner L, Glehr M, Friesenbichler J, Brcic I, Bergovec M. Cat at home? Cat scratch disease with atypical presentations and aggressive radiological findings mimicking sarcoma, a potential diagnostic pitfall. Acta Orthop 2021; 92:753-759. [PMID: 34165046 PMCID: PMC8635669 DOI: 10.1080/17453674.2021.1941624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Cat scratch disease (CSD) is a self-limiting disease caused by Bartonella (B.) henselae. It is characterized by granulomatous infection, most frequently involving lymph nodes. However, it can present with atypical symptoms including musculoskeletal manifestations, posing a diagnostic challenge. We describe the prevalence and demographics of CSD cases referred to a sarcoma center, and describe the radiological, histological, and molecular findings.Patients and methods - Our cohort comprised 10 patients, median age 27 years (12-74) with clinical and radiological findings suspicious of sarcoma.Results - 7 cases involved the upper extremities, and 1 case each involved the axilla, groin, and knee. B. henselae was found in 6 cases tested using polymerase chain reaction and serology in 5 cases. 9 cases were soft tissue lesions and 1 lesion involved the bone. 1 patient had concomitant CSD with melanoma metastasis in enlarged axillary lymph nodes. On MRI, 5 soft tissue lesions were categorized as probably inflammatory. In 3 cases, with still detectable lymph node structure and absent or initial liquefaction, the differential diagnosis included lymph node metastasis. A sarcoma diagnosis was suggested in 4 cases. The MRI imaging features of the bone lesion were suspicious of a bone tumor or osteomyelitis.Interpretation - Atypical imaging findings cause a diagnostic challenge and the differential diagnosis includes malignant neoplasms (such as sarcoma or carcinoma metastasis) and other infections. The distinction between these possibilities is crucial for treatment and prognosis.
Collapse
Affiliation(s)
| | - Jasminka Igrec
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
| | - Lukas Leitner
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
| | - Mathias Glehr
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
| | | | - Iva Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Graz, Austria
| | - Marko Bergovec
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
| |
Collapse
|
38
|
Ohno T, Saito S, Iwata E, Ushida S, Otsuka R, Miyahara K, Matsuura A. Blood culture-negative endocarditis caused by Bartonella henselae: a case report. Indian J Thorac Cardiovasc Surg 2021; 38:187-190. [PMID: 34754148 PMCID: PMC8568566 DOI: 10.1007/s12055-021-01266-2] [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: 06/18/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
Bartonella henselae is well known as a causative organism of cat scratch disease. Although this bacterium infrequently involves the heart, the diagnosis is difficult to confirm. A 75-year-old woman who had a pet cat presented with pancytopenia, hepatosplenomegaly, and low-grade fever. Echocardiography depicted sessile nodules on the aortic valve. C-reactive protein concentration was low, and leukocytosis was not seen. Two sets of blood culture turned out negative. However, elevated B. henselae immunoglobulin G titer led us to the diagnosis of infective endocarditis. Minocycline was administered orally in combination with intravenous administration of gentamicin as an antimicrobial treatment. The patient underwent aortic valve replacement 2 months after her initial visit. Warthin-Starry silver staining did not show any bacterial bodies. The culture of the vegetation tissue was negative. Polymerase chain reaction testing of the excised valve tissue detected the deoxyribonucleic acid of the organism. The postoperative course was uneventful, and the patient was discharged home.
Collapse
Affiliation(s)
- Tsukasa Ohno
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Shunei Saito
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Eri Iwata
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Sen Ushida
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Ryohei Otsuka
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Ken Miyahara
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Akio Matsuura
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| |
Collapse
|
39
|
Santhanam H, Nguyen MHN, Muthukumarasamy N, Mehta A, Francisco MT, Fountain RR, Helmstetter NJ. Bartonella endocarditis in patients with right ventricle-to-pulmonary artery conduit: 2 case reports and literature review. IDCases 2021; 26:e01306. [PMID: 34722156 PMCID: PMC8536538 DOI: 10.1016/j.idcr.2021.e01306] [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: 09/19/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022] Open
Abstract
Bartonella species are Gram-negative bacilli and fastidious bacteria that can cause a number of clinical syndromes, including blood culture-negative infective endocarditis (IE). The two most commonly isolated species in humans are Bartonella quintana, the agent of trench fever, and Bartonella henselae, mostly known for causing cat scratch disease (Edouard et al., 2015 [1]; Edouard and Raoult, 2010 [2]). Both species also cause bacillary angiomatosis, primarily in immunocompromised patients (Edouard et al., 2015 [1]; Fournier et al., 2001 [3]). The risk of B. henselae IE is increased in patients with cardiac valvular disease and congenital heart disease (CHD) (Edouard and Raoult, 2010 [2]; Das et al., 2009 [4]; Abandeh et al., 2012 [5]; Ouellette et al., 2016 [6]; Hoffman et al., 2007 [7]; Georgievskaya et al., 2014 [8]). In this article, we detail two cases of Bartonella IE in patients with right ventricle-to-pulmonary artery (RV-PA) conduits who presented to our institution. We also perform a literature review on Bartonella IE in patients with a history of RV-PA conduit or pulmonary valve replacement.
Collapse
Affiliation(s)
- Haripriya Santhanam
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Minh H N Nguyen
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA.,Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Nirmal Muthukumarasamy
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Aditya Mehta
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Michael T Francisco
- Department of Hematology/Oncology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Robin R Fountain
- Bronson Methodist Hospital, Pediatric Cardiology, 601 John St, Kalamazoo, MI 49007, USA
| | - Nicholas J Helmstetter
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA.,Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| |
Collapse
|
40
|
Han HJ, Li ZM, Li X, Liu JX, Peng QM, Wang R, Gu XL, Jiang Y, Zhou CM, Li D, Xiao X, Yu XJ. Bats and their ectoparasites (Nycteribiidae and Spinturnicidae) carry diverse novel Bartonella genotypes, China. Transbound Emerg Dis 2021; 69:e845-e858. [PMID: 34695291 PMCID: PMC9543326 DOI: 10.1111/tbed.14357] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
Bartonella species are facultative intracellular bacteria and recognized worldwide as emerging zoonotic pathogens. Bartonella were isolated or identified by polymerase chain reaction (PCR) in bats and their ectoparasites worldwide, whereas the association between them was scarce, especially in Asia. In this study, a retrospective analysis with frozen samples was carried out to identify the genetic diversity of Bartonella in bats and their ectoparasites and to investigate the relationships of Bartonella carried by bats and their ectoparasites. Bats and their ectoparasites (bat flies and bat mites) were collected from caves in Hubei Province, Central China, from May 2018 to July 2020. Bartonella were screened by PCR amplification and sequencing of three genes (gltA, rpoB, and ftsZ). Bats, bat flies, and bat mites carried diverse novel Bartonella genotypes with a high prevalence. The sharing of some Bartonella genotypes between bats and bat flies or bat mites indicated a potential role of bat flies and bat mites as vectors of bartonellae, while the higher genetic diversity of Bartonella in bat flies than that in bats might be due to the vertical transmission of this bacterium in bat flies. Therefore, bat flies might also act as reservoirs of Bartonella. In addition, human‐pathogenic B. mayotimonesis was identified in both bats and their ectoparasites, which expanded our knowledge on the geographic distribution of this bacterium and suggested a potential bat origin with bat flies and bat mites playing important roles in the maintenance and transmission of Bartonella.
Collapse
Affiliation(s)
- Hui-Ju Han
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Ze-Min Li
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Xia Li
- Microbiological Laboratory, Yantai Center for Disease Control and Prevention, Yantai, China
| | - Jian-Xiao Liu
- Clinical Laboratory, Xingtai Third Hospital, Xingtai, China
| | - Qiu-Ming Peng
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Rui Wang
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Xiao-Lan Gu
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Yuan Jiang
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Chuan-Min Zhou
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Dan Li
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Xiao Xiao
- Institute of Epidemiology Research, Hubei University of Chinese Medicine, Wuhan, China
| | - Xue-Jie Yu
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| |
Collapse
|
41
|
[Recurrent intracerebral haemorrhage in a 24-year-old female patient]. Internist (Berl) 2021; 63:103-109. [PMID: 34586426 DOI: 10.1007/s00108-021-01157-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
A 24-year-old female patient from Sierra Leone was referred to the authors' hospital after several unclear intracerebral bleeding events and an echogenic structure on the aortic valve. The patient was receiving oral anticoagulation therapy due to paroxysmal atrial fibrillation and left ventricular noncompaction. Fluorescence in situ hybridization in combination with polymerase chain reaction and sequencing revealed infective endocarditis of the mitral and aortic valve caused by Bartonella quintana. In retrospect, the intracerebral bleeding events could be identified as septic emboli with secondary haemorrhagic transformation under anticoagulation therapy. The patient showed significant clinical improvement and no further bleeding events occurred after receiving biological mitral and aortic valve replacement and several weeks of doxycycline and gentamicin antibiotic therapy.
Collapse
|
42
|
Ding F, Shrestha NK, Chetrit M, Verma B, Gordon S, Pettersson GB, Unai S, Griffin BP, Xu B. Clinical and Echocardiographic Characteristics of Bartonella Infective Endocarditis: An 8-Year Single-Centre Experience in the United States. Heart Lung Circ 2021; 31:350-357. [PMID: 34456130 DOI: 10.1016/j.hlc.2021.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/20/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infective endocarditis due to Bartonella species is rare. The clinical and echocardiographic characteristics are not well defined. We aimed to investigate the clinical and echocardiographic findings of Bartonella endocarditis in the contemporary era. METHODS The infective endocarditis (IE) registry and echocardiographic database at our institution were retrospectively analysed to evaluate the clinical and echocardiographic features of Bartonella endocarditis. RESULTS Between January 2008 and December 2015, there were 11 patients with Bartonella IE (0.84% among a total of 1,308 cases of definite IE): median age 54 (30-69) years, all male, 9 Caucasian, 10 had a history of cat exposure, 10 had a pre-existing valvulopathy including 6 patients with a prosthetic valve with prosthesis age range between 3 to 5 years and 1 patient with implantable cardioverter defibrillator (ICD). Bartonella henselae was responsible for all the cases. Echocardiographic evidence of IE was found in 6 of 11 patients on transthoracic echocardiography (TTE), and 6 of 8 on transoesophageal echocardiography (TEE). Bartonella IE was associated with significant valvular destruction and dysfunction on echocardiography. Nine (9) patients were managed surgically with excellent outcomes, including two patients who failed initial medical therapy. Two (2) patients who were managed medically had progression of valvular dysfunction. At a median follow-up of 6 months, there were no deaths attributable to IE or other cardiovascular causes. CONCLUSION In a contemporary single-centre cohort in the United States, Bartonella IE remains rare, but should be considered when pathogen could not be identified in patients with suspected IE, especially those with prosthetic valves or bicuspid aortic valve (BAV). The vast majority of patients with Bartonella IE were managed surgically with excellent outcomes.
Collapse
Affiliation(s)
- Feihong Ding
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Chetrit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beni Verma
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
43
|
Shaikh G, Gosmanova EO, Rigual-Soler N, Der Mesropian P. Systemic Bartonellosis Manifesting With Endocarditis and Membranoproliferative Glomerulonephritis. J Investig Med High Impact Case Rep 2021; 8:2324709620970726. [PMID: 33155512 PMCID: PMC7656866 DOI: 10.1177/2324709620970726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cat scratch disease caused by Bartonella species is mostly benign and self-limiting condition. Systemic infection is uncommon in immunocompetent host. We describe the case of a 66-year-old male who presented with sudden painless left eye blindness and brown-colored urine. Laboratory findings revealed progressively rising serum creatinine in association with nephrotic-range proteinuria at 7 g/day and glomerular hematuria on urinalysis. An echocardiogram demonstrated mitral and tricuspid valve vegetations despite multiple negative blood cultures. The left eye blindness was attributed to retinal artery occlusion from septic valvular embolus. Kidney biopsy showed membranoproliferative glomerulonephritis pattern of injury with "full house" pattern on immunofluorescent staining with subendothelial deposits on electron microscopy. Markedly elevated IgG (immunoglobulin G) titers for B henselae and B quintana were discovered. The patient had several cats at home. Kidney failure rapidly progressed to require hemodialysis. Once the diagnosis of systemic bartonellosis was confirmed, doxycycline (for 4 months) with rifampicin (for 3 months) were initiated. Repeat echocardiogram in 4 months demonstrated a resolution of valvular vegetations; however, the left eye blindness was permanent. In the present case the correct diagnosis of systemic bartonellosis allowed institution of appropriate antibiotic therapy and to also achieve a partial recovery of renal function and to discontinue hemodialysis.
Collapse
Affiliation(s)
- Gulvahid Shaikh
- Albany Stratton VA Medical Center, Albany, NY, USA.,Albany Medical College, Albany, NY, USA
| | - Elvira O Gosmanova
- Albany Stratton VA Medical Center, Albany, NY, USA.,Albany Medical College, Albany, NY, USA
| | | | - Paul Der Mesropian
- Albany Stratton VA Medical Center, Albany, NY, USA.,Albany Medical College, Albany, NY, USA
| |
Collapse
|
44
|
Lashnits E, Neupane P, Bradley JM, Richardson T, Maggi RG, Breitschwerdt EB. Comparison of Serological and Molecular Assays for Bartonella Species in Dogs with Hemangiosarcoma. Pathogens 2021; 10:pathogens10070794. [PMID: 34201572 PMCID: PMC8308881 DOI: 10.3390/pathogens10070794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Currently, a gold standard diagnostic test for Bartonella infection in dogs is lacking. This represents a critical limitation for the development and evaluation of new diagnostic tests, as well as for the diagnosis of, and research on, bartonellosis in dogs. This retrospective observational study aims to compare the results of commonly performed and newly-reported Bartonella spp. diagnostic tests in banked clinical specimens from 90 dogs with hemangiosarcoma (HSA) using composite reference standard (CRS) and random effects latent class analysis (RE-LCA) techniques. Samples from each dog were tested using six serological or molecular diagnostic assays, including indirect fluorescent antibody (IFA) and Western blot (WB) for the detection of antibodies in serum, and qPCR and droplet digital PCR (ddPCR) in blood and fresh frozen tissue biopsy samples (mainly splenic HSA tumors and histopathologically normal spleen or skin/adipose tissue). Bartonella infection prevalence was estimated to be 78% based on the CRS (parallel testing with all six assays), and 64% based on the RE-LCA model. The assay with the highest diagnostic accuracy was qPCR performed on fresh frozen tissue biopsy samples (sensitivity: 94% by RE-LCA and 80% by CRS; specificity: 100%). When comparing newly-reported to traditional Bartonella diagnostic assays, ddPCR was more sensitive for the detection of Bartonella DNA than qPCR when testing blood samples (36% vs. 0%, p < 0.0001). Dogs that were positive on serological assays alone with negative molecular assays were highly unlikely (<3%) to be classified as infected by the RE-LCA model. These data indicate that Bartonella spp. DNA can be PCR amplified from fresh frozen tissues from a majority of dogs with HSA using both qPCR and ddPCR, supporting the use of these methods for future controlled studies comparing the prevalence of Bartonella spp. DNA in the tissue of dogs with HSA to that of unaffected controls.
Collapse
Affiliation(s)
- Erin Lashnits
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53713, USA;
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Pradeep Neupane
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Julie M. Bradley
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Toni Richardson
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
| | - Ricardo G. Maggi
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Edward B. Breitschwerdt
- Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA; (P.N.); (J.M.B.); (T.R.); (R.G.M.)
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
- Correspondence:
| |
Collapse
|
45
|
Laboratory Diagnosis of 37 Cases of Bartonella Endocarditis Based on Enzyme Immunoassay and Real-Time PCR. J Clin Microbiol 2021; 59:JCM.02217-20. [PMID: 33731411 DOI: 10.1128/jcm.02217-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
Bartonella spp., mostly Bartonella quintana and B. henselae, are a common cause of culture-negative endocarditis. Serology using immunofluorescence assay (IFA) and PCR performed on cardiac tissues are the mainstays of diagnosis. We developed an enzyme immunoassay (EIA) and a novel multiplex real-time PCR assay, utilizing Bartonella genus-specific, B. henselae-specific, and B. quintana-specific SimpleProbe probes, for diagnosis of Bartonella endocarditis. We aimed to evaluate the performance of these assays. Thirty-seven patients with definite endocarditis, 18 with B. henselae, 18 with B. quintana, and 1 with B. koehlerae, were studied. Diagnosis was confirmed by conventional PCR and DNA sequencing of surgical cardiac specimens. Similar to the case with IFA, anti-Bartonella IgG titers of ≥1:800 were found in 94% of patients by EIA; cross-reactivity between B. henselae and B. quintana precluded species-specific serodiagnosis, and frequent (41%) but low-titer cross-reactivity between Coxiella burnetii antibodies and B. henselae antigen was found in patients with Q fever endocarditis. Low-titer (1:100) cross-reactivity was uncommonly found also in patients with brucellosis and culture-positive endocarditis, particularly Enterococcus faecalis endocarditis. Real-time PCR performed on explanted heart valves/vegetations was in complete agreement with results of sequence-based diagnosis with characteristic melting curves. The genus-specific probe identified five additional endocarditis-associated Bartonella spp. at the genus level. In conclusion, EIA coupled with a novel real-time PCR assay can play an important role in Bartonella endocarditis diagnosis and expand the diagnostic arsenal at the disposal of the clinical microbiologist. Since serology remains a major diagnostic tool, recognizing its pitfalls is essential to avoid incorrect diagnosis.
Collapse
|
46
|
Godfrey R, Curtis S, Schilling WH, James PR. Blood culture negative endocarditis in the modern era of 16S rRNA sequencing. Clin Med (Lond) 2021; 20:412-416. [PMID: 32675149 DOI: 10.7861/clinmed.2019-0342] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood culture negative endocarditis (BCNE) accounts for up to 20% of infective endocarditis. While the most common cause of BCNE remains the initiation of antibiotics prior to culture, intracellular organisms such as Coxiella and Bartonella spp account for a significant proportion of cases. Identifying the infecting organism remains important to ensure optimal antimicrobial treatment. However, these organisms can be difficult to diagnose. We outline a systematic approach to BCNE. Over half of patients with infective endocarditis now undergo early surgery and 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR) of excised tissue can be vitally important to secure a diagnosis. Molecular testing is likely to become a key tool in improving outcomes from BCNE and contribute to an improved understanding of the aetiology. We advocate modifying the Duke criteria to incorporate organisms identified on molecular testing, including 16S rRNA PCR, in particular from explanted tissue.
Collapse
Affiliation(s)
| | - Sally Curtis
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | |
Collapse
|
47
|
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
|
48
|
Bartonella species as a cause of culture-negative endocarditis in South Africa. Eur J Clin Microbiol Infect Dis 2021; 40:1873-1879. [PMID: 33829350 DOI: 10.1007/s10096-021-04239-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
Previous reports have highlighted the high prevalence of blood culture negative endocarditis (BCNE) in South Africa. The Tygerberg Endocarditis Cohort (TEC) study is an ongoing prospective cohort study of patients with confirmed or suspected IE presenting to Tygerberg Academic Hospital, Cape Town, South Africa. Current analysis includes patients that presented between November 2019 and August 2020. Forty four (44) patients have been included in this ongoing study. Fourteen of the 44 patients (31.8%) had BCNE. Further analysis of the patients with BCNE identified Bartonella species as the most common causative organism (n=6; 43%). Other causes included Mycoplasma species (n=2). No cause could be identified in 4 of the 44 patients (9%). Bartonella quintana was identified with PCR of valvular tissue as the causative organism in 4 of the 5 patients that underwent urgent surgery. The patients with Bartonella IE (n=6) had an average age of 39 years with equal gender distribution. The common clinical features were clubbing (n=5; 83%), anemia (n=4; 66.6%), haematuria (n=3; 50%), acute on chronic severe regurgitant lesion (n=3; 50%) and acute severe regurgitant lesion (n=2; 33.3%).The aortic valve was involved in 5 of 6 patients. During a mean follow-up period of 251 days after diagnosis, no major adverse events occurred. Bartonella-associated IE is an important cause of BCNE in the Western Cape of South Africa. Imaging findings (in patients with BCNE) of significant valvular destruction with large vegetations on the aortic valve not affected by congenital or rheumatic valve disease should raise the suspicion of Bartonella-associated IE.
Collapse
|
49
|
Plantinga NL, Vos RJ, Georgieva L, Roescher N. Bartonella quintana as a cause for prosthetic valve endocarditis and post-sternotomy mediastinitis. Access Microbiol 2021; 3:000217. [PMID: 34151169 PMCID: PMC8209714 DOI: 10.1099/acmi.0.000217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/28/2021] [Indexed: 12/25/2022] Open
Abstract
An otherwise healthy patient, with minimal clinical, biochemical and peroperative signs of infection, was diagnosed with Bartonella quintana prosthetic valve endocarditis by 16S PCR. The patient subsequently developed a post-sternotomy mediastinitis and Bartonella quintana was the only detected pathogen. Bartonella quintana can cause severe infections in individuals not classically at risk, and may be missed in the routine diagnostic work-up of endocarditis.
Collapse
Affiliation(s)
- Nienke L Plantinga
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roemer J Vos
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Lyuba Georgieva
- Department of Internal Medicine, Beatrix Hospital, Gorinchem, The Netherlands
| | - Nienke Roescher
- Department of Medical Microbiology and Immunology, St. Antonius hospital, Nieuwegein, The Netherlands
| |
Collapse
|
50
|
Kotova EO, Domonova EA, Kobalava ZD, Karaulova JL, Pisaryuk AS, Balatskiy AV, Akimkin VG. Modern trends in identification of causative agents in infective endocarditis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Advances in the diagnosis and treatment of patients with infectious endocarditis are limited by the high frequency of cases with an unknown etiology and imperfection of microbiological (cultural) methods. To overcome these problems new approaches to the identification of infectious endocarditis pathogens were introduced, which allowed achieving certain positive results. However, it should be noted that despite the wide variety of diagnostic tools currently used, there is no ideal method for etiological laboratory diagnosis of infectious endocarditis. The article discusses the features and place of immunochemical, molecular biological (MALDI-TOF MS, real-time PCR, sequencing, in situ fluorescence hybridization, metagenomic methods, etc.), immunohistochemical methods, and their advantages and limitations.
Collapse
Affiliation(s)
| | | | | | | | - A. S. Pisaryuk
- Peoples’ Friendship University of Russia (RUDN);
Moscow City Hospital named after V.V. Vinogradov
| | | | | |
Collapse
|