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Rajabi SA, Ownagh A, Hadian M. Genomic detection and phylogenetic analysis of Bartonella quintana in pet cats from Urmia City, Northwest Iran. Comp Immunol Microbiol Infect Dis 2024; 105:102125. [PMID: 38199070 DOI: 10.1016/j.cimid.2024.102125] [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: 09/02/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The aim of this study was to investigate the presence and genetic characteristics of Bartonella quintana in pet cats from Urmia City, located in the northwest of Iran. Blood samples were collected from 200 cats, and their age, gender, and breed were noted. Nested-PCR and sequencing were used to identify B. quintana in positive samples, and the ftsZ gene sequences were analyzed using BioEdit software. The gene sequence obtained in this study exhibited 100.00 % similarity to reference sequences in the GenBank® database, and a phylogenetic tree was constructed using MEGA11. The results revealed that 15 % of the cats (30 out of 200 blood samples) tested positive for the B. quintana gene, with a 95 % confidence interval of 10.71 % to 20.61 %.
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Affiliation(s)
- Sima Alempour Rajabi
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Abdolghaffar Ownagh
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran.
| | - Mojtaba Hadian
- Department of Clinical Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
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2
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Kotova EO, Moiseeva AY, Kobalava ZD, Domonova EA, Pisaruk AS, Silveistrova OY, Kakhktsyan PV, Vladimirov VV. Effect of Antibiotic Therapy on the Sensitivity of Etiological Diagnostic Methods in Patients with Infective Endocarditis after Surgery. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2023. [DOI: 10.20996/1819-6446-2023-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Aim. Assessment of impact of the duration of preoperative antimicrobial therapy (AMT) on the sensitivity of microbiological examination and polymerase chain reaction (PCR) of blood/tissues of resected valves in operated patients with infective endocarditis (IE).Materials and methods. 52 operated patients with active IE were included prospectively (Duke criteria, 2015). All patients underwent microbiological examination of blood before admission to the cardiac surgery hospital, as well as parallel simultaneous microbiological examination and PCR of blood/tissues of excised valves, followed by Sanger sequencing. The duration of preoperative treatment was calculated from the first day of AMT according to IE diagnosis to the day of surgery.Results. The causative agent of IE was established in 84.6% (n=44) patients by means of complex etiological diagnosis. A significant decrease in the sensitivity of microbiological examination of venous blood was revealed when performed in the period before and after hospitalization to a surgical hospital (up 44.2% to 17.3%, p<0.05). When comparing microbiological examination of blood/tissues of resected valves and PCR of blood/tissues of resected valves, molecular biological methods demonstrated the greatest sensitivity, with a great advantage when examining the tissues of resected valves (17.3% and 19.2% vs. 38.5% and 75.0%, respectively; p<0.001). The microbiological examination of venous blood performed at an early date before admission to the cardiac surgery hospital was comparable in sensitivity to the PCR blood test performed at a later date after prolonged AMT, and significantly less sensitive in relation to the PCR of resected valve tissues [44.2% and 38.5% (p>0.05) vs. 75.0% (p<0.05)]. In course of AMT 1-28 days, there were comparable results of microbiological examination with PCR blood examination and significantly better results of PCR of resected valve tissues [31.0% and 34.5% and 41.4% (p>0.05) vs 72.4% (p<0.001), respectively], and with AMT ≥ 29 days, microbiological examination of any biological material was negative in all patients, and PCR of blood/tissues of resected valves retained high sensitivity (0% and 0% vs. 34.8% and 78.3%, respectively; p<0.01).Conclusion. Long-term preoperative AMT significantly reduced the sensitivity of microbiological examination of resected valve blood/tissue in operated patients with IE, whereas PCR of resected valve blood/tissue was highly sensitive even with preoperative AMT for more than 29 days.
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Affiliation(s)
- E. O. Kotova
- Peoples’ Friendship University of Russia (RUDN); City Hospital named after V.V. Vinogradov
| | | | - Zh. D. Kobalava
- Peoples’ Friendship University of Russia (RUDN); City Hospital named after V.V. Vinogradov
| | - E. A. Domonova
- Central Research Institute of Epidemiology of The Federal Service on Customers' Rights Protection and Human Well-being Surveillance
| | - A. S. Pisaruk
- Peoples’ Friendship University of Russia (RUDN); City Hospital named after V.V. Vinogradov
| | - O. Yu. Silveistrova
- Central Research Institute of Epidemiology of The Federal Service on Customers' Rights Protection and Human Well-being Surveillance
| | - P. V. Kakhktsyan
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery
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3
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Köseoğlu AE, Can H, Güvendi M, Karakavuk M, Manyatsi P, Erkunt Alak S, Değirmenci Döşkaya A, Gül A, Döşkaya M, Gürüz AY, Ün C. Molecular prevalence and genetic diversity of Bartonella spp. in stray cats of İzmir, Turkey. Parasit Vectors 2022; 15:305. [PMID: 36038877 PMCID: PMC9422166 DOI: 10.1186/s13071-022-05431-3] [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: 06/03/2022] [Accepted: 08/04/2022] [Indexed: 12/13/2022] Open
Abstract
Background Bartonella spp. are vector-borne pathogens that cause zoonotic infections in humans. One of the most well-known of these is cat-scratch disease caused by Bartonella henselae and Bartonella clarridgeiae, with cats being the major reservoir for these two bacteria. Izmir, Turkey is home to many stray cats, but their potential role as a reservoir for the transmission of Bartonella to humans has not been investigated yet. Therefore, the aim of this study was to investigate the prevalence of Bartonella species and their genetic diversity in stray cats living in Izmir. Methods Molecular prevalence of Bartonella spp. in stray cats (n = 1012) was investigated using a PCR method targeting the 16S-23S internal transcribed spacer gene (ITS), species identification was performed by sequencing and genetic diversity was evaluated by haplotype analysis. Results Analysis of the DNA extracted from 1012 blood samples collected from stray cats revealed that 122 samples were Bartonella-positive, which is a molecular prevalence of 12.05% (122/1012; 95% confidence interval [CI] 10.1–14.2%). Among the Bartonella-positive specimens, 100 (100/122; 81.96%) were successfully sequenced, and B. henselae (45/100; 45%), B. clarridgeiae (29/100; 29%) and Bartonella koehlerae (26/100; 26%) were identified by BLAST and phylogenetic analyses. High genetic diversity was detected in B. clarridgeiae with 19 haplotypes, followed by B. henselae (14 haplotypes) and B. koehlerae (8 haplotypes). Conclusions This comprehensive study analyzing a large number of samples collected from stray cats showed that Bartonella species are an important source of infection to humans living in Izmir. In addition, high genetic diversity was detected within each Bartonella species. Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05431-3.
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Affiliation(s)
- Ahmet Efe Köseoğlu
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Biruni University, Istanbul, Turkey.,Department of Biology Molecular Biology Section, Faculty of Science, Ege University, Izmir, Turkey
| | - Hüseyin Can
- Department of Biology Molecular Biology Section, Faculty of Science, Ege University, Izmir, Turkey.
| | - Mervenur Güvendi
- Department of Biology Molecular Biology Section, Faculty of Science, Ege University, Izmir, Turkey
| | | | - Pumla Manyatsi
- Department of Biology Molecular Biology Section, Faculty of Science, Ege University, Izmir, Turkey
| | - Sedef Erkunt Alak
- Department of Biology Molecular Biology Section, Faculty of Science, Ege University, Izmir, Turkey
| | | | - Aytül Gül
- Department of Bioengineering, Faculty of Engineering, Ege University, Izmir, Turkey
| | - Mert Döşkaya
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Adnan Yüksel Gürüz
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Cemal Ün
- Department of Biology Molecular Biology Section, Faculty of Science, Ege University, Izmir, Turkey
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4
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Singhal C, Bruno JG, Kaushal A, Sharma TK. Recent Advances and a Roadmap to Aptamer-Based Sensors for Bloodstream Infections. ACS APPLIED BIO MATERIALS 2021; 4:3962-3984. [PMID: 35006817 DOI: 10.1021/acsabm.0c01358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present review is intended to describe bloodstream infections (BSIs), the major pathogens responsible for BSIs, conventional tests and their limitations, commercially available methods used, and the aptamer and nanomaterials-based approaches developed so far for the detection of BSIs. The advantages associated with aptamers and the aptamer-based sensors, the comparison between the aptamers and the antibodies, and the various types of aptasensors developed so far for the detection of bloodstream infections have been described in detail in the present review. Also, the future outlook and roadmap toward aptamer-based sensors and the challenges associated with the aptamer development have also been concluded in this review.
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Affiliation(s)
- Chaitali Singhal
- Aptamer Technology and Diagnostic Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India
| | - John G Bruno
- Nanohmics, Inc., Austin, Texas 78741, United States
| | - Ankur Kaushal
- Centre of Nanotechnology, Amity University, Manesar, Gurugram, Haryana 122413, India
| | - Tarun K Sharma
- Aptamer Technology and Diagnostic Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India
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5
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Lemos AP, Domingues R, Gouveia C, de Sousa R, Brito MJ. Atypical bartonellosis in children: What do we know? J Paediatr Child Health 2021; 57:653-658. [PMID: 33301212 DOI: 10.1111/jpc.15304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Abstract
AIM To characterise Bartonella infections in a paediatric population requiring hospital admission and review its treatment. METHODS Longitudinal observational retrospective data analysis of children and adolescents admitted with Bartonella infection at a paediatric tertiary hospital from 2010 to 2019. RESULTS We identified 16 cases of bartonellosis, with a mean age of 8.0 ± 4.5 years old, no sex predominance and 14 had contact with cats. Most of the cases occurred in fall and winter. Clinical presentations included osteomyelitis/arthritis (n = 9), hepatosplenic disease (n = 2), lymphadenitis (n = 2), neuroretinitis (n = 2) and encephalitis (n = 1). Clinical diagnosis was confirmed by serology (n = 16) and Bartonella DNA detection in patient's lymph nodes/hepatic lesion (n = 3). Therapeutic approach varied according to the clinical presentation: azithromycin in lymphadenitis, rifampicin plus ciprofloxacin in hepatosplenic disease, rifampicin and doxycycline in neuroretinitis, ceftriaxone in encephalitis and azithromycin, cotrimoxazole or rifampicin plus azithromycin, cefuroxime, ciprofloxacin or doxycycline in osteomyelitis/arthritis. Immunodeficiency was excluded in seven patients. Seven patients' cats were screened by veterinarians and treated when infected (n = 5). CONCLUSIONS In these clinical presentations, where other infections may be involved, a high index of suspicion is necessary, with emphasis on the epidemiological context. The association of systemic forms with immunodeficiency did not occur in our study. The lack of recommendations for treatment of atypical infection makes the approach of these cases a challenge. Randomised control studies are essential to define the best approach in each case.
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Affiliation(s)
- Ana P Lemos
- Department of Infectious Diseases, Hospital Dona Estefânia, Lisbon, Portugal
| | - Rui Domingues
- Department of Infectious Diseases, Hospital Dona Estefânia, Lisbon, Portugal
| | - Catarina Gouveia
- Department of Infectious Diseases, Hospital Dona Estefânia, Lisbon, Portugal
| | - Rita de Sousa
- Centre of Study of Vectors and Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Maria J Brito
- Department of Infectious Diseases, Hospital Dona Estefânia, Lisbon, Portugal
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6
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Marks F, Liu J, Soura AB, Gasmelseed N, Operario D, Grundy B, Wieser J, Gratz J, Meyer CG, Im J, Lim JK, von Kalckreuth V, Cruz Espinoza LM, Konings F, Jeon HJ, Rakotozandrindrainy R, Zhang J, Panzner U, Houpt E. Pathogens causing acute febrile illness among children and adolescents in Burkina Faso, Madagascar and Sudan. Clin Infect Dis 2021; 73:1338-1345. [PMID: 33822011 PMCID: PMC8528393 DOI: 10.1093/cid/ciab289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background The etiology and optimal clinical management of acute febrile illness (AFI) is poorly understood. Methods Blood samples taken from study participants with acute fever (≥37.5°C) or a history of fever and recruited into the previous Typhoid Fever Surveillance in Africa (TSAP) study were evaluated using a polymerase chain reaction (PCR)-based TaqMan-Array Card designed to detect a panel of bacterial, viral, and parasitic pathogens. Clinical metadata were also assessed. Results A total of 615 blood samples available for analysis originated from Burkina Faso (n = 53), Madagascar (n = 364), and Sudan (n = 198) and were taken from participants ranging in age from 0–19 years. Through the TaqMan-Array Card, at least 1 pathogen was detected in 62% (33 of 53), 24% (86 of 364), and 60% (118 of 198) of specimens from Burkina Faso, Madagascar, and Sudan, respectively. The leading identified pathogen overall was Plasmodium spp., accounting for 47% (25 of 53), 2.2% (8 of 364), and 45% (90 of 198) of AFI at the respective sites. In Madagascar, dengue virus was the most prevalent pathogen (10.2%). Overall, 69% (357 of 516) of patients with clinical diagnoses of malaria, respiratory infection, or gastrointestinal infection were prescribed a World Health Organization guideline-recommended empiric antibiotic, whereas only 45% (106 of 237) of patients with pathogens detected were treated with an antibiotic exerting likely activity. Conclusions A PCR approach for identifying multiple bacterial, viral, and parasitic pathogens in whole blood unveiled a diversity of previously undetected pathogens in AFI cases and carries implications for the appropriate management of this common syndrome.
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Affiliation(s)
- Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,University of Antananarivo, Antananarivo, Madagascar.,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Nagla Gasmelseed
- Faculty of Medicine at the University of Gezira, Wad Medani, Sudan
| | - Darwin Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Brian Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - John Wieser
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Christian G Meyer
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam.,Institute of Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea.,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Jixian Zhang
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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7
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Downey RD, Russo SM, Hauger SB, Murphey DK, Marx G, Huynh T, Denison AM, Quirt R, Bailey A, Fernandez M. Identification of an Emergent Pathogen, Bartonella vinsonii, Using Next-Generation Sequencing in a Patient With Culture-Negative Endocarditis. J Pediatric Infect Dis Soc 2021; 10:213-216. [PMID: 32092135 DOI: 10.1093/jpids/piaa014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/04/2020] [Indexed: 11/15/2022]
Abstract
Diagnosis and treatment of culture negative endocarditis remains a challenge. This report describes a rare cause of endocarditis in humans, Bartonella vinsonii, identified through next generation sequencing of plasma microbial cell-free DNA with confirmation of cardiac valve tissue infection through immunohistochemical staining and polymerase chain reaction.
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Affiliation(s)
| | | | - Sarmistha B Hauger
- Dell Children's Medical Center, Austin, Texas, USA.,Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Donald K Murphey
- Dell Children's Medical Center, Austin, Texas, USA.,Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Grace Marx
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Thanhthao Huynh
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy M Denison
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Quirt
- Dell Children's Medical Center, Austin, Texas, USA
| | - Ann Bailey
- Dell Children's Medical Center, Austin, Texas, USA
| | - Marisol Fernandez
- Dell Children's Medical Center, Austin, Texas, USA.,Dell Medical School, University of Texas at Austin, Austin, Texas, USA
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8
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Meher-Homji Z, Graves SR, Trubiano J, Holmes NE. Bartonella Quintana prosthetic aortitis successfully treated with doxycycline. BMJ Case Rep 2019; 12:12/7/e229877. [PMID: 31296621 DOI: 10.1136/bcr-2019-229877] [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] [Indexed: 11/03/2022] Open
Abstract
Bartonella quintana is a rare cause of culture-negative endovascular infection, characterised by intracellular persistence. We describe a case of ascending aortic prosthetic graft infection due to B. quintana, in a patient with past unrecognised necrotising aortitis, which was successfully treated with doxycycline monotherapy.
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Affiliation(s)
- Zaal Meher-Homji
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Victoria, Australia
| | - Jason Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
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9
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Kleynhans DJ, Sarli J, Hatyoka LM, Alagaili AN, Bennett NC, Mohammed OB, Bastos ADS. Molecular assessment of Bartonella in Gerbillus nanus from Saudi Arabia reveals high levels of prevalence, diversity and co-infection. INFECTION GENETICS AND EVOLUTION 2018; 65:244-250. [PMID: 30071312 DOI: 10.1016/j.meegid.2018.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/19/2018] [Accepted: 07/28/2018] [Indexed: 11/16/2022]
Abstract
Bartonellae bacteria are associated with several re-emerging human diseases. These vector-borne pathogens have a global distribution, yet data on Bartonella prevalence and diversity in the Arabian Peninsula are limited. In this study we assessed the Bartonella infection status of the Baluchistan gerbil (Gerbillus nanus), a species associated with pastoral communities throughout the Middle East region, using a multi-gene PCR screening approach. The results demonstrated that 94 (68.1%) of the 138 gerbils trapped on a monthly basis, over a period of one year, were PCR-positive. Sequencing of the gltA gene region confirmed the presence of four discrete Bartonella lineages (I-IV) and high levels of co-infection (33.0%). Each of the four lineages, varied in overall abundance (7.5%-47.9%) and had discernible seasonal peaks. Bartonella status was significantly correlated with ectoparasite presence, but not with sex, nor with season. Statistical analyses further revealed that co-infected individuals had a significantly higher relative body condition. Multi-locus sequence analysis (MLSA) performed with a concatenated dataset of three genetic loci (gltA, nuoG, and rpoB), 1452 nucleotides (nt) in length confirmed that lineage IV, which occurred in 24 PCR-positive animals (25.5%), is most closely related to zoonotic B. elizabethae. The remaining three lineages (I-III) formed a monophyletic clade which, on the basis of gltA was shown to contain bartonellae from diverse Gerbillinae species from the Middle East, suggestive of a gerbil-associated species complex in this region. Lineage I was identical to a Candidatus B. sanaae strain identified previously in Bushy-tailed jirds (Sekeetamys calurus) from Egypt, wherease MLSA indicate that lineages II and III are novel. The high levels of infection and co-infection, together with the presence of multiple Bartonella lineages indicate that Gerbillus nanus is likely a natural reservoir of Bartonella in the Arabian Peninsula.
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Affiliation(s)
- Dewald J Kleynhans
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, South Africa
| | - Joshua Sarli
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, South Africa
| | - Luiza M Hatyoka
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, South Africa
| | - Abdulaziz N Alagaili
- KSU Mammals Research Chair, Department of Zoology, King Saud University, Riyadh, Saudi Arabia
| | - Nigel C Bennett
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, South Africa; KSU Mammals Research Chair, Department of Zoology, King Saud University, Riyadh, Saudi Arabia
| | - Osama B Mohammed
- KSU Mammals Research Chair, Department of Zoology, King Saud University, Riyadh, Saudi Arabia
| | - Armanda D S Bastos
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, South Africa.
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10
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Abstract
Since the reclassification of the genus Bartonella in 1993, the number of species has grown from 1 to 45 currently designated members. Likewise, the association of different Bartonella species with human disease continues to grow, as does the range of clinical presentations associated with these bacteria. Among these, blood-culture-negative endocarditis stands out as a common, often undiagnosed, clinical presentation of infection with several different Bartonella species. The limitations of laboratory tests resulting in this underdiagnosis of Bartonella endocarditis are discussed. The varied clinical picture of Bartonella infection and a review of clinical aspects of endocarditis caused by Bartonella are presented. We also summarize the current knowledge of the molecular basis of Bartonella pathogenesis, focusing on surface adhesins in the two Bartonella species that most commonly cause endocarditis, B. henselae and B. quintana. We discuss evidence that surface adhesins are important factors for autoaggregation and biofilm formation by Bartonella species. Finally, we propose that biofilm formation is a critical step in the formation of vegetative masses during Bartonella-mediated endocarditis and represents a potential reservoir for persistence by these bacteria.
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11
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Hobson C, Le Brun C, Beauruelle C, Maakaroun-Vermesse Z, Mereghetti L, Goudeau A, Lanotte P. Detection of Bartonella in cat scratch disease using a single-step PCR assay kit. J Med Microbiol 2017; 66:1596-1601. [PMID: 29068281 DOI: 10.1099/jmm.0.000626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Bartonella is an increasingly isolated emerging pathogen that can cause severe illness in humans, including cat scratch disease (CSD). The bacteria are difficult to grow and thus many detection methods have been developed, especially molecular. We previously developed a PCR method targeting ribC to identify Bartonella sp. A manufactured kit (RealCycler BART, Progenie Molecular) was commercialised shortly thereafter for the detection of Bartonella infection, including Bartonella henselae. METHODOLOGY We performed a comparison between this test and our in-house PCR assay on 73 lymphadenopathy samples sent to the laboratory for suspicion of CSD.Results/Key findings. Among the 28 positive samples for Bartonella, 21 were identified by the two PCR assays, and seven by the commercial kit only. CONCLUSION The performance of this commercial kit suggests that it could be a suitable alternative to our in-house PCR assay, highlighting the importance of the molecular methods used to diagnose CSD.
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Affiliation(s)
- C Hobson
- CHRU de Tours, Service de Bactériologie-Virologie, F-37044 Tours, France
| | - C Le Brun
- CHRU de Tours, Service de Bactériologie-Virologie, F-37044 Tours, France
| | - C Beauruelle
- CHRU de Tours, Service de Bactériologie-Virologie, F-37044 Tours, France.,ISP, INRA, Université François Rabelais de Tours, UMR 1282, F-37380, Nouzilly, France
| | - Z Maakaroun-Vermesse
- CHRU de Tours, Service de Médecine et Maladies Infectieuses, F-37044 Tours, France
| | - L Mereghetti
- CHRU de Tours, Service de Bactériologie-Virologie, F-37044 Tours, France.,ISP, INRA, Université François Rabelais de Tours, UMR 1282, F-37380, Nouzilly, France
| | - A Goudeau
- CHRU de Tours, Service de Bactériologie-Virologie, F-37044 Tours, France
| | - P Lanotte
- ISP, INRA, Université François Rabelais de Tours, UMR 1282, F-37380, Nouzilly, France.,CHRU de Tours, Service de Bactériologie-Virologie, F-37044 Tours, France
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12
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Abstract
The paleomicrobiology of coprolites, which are fossilized fecal materials, has already yielded data about various organisms, including micro-eukaryotes, bacteria, and archaea, thus expanding our comprehension of ancient human dietary habits, gut microbiota, and intestinal and systemic infections. This mini-review briefly describes previous works and summarizes the main techniques used in handling coprolites and the findings obtained about ancient gut microbiota. Past intestinal and systemic infections are outlined.
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13
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Lockrow J, Longstreth W, Davis AP. Intracranial Aneurysms From Presumed Infective Endocarditis. Neurohospitalist 2016; 6:80-6. [DOI: 10.1177/1941874415605879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jason Lockrow
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Will Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Arielle P. Davis
- Department of Neurology, University of Washington, Seattle, WA, USA
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14
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Affiliation(s)
- B Cherie Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, UK
| | - Gilbert Habib
- Aix-Marseille Université, Marseille, France Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - John E Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, UK
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Mito T, Hirota Y, Suzuki S, Noda K, Uehara T, Ohira Y, Ikusaka M. Bartonella henselae Infective Endocarditis Detected by a Prolonged Blood Culture. Intern Med 2016; 55:3065-3067. [PMID: 27746451 PMCID: PMC5109581 DOI: 10.2169/internalmedicine.55.7006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. Accordingly, infective endocarditis and heart failure were diagnosed. Although a blood culture was negative on day 7 after admission, a prolonged blood culture with subculture was performed according to the patient's history of contact with cats. Consequently, Bartonella henselae was isolated. Bartonella species are fastidious bacteria that cause blood culture-negative infective endocarditis. This case demonstrates that B. henselae may be detected by prolonged incubation of blood cultures.
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Affiliation(s)
- Tsutomu Mito
- Department of General Medicine, Chiba University Hospital, Japan
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16
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Opota O, Jaton K, Greub G. Microbial diagnosis of bloodstream infection: towards molecular diagnosis directly from blood. Clin Microbiol Infect 2015; 21:323-31. [PMID: 25686695 DOI: 10.1016/j.cmi.2015.02.005] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/01/2015] [Accepted: 02/04/2015] [Indexed: 11/19/2022]
Abstract
When a bloodstream infection (BSI) is suspected, most of the laboratory results-biochemical and haematologic-are available within the first hours after hospital admission of the patient. This is not the case for diagnostic microbiology, which generally takes a longer time because blood culture, which is to date the reference standard for the documentation of the BSI microbial agents, relies on bacterial or fungal growth. The microbial diagnosis of BSI directly from blood has been proposed to speed the determination of the etiological agent but was limited by the very low number of circulating microbes during these paucibacterial infections. Thanks to recent advances in molecular biology, including the improvement of nucleic acid extraction and amplification, several PCR-based methods for the diagnosis of BSI directly from whole blood have emerged. In the present review, we discuss the advantages and limitations of these new molecular approaches, which at best complement the culture-based diagnosis of BSI.
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Affiliation(s)
- O Opota
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland; Infectious Diseases Service, University of Lausanne and University Hospital Center, Lausanne, Switzerland.
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Reeves WK, Durden LA, Iwakami M, Vince KJ, Paul RR. Rickettsial diseases and ectoparasites from military bases in Japan. J Parasitol 2014; 101:150-5. [PMID: 25548900 DOI: 10.1645/14-662.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Ectoparasitic arthropods are often vectors of rickettsiosis. We conducted a survey of ectoparasites on U.S. military facilities throughout Japan with the use of specimens submitted by pest control, public health, and veterinary personnel. Over 1,600 individual ectoparasites were collected. Fifteen species were identified, including several significant vectors of human diseases such as scrub typhus and rickettsial spotted fevers. These ectoparasites included Ctenocephalides felis , Haemaphysalis longicornis, Ixodes persulcatus , Leptotrombidium fuji, Leptotrombidium pallidum, and Rhipicephalus sanguineus . Rickettsial agents were detected by PCR and DNA sequencing. These included Bartonella henselae , Bartonella japonica, a novel Bartonella, Coxiella burnetii , an unnamed Coxiella, Ehrlichia canis , Orientia tsutsugamushi , Rickettsia typhi , and "Rickettsia Rf2125"/"Rickettsia cf1and5".
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Affiliation(s)
- Will K Reeves
- U.S. Air Force School of Aerospace Medicine/PHR, 2510 5th Street, Wright-Patterson Air Force Base 45433
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18
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Abstract
In recent years, quantitative real-time PCR tests have been extensively developed in clinical microbiology laboratories for routine diagnosis of infectious diseases, particularly bacterial diseases. This molecular tool is well-suited for the rapid detection of bacteria directly in clinical specimens, allowing early, sensitive and specific laboratory confirmation of related diseases. It is particularly suitable for the diagnosis of infections caused by fastidious growth species, and the number of these pathogens has increased recently. This method also allows a rapid assessment of the presence of antibiotic resistance genes or gene mutations. Although this genetic approach is not always predictive of phenotypic resistances, in specific situations it may help to optimize the therapeutic management of patients. Finally, an approach combining the detection of pathogens, their mechanisms of antibiotic resistance, their virulence factors and bacterial load in clinical samples could lead to profound changes in the care of these infected patients.
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Affiliation(s)
- Max Maurin
- Laboratoire de Bactériologie, Département des Agents Infectieux, Institut de Biologie et Pathologie, CHU de Grenoble, Université Joseph Fourier Grenoble 1, France.
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Rostad CA, McElroy AK, Hilinski JA, Thompson MP, Drew CP, Denison AM, Zaki SR, Mahle WT, Rogers J, Abramowsky CR, Shehata B. Bartonella henselae-mediated disease in solid organ transplant recipients: two pediatric cases and a literature review. Transpl Infect Dis 2012; 14:E71-81. [PMID: 22862881 DOI: 10.1111/j.1399-3062.2012.00774.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/15/2012] [Accepted: 03/19/2012] [Indexed: 01/27/2023]
Abstract
Bartonella henselae, the etiologic agent of cat-scratch disease, causes a well-defined, self-limited syndrome of fever and regional lymphadenopathy in immunocompetent hosts. In immunocompromised hosts, however, B. henselae can cause severe disseminated disease and pathologic vasoproliferation known as bacillary angiomatosis (BA) or bacillary peliosis. BA was first recognized in patients infected with human immunodeficiency virus. It has become more frequently recognized in solid organ transplant (SOT) recipients, but reports of pediatric cases remain rare. Our review of the literature revealed only one previously reported case of BA in a pediatric SOT recipient. We herein present 2 pediatric cases, one of which is the first reported case of BA in a pediatric cardiac transplant recipient, to our knowledge. In addition, we review and summarize the literature pertaining to all cases of B. henselae-mediated disease in SOT recipients.
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Affiliation(s)
- C A Rostad
- Department of Pediatrics, Emory University, Atlanta, Georgia 30322, USA
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21
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Forme hépato-splénique de la maladie des griffes du chat chez un enfant de 3ans. Arch Pediatr 2012; 19:603-6. [DOI: 10.1016/j.arcped.2012.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/20/2011] [Accepted: 03/22/2012] [Indexed: 11/15/2022]
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22
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Liberto MC, Lamberti AG, Marascio N, Matera G, Quirino A, Barreca GS, Baudi F, Focà A. Molecular identification of Bartonella quintana infection using species-specific real-time PCR targeting transcriptional regulatory protein (bqtR) gene. Mol Cell Probes 2011; 25:238-42. [DOI: 10.1016/j.mcp.2011.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/13/2011] [Accepted: 07/15/2011] [Indexed: 11/28/2022]
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Robinson MT, Morgan ER, Woods D, Shaw SE. Real-time and multiplex real-time polymerase chain reactions for the detection of Bartonella henselae within cat flea, Ctenocephalides felis, samples. MEDICAL AND VETERINARY ENTOMOLOGY 2010; 24:449-455. [PMID: 20704655 DOI: 10.1111/j.1365-2915.2010.00901.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Bartonella henselae (Rhizobiales: Bartonellacae), the agent of cat-scratch disease, is an emerging bacterial pathogen which can be transmitted via infective faecal material of Ctenocephalides felis Bouché (Siphonaptera: Pulicidae). Worldwide, B. henselae has been identified in 1-53% of felines and 2.9-17.4% of fleas. Although culture is the routine method for detection, the procedure is time-consuming and is rarely used for isolation directly from flea vectors. The current study reports the development of a quantitative real-time polymerase chain reaction (qPCR) to detect and quantify B. henselae organisms from vector samples. The qPCR is specific and detects as few as 2.5 genome copies. To enable direct quantification of Bartonella organisms in different vector samples, we developed a qPCR to detect C. felis DNA that also acts as an extraction control. Combining both PCRs into a multiplex format validates B. henselae results when sampling flea populations, although there is a reduction in sensitivity. This reduction might be counteracted by a different combination of probe fluorophores.
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Affiliation(s)
- M T Robinson
- School of Clinical Veterinary Science, University of Bristol, Langford, UK.
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Abstract
Infective endocarditis (IE) is a bacterial disease that commonly occurs in dogs. Difficulty in diagnosis and underreporting of IE in dogs contribute to the reported low prevalence rate of the disease. The mitral and aortic valves are the worst affected by IE. Common causative microbial agents include Staphylococcus spp, Streptococcus spp, Escherichia coli, and Bartonella spp. Congestive heart failure, immune-mediated disease, and thromboembolism are the major complications of IE. Diagnosis of IE by echocardiography and long-term treatment with broad-spectrum antibiotics may contribute to the timely detection and treatment of the disease.
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Culture-Negative Endocarditis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181c7543f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miyatake C, Asano T, Mishina-Ikegami K, Takeuchi H, Koizumi S, Hatori T, Fujino O. Cat scratch disease confirmed by immunological and polymerase-chain-reaction-based diagnosis using serum. Pediatr Int 2010; 52:e98-e100. [PMID: 20500473 DOI: 10.1111/j.1442-200x.2009.02983.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chiharu Miyatake
- Department of Pediatrics, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
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27
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Westling K, Vondracek M. Actinobacillus (Aggregatibacter) actinomycetemcomitans (HACEK) identified by PCR/16S rRNA sequence analysis from the heart valve in a patient with blood culture negative endocarditis. ACTA ACUST UNITED AC 2009; 40:981-3. [DOI: 10.1080/00365540802325922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Martín L, Vidal L, Campins A, Salvá F, Riera M, Carrillo A, Sáez de Ibarra JI. Bartonella as a cause of blood culture-negative endocarditis. Description of five cases. Rev Esp Cardiol 2009; 62:694-7. [PMID: 19480767 DOI: 10.1016/s1885-5857(09)72235-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is evidence that Bartonella is an etiologic factor in human endocarditis. The objective of this article was to describe cases of endocarditis due to Bartonella observed at a tertiary-care hospital during 1995-2006. Overall, 140 cases of infective endocarditis were seen, of which 10 were blood culture-negative endocarditis, with five being due to Bartonella. In four cases, there had been contact with cats. Only two patients had pre-existing cardiac valvular disease. Three had extracardiac disease manifestations. In three cases, polymerase chain reaction (PCR) tests on cardiac valvular tissue gave positive results. Two patients had positive serology test results for Chlamydophila and another two, positive results for Coxiella burnetii. All five patients needed surgery, and the outcome was favorable in all five. The presence of Bartonella must be considered in patients with blood culture-negative endocarditis. Although serological testing is essential for the diagnosis, cross-reactions between Bartonella and C. burnetii or Chlamydophila are frequent, and PCR tests on cardiac valvular tissue, therefore, play an important diagnostic role.
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Affiliation(s)
- Luisa Martín
- Servicio de Medicina Interna-Infecciosas, Hospital Universitario Son Dureta, Palma de Mallorca, Baleares, España.
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29
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Martín L, Vidal L, Campins A, Salvá F, Riera M, Carrillo A, Sáez de Ibarra JI. Bartonella como causa de endocarditis con hemocultivos negativos. Descripción de 5 casos. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71338-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ramón Blanco J, Jado I, Marín M, Sanfeliu I, Portillo A, Anda P, Pons I, Antonio Oteo J. Diagnóstico microbiológico de las infecciones por patógenos bacterianos emergentes: Anaplasma, Bartonella, Rickettsia, Tropheryma whipplei. Enferm Infecc Microbiol Clin 2008; 26:573-80. [DOI: 10.1157/13128275] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Lang S. Getting to the heart of the problem: serological and molecular techniques in the diagnosis of infective endocarditis. Future Microbiol 2008; 3:341-9. [DOI: 10.2217/17460913.3.3.341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infective endocarditis is diagnosed using the Duke criteria, which rely predominantly on cardiac imaging and recovery of a causative organism from the bloodstream. These criteria can be inconclusive, particularly when blood cultures remain sterile either due to the fastidious nature of the infecting organism or prior antibiotic therapy. Serology and, more recently, molecular techniques have been investigated as a solution to the problematic negative blood culture. The detection of elevated antibody levels has proved particularly useful in the diagnosis of those patients infected with organisms that cannot be cultured using standard laboratory methods, whilst molecular methods have been successfully used in the detection of both fastidious pathogens and those inhibited by prior antibiotic therapy. In view of recent and ongoing developments in the field of molecular diagnostics, these techniques will become increasingly important not only in the routine investigation of infectious disease, but specifically the diagnosis of endocarditis.
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Affiliation(s)
- Sue Lang
- Glasgow Caledonian University, Department of Biological & Biomedical Sciences, Cowcaddens Road, Glasgow, G4 0BA, UK
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33
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De Clerck KF, Van Offel JF, Vlieghe E, Van Marck E, Stevens WJ. Bartonella endocarditis mimicking adult Still's disease. Acta Clin Belg 2008; 63:190-2. [PMID: 18714850 DOI: 10.1179/acb.2008.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We describe the case of a 39-year-old Caucasian woman who was admitted to the University Hospital of Antwerp with a clinical picture suggestive of adult Still's disease. Even though a transoesophageal echocardiography showed endocarditis of the aortic valve, blood cultures remained negative. Additional serological testing revealed a positive result for Bartonella henselae. Histology of the supraclavicular lymph node showed a reactive lymph node with a positive polymerase chain reaction (PCR) for Bartonella henselae. Prednisolone treatment was started in a dosage of 10 mg per day and rifampicin 600 mg/d in combination with doxycyclin 200 mg/d was given for 6 months. During therapy the patient gradually improved and signs of endocarditis disappeared on echocardiography.
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Affiliation(s)
- K F De Clerck
- Department of Immunology-Allergology-Rheumatology, University of Antwerp, Belgium
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34
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Isolation and characterization of Bartonella bacilliformis from an expatriate Ecuadorian. J Clin Microbiol 2007; 46:627-37. [PMID: 18094131 DOI: 10.1128/jcm.01207-07] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Carrion's disease is typically biphasic with acute febrile illness characterized by bacteremia and severe hemolytic anemia (Oroya fever), followed by benign, chronic cutaneous lesions (verruga peruana). The causative agent, Bartonella bacilliformis, is endemic in specific regions of Peru and Ecuador. We describe atypical infection in an expatriate patient who presented with acute splenomegaly and anemia 3 years after visiting Ecuador. Initial serology and PCR of the patient's blood and serum were negative for Bartonella henselae, Bartonella quintana, and B. bacilliformis. Histology of splenic biopsy was suggestive of bacillary angiomatosis, but immunohistochemistry ruled out B. henselae and B. quintana. Bacilli (isolate EC-01) were subsequently cultured from the patient's blood and analyzed using multilocus sequence typing, protein gel electrophoresis with Western blotting, and an immunofluorescence assay (IFA) against a panel of sera from patients with Oroya fever in Peru. The EC-01 nucleotide sequences (gltA and internal transcribed spacer) and protein band banding pattern were most similar to a subset of B. bacilliformis isolates from the region of Caraz, Ancash, in Peru, where B. bacilliformis is endemic. By IFA, the patient's serum reacted strongly to two out of the three Peruvian B. bacilliformis isolates tested, and EC-01 antigen reacted with 13/20 Oroya fever sera. Bacilliary angiomatosis-like lesions were also detected in the spleen of the patient, who was inapparently infected with B. bacilliformis and who presumably acquired infection in a region of Ecuador where B. bacilliformis was not thought to be endemic. This study suggests that the range of B. bacilliformis may be expanding from areas of endemicity in Ecuador and that infection may present as atypical clinical disease.
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35
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Fournier PE, Drancourt M, Raoult D. Bacterial genome sequencing and its use in infectious diseases. THE LANCET. INFECTIOUS DISEASES 2007; 7:711-23. [DOI: 10.1016/s1473-3099(07)70260-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Naber CK, Erbel R. Infective endocarditis with negative blood cultures. Int J Antimicrob Agents 2007; 30 Suppl 1:S32-6. [PMID: 17890062 DOI: 10.1016/j.ijantimicag.2007.07.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 07/10/2007] [Indexed: 12/11/2022]
Abstract
Culture-negative endocarditis is important as it has a relatively poor prognosis. The principal reason for negative cultures is prior antibiotic therapy although fastidious organisms such as Bartonella spp. and Coxiella burnetii are also important. PCR may offer significant advantages in diagnosis but tests require standardisation. Modification of current diagnostic criteria is required. Empirical cover of MRSA needs to be considered.
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Affiliation(s)
- Christoph K Naber
- Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Hufelandstrasse 5545122 Essen, Germany.
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Fenollar F, Raoult D. Molecular diagnosis of bloodstream infections caused by non-cultivable bacteria. Int J Antimicrob Agents 2007; 30 Suppl 1:S7-15. [PMID: 17707613 DOI: 10.1016/j.ijantimicag.2007.06.024] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 06/05/2007] [Indexed: 11/18/2022]
Abstract
Bloodstream infections are an important cause of morbidity and mortality in patients. Blood culture is clearly the most important diagnostic procedure for identifying micro-organisms involved in bloodstream infections except when the patient has previously received antibiotics or in the presence of slow-growing or intracellular micro-organisms. Detection of micro-organisms, mainly in blood, using pathogen-specific or broad-range PCR assays is promising. However, it is very important to emphasise that the interpretation of this molecular tool is critical because of the risk of interfering contamination, underlining the necessity to interpret the results obtained with caution. Presently, due to more widely available data and to rapid advances in biotechnology, two significant improvements allow new perspectives for molecular diagnosis. Indeed, the complete sequences of genomes have provided an important source of gene sequences for PCR-based assays. In addition, the development of real-time PCR offers several advantages in comparison to conventional PCR, including speed, simplicity, quantitative capability and low risk of contamination. Herein, we review the usefulness of molecular diagnosis of highly fastidious micro-organisms in the context of three different bloodstream infections: systemic diseases (rickettsiosis, Q fever, bartonellosis, Whipple's disease), blood-culture-negative endocarditis and bioterrorism attack.
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Affiliation(s)
- Florence Fenollar
- Université de la Méditerranée, Pôle de Maladies Infectieuses, Marseille, France
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38
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Diederen BMW, Vermeulen MJ, Verbakel H, van der Zee A, Bergmans A, Peeters MF. Evaluation of an internally controlled real-time polymerase chain reaction assay targeting the groEL gene for the detection of Bartonella spp. DNA in patients with suspected cat-scratch disease. Eur J Clin Microbiol Infect Dis 2007; 26:629-33. [PMID: 17624560 DOI: 10.1007/s10096-007-0353-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bartonella (B.) henselae is the causative agent of cat-scratch disease (CSD), which usually presents as a self-limiting lymphadenopathy. This study reports the development and evaluation of an internally controlled real-time polymerase chain reaction targeting the groEL gene for detection of Bartonella spp. DNA was extracted using the MagNA Pure system. The lower detection limit was 10-100 fg DNA and the in vitro sensitivity of the assay was not affected by duplexing with an internal control PCR. The real-time PCR assay detected DNA from all five B. henselae strains tested, and from B. birtlesii, B. vinsonii subsp. vinsonii, B. vinsonii subsp. arupensis and B. doshiae. The assay generated negative results with a selection of other bacteria, including several Mycobacterium spp., Streptococcus pyogenes and Staphylococcus aureus. Results of real-time PCR in clinical samples were compared with those of a conventional 16S rDNA-based PCR assay. During the period described in the Material and methods section, real-time PCR and conventional 16S PCR were performed on 73 clinical samples. Of these samples, 29 (40%) were found to give positive results and 44 (60%) gave negative results, both by real-time PCR and by conventional PCR, with a 100% agreement between the two tests. The PCR developed in this study is a rapid, sensitive, and simple method for the detection of Bartonella spp. in CSD and is suitable for implementation in the diagnostic laboratory.
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Affiliation(s)
- B M W Diederen
- Regional Laboratory of Public Health Haarlem, The Netherlands.
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39
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Idowu BD, Al-Adnani M, O'Donnell P, Yu L, Odell E, Diss T, Gale RE, Flanagan AM. A sensitive mutation-specific screening technique for GNAS1 mutations in cases of fibrous dysplasia: the first report of a codon 227 mutation in bone. Histopathology 2007; 50:691-704. [PMID: 17493233 DOI: 10.1111/j.1365-2559.2007.02676.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To report on the mutation-specific restriction enzyme digest (MSRED) method using paraffin-embedded tissue as a means of detecting GNAS1 mutations in fibrous dysplasia (FD), and to determine if any of the reported GNAS1 mutations in endocrine neoplasms, not previously documented in FD, can be found in FD. METHODS AND RESULTS Sixty-seven cases of extragnathic FD were analysed as two groups, 1997-2002 and 2003-06, chosen because tissue fixation and decalcification methods were more accurately recorded in the latter. MSRED revealed that between 2003 and 2006, 93% of 28 'in house' extragnathic cases harboured a GNAS1 mutation, compared with 75% of 32 cases before 2003. Fixation times of no more than 48 h and decalcification in ethylenediamine tetraacetic acid gave the best results. Of the 56 mutations detected (five gnathic, 51 extragnathic), 32 (57%) were R201H, 21 (38%) were R201C and three (5%) were Q227L. Two Q227L extragnathic cases had unusual clinical/radiological findings. No mutations were detected in osteofibrous dysplasia. CONCLUSION Detection of GNAS1 mutations by MSRED is a valuable adjunct to the histopathological diagnosis of FD. This is the first report of a Q227L mutation in FD, although it has been previously documented in pituitary adenoma.
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Affiliation(s)
- B D Idowu
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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40
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Kelly P, Rolain JM, Maggi R, Sontakke S, Keene B, Hunter S, Lepidi H, Breitschwerdt KT, Breitschwerdt EB. Bartonella quintana endocarditis in dogs. Emerg Infect Dis 2007; 12:1869-72. [PMID: 17326937 PMCID: PMC3291365 DOI: 10.3201/eid1212.060724] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
TOC summary line: PCR and sequencing provide the first evidence that B. quintana can be pathogenic in dogs. We provide the first evidence that Bartonella quintana can infect dogs and cause typical signs of endocarditis. Using PCR and sequencing, we identified B. quintana in the blood of a dog from the United States with aortic valve endocarditis and probably also in the mitral valve of a dog from New Zealand with endocarditis.
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Affiliation(s)
- Patrick Kelly
- Ross University, Basseterre, Saint Kitts, West Indies.
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From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection. BMC Infect Dis 2007; 7:30. [PMID: 17442105 PMCID: PMC1868026 DOI: 10.1186/1471-2334-7-30] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 04/18/2007] [Indexed: 11/10/2022] Open
Abstract
Background Most patients with infectious endocarditis (IE) due to Bartonella henselae have a history of exposure to cats and pre-existing heart valve lesions. To date, none of the reported patients have had a history of typical cat scratch disease (CSD) which is also a manifestation of infection with B. henselae. Case presentation Here we report the case of a patient who had CSD and six months later developed IE of the mitral valve caused by B. henselae. Conclusion Based on this unique case, we speculate that CSD represents the primary-infection of B. henselae and that IE follows in patients with heart valve lesions.
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Wikswo ME, Hu R, Metzger ME, Eremeeva ME. Detection of Rickettsia rickettsii and Bartonella henselae in Rhipicephalus sanguineus ticks from California. JOURNAL OF MEDICAL ENTOMOLOGY 2007; 44:158-62. [PMID: 17294935 DOI: 10.1603/0022-2585(2007)44[158:dorrab]2.0.co;2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Sixty-two questing adult Rhipicephalus sanguineus (Latreille) ticks were collected by direct removal from blades of turfgrass and adjacent concrete walkways at a suburban home in Riverside County, CA, and tested for the presence of Rickettsia, Bartonella, and Ehrlichia DNA. Polymerase chain reaction (PCR) was used to amplify fragments of the 17-kDa antigen gene and the rOmpA gene of the spotted fever group rickettsiae. One male tick contained R. rickettsii DNA; its genotype differed from R. rickettsii isolates found in Montana and Arizona that cause Rocky Mountain spotted fever and from Hlp#2 and 364D serotypes. One male tick and one female tick contained B. henselae DNA. No Ehrlichia platys or Ehrlichia canis DNAs were detected using nested PCR for their 16S rRNA genes. These findings extend the area where Rickettsia rickettsii may be vectored by Rh. sanguineus. Rh. sanguineus also may be infected with Bartonella henselae, a human pathogen that is typically associated with fleas and causes cat scratch disease.
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Affiliation(s)
- Mary Elizabeth Wikswo
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Oteo JA, Castilla A, Arosey A, Blanco JR, Ibarra V, Morano LE. [Endocarditis due to Bartonella spp. Three new clinical cases and Spanish literature review]. Enferm Infecc Microbiol Clin 2006; 24:297-301. [PMID: 16762254 DOI: 10.1157/13089663] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases, such as culture-negative endocarditis. METHODS Description of 3 cases of endocarditis due to Bartonella spp. and review of those previously reported in Spain. RESULTS Including these 3 new cases of endocarditis due to Bartonella spp., a total of 6 cases have been reported in Spain. The median age of the patients was 51.6 years and 83.3% were men. There was history of contact with cats in 66.7%, and 50% were alcoholic. Only one patient had prior valvular disease. There were no clinical manifestations typical to any of the Bartonella species. The aortic valve was the one most commonly affected. In all cases, B. henselae was the agent implicated. The diagnosis was made by serology in 5 cases (83.3%). The outcome was favorable in all patients, although 4 of them (66.7%) required valve replacement. CONCLUSION Endocarditis due to Bartonella spp. is present in Spain and is likely to be underestimated. We should suspect this pathogen in patients with negative blood cultures and a history of chronic alcoholism, homeless patients, and those who have had contact with cats or who have been bitten by fleas or lice, as well as patients with endocarditis and positive serology against Chlamydia spp.
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MESH Headings
- Actinobacillus Infections/complications
- Adult
- Aged
- Aggregatibacter actinomycetemcomitans/isolation & purification
- Alcoholism/complications
- Animals
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Bacterial/blood
- Aortic Valve/microbiology
- Bartonella Infections/blood
- Bartonella Infections/complications
- Bartonella Infections/diagnosis
- Bartonella Infections/drug therapy
- Bartonella Infections/epidemiology
- Bartonella Infections/surgery
- Bartonella henselae/immunology
- Bartonella henselae/isolation & purification
- Blood/microbiology
- Cardiomyopathy, Hypertrophic/complications
- Cat-Scratch Disease/blood
- Cat-Scratch Disease/complications
- Cat-Scratch Disease/diagnosis
- Cat-Scratch Disease/drug therapy
- Cat-Scratch Disease/surgery
- Cats
- Ceftriaxone/therapeutic use
- Chlamydia/immunology
- Ciprofloxacin/therapeutic use
- Combined Modality Therapy
- Disease Susceptibility
- Doxycycline/therapeutic use
- Endocarditis, Bacterial/blood
- Endocarditis, Bacterial/drug therapy
- Endocarditis, Bacterial/epidemiology
- Endocarditis, Bacterial/etiology
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/surgery
- Endocarditis, Subacute Bacterial/etiology
- Endocarditis, Subacute Bacterial/microbiology
- False Negative Reactions
- Female
- Gentamicins/therapeutic use
- Heart Valve Prosthesis Implantation
- Humans
- Male
- Middle Aged
- Spain/epidemiology
- Vancomycin/therapeutic use
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Affiliation(s)
- José Antonio Oteo
- Area de Enfermedades Infecciosas, Complejo Hospitalario San Millán-San Pedro de La Rioja, Hospital de La Rioja, Logroño, España.
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Abstract
Sterile blood cultures are noted in one third of patients with infectious endocarditis. Although in half of cases this is due to previous antibiotic therapy, in the other half, the aetiology of culture-negative endocarditis is intracellular bacteria such as Coxiella burnetii or fastidious growing bacteria. Although it was previously considered that the prevalence of such organisms was identical throughout the world, recent investigations on Bartonella endocarditis clearly showed that the aetiology of culture-negative endocarditis is likely to be strongly related to epidemiology of the agent in each country. During the past decade the use of molecular techniques such as PCR with subsequent sequencing to detect or to identify bacteria in valves from patients with infectious endocarditis have considerably improved the aetiological diagnosis. This is especially true in the case of culture-negative endocarditis following earlier antibiotic therapy. However, the fact that DNA remnants of past endocarditis can be detected some time after the acute episode, when the patient has been cured, suggests that the predictive value of these techniques along with the traditional histology and culture need to be evaluated closely.
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Affiliation(s)
- Philippe Brouqui
- Service des Maladies Infectieuses et Tropicales, CHU Nord AP-HM & Unité des rickettsies, Faculté de Médecine, Université de la Méditérranée, Marseilles, France.
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Raoult D. Etiological diagnostic of blood culture negative endocarditis. Enferm Infecc Microbiol Clin 2006; 24:295-6. [PMID: 16762253 DOI: 10.1157/13089662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Espy MJ, Uhl JR, Sloan LM, Buckwalter SP, Jones MF, Vetter EA, Yao JDC, Wengenack NL, Rosenblatt JE, Cockerill FR, Smith TF. Real-time PCR in clinical microbiology: applications for routine laboratory testing. Clin Microbiol Rev 2006; 19:165-256. [PMID: 16418529 PMCID: PMC1360278 DOI: 10.1128/cmr.19.1.165-256.2006] [Citation(s) in RCA: 800] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Real-time PCR has revolutionized the way clinical microbiology laboratories diagnose many human microbial infections. This testing method combines PCR chemistry with fluorescent probe detection of amplified product in the same reaction vessel. In general, both PCR and amplified product detection are completed in an hour or less, which is considerably faster than conventional PCR detection methods. Real-time PCR assays provide sensitivity and specificity equivalent to that of conventional PCR combined with Southern blot analysis, and since amplification and detection steps are performed in the same closed vessel, the risk of releasing amplified nucleic acids into the environment is negligible. The combination of excellent sensitivity and specificity, low contamination risk, and speed has made real-time PCR technology an appealing alternative to culture- or immunoassay-based testing methods for diagnosing many infectious diseases. This review focuses on the application of real-time PCR in the clinical microbiology laboratory.
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Affiliation(s)
- M J Espy
- Mayo Clinic, 200 First St. SW, Hilton 470, Rochester, MN 55905, USA.
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Weinstein MP. Emerging Data Indicating that Extended Incubation of Blood Cultures Has Little Clinical Value. Clin Infect Dis 2005; 41:1681-2. [PMID: 16267744 DOI: 10.1086/497603] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 08/10/2005] [Indexed: 11/04/2022] Open
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Maggi RG, Breitschwerdt EB. Isolation of Bacteriophages from Bartonella vinsonii subsp. berkhoffii and the Characterization of Pap31 Gene Sequences from Bacterial and Phage DNA. J Mol Microbiol Biotechnol 2005; 9:44-51. [PMID: 16254445 DOI: 10.1159/000088145] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bacteriophages enhance bacterial survival, facilitate bacterial adaptation to new environmental conditions, assist in the adaptation to a new host species, and enhance bacterial evasion or inactivation of host defense mechanisms. We describe the detection and purification of a novel tailed bacteriophage from Bartonella vinsonii subsp. berkhoffii, which was previously described as a bacteriophage-negative species. We also compare B. vinsonii subsp. berkhoffi Pap31 bacteriophage gene sequences to B. henselae (Houston I), and B. quintana (Fuller) bacteriophage Pap31 sequences. Negative staining electron microscopy of log phase culturesof B. vinsonii subsp. berkhoffii identified bacteriophages, possessing a 50-nm icosahedric head diameter and a 60- to 80-nm contractile tail. Sequence analysis of the bacteriophage Pap31 gene from B. vinsonii subsp. berkhoffii showed three consensus sequences and a 12-bp insertion when compared with Pap31 gene sequences from B. henselae (Houston I) and B. quintana (Fuller) bacteriophages. Isolation of B. vinsonii subsp. berkhoffii bacteriophages containing a Pap31 gene suggests that this heme-binding protein gene might play an important role in bacterial virulence through the genetic exchange of DNA within this subspecies. Defining phage-associated genes may also contribute to the enhanced understanding of the evolutionary relationships among members of the genus Bartonella.
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Affiliation(s)
- Ricardo G Maggi
- Vector-Borne Diseases Diagnostic Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
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Hansmann Y, DeMartino S, Piémont Y, Meyer N, Mariet P, Heller R, Christmann D, Jaulhac B. Diagnosis of cat scratch disease with detection of Bartonella henselae by PCR: a study of patients with lymph node enlargement. J Clin Microbiol 2005; 43:3800-6. [PMID: 16081914 PMCID: PMC1233974 DOI: 10.1128/jcm.43.8.3800-3806.2005] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cat scratch disease (CSD) is mostly due to Bartonella henselae after inoculation of the organism through a skin injury. Since the causative bacteria cannot be easily cultured from human lymph node samples, the diagnosis usually relies on epidemiological, clinical, histological, and serological criteria (classical criteria). A study was performed to determine the diagnostic value of PCR analysis for the detection of B. henselae for the diagnosis of CSD and its place in the diagnostic strategy alongside the classical criteria. Over a 7-year period, lymph node biopsy specimens or cytopunctures from 70 patients were systematically tested by PCR for the presence of B. henselae DNA (htrA gene) in the Bacteriology Laboratory of the Hôpitaux Universitaires de Strasbourg. Serological testing by an immunofluorescence assay for B. henselae antibodies was also performed for each patient, and clinical, epidemiological, and histological data were collected. The patients were then divided into two groups according to the number of positive diagnostic criteria for CSD: 29 patients with definite CSD (two or more classical criteria) and 15 patients with possible CSD (less than two classical criteria). The remaining 26 patients for whom another diagnosis was retained were used as a control group. Among all criteria, PCR analysis had the best specificity (100%). The PCR assay for B. henselae was positive for 22 (76%; 95% confidence interval [CI95], 56.5 to 89.7%) of the 29 definite CSD patients and 3 (20%; CI95, 4.3 to 48.1%) of the 15 possible CSD patients. We then studied combinations of diagnostic criteria, including B. henselae PCR analysis. The best diagnostic performance was observed if at least two criteria were present among serologic, epidemiologic, histological, and molecular criteria.
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Affiliation(s)
- Yves Hansmann
- Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, 67091 Strasbourg Cedex, France.
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Ciervo A, Mastroianni CM, Ajassa C, Pinto A, Ciceroni L. Rapid identification of Bartonella henselae by real-time polymerase chain reaction in a patient with cat scratch disease. Diagn Microbiol Infect Dis 2005; 53:75-7. [PMID: 16054323 DOI: 10.1016/j.diagmicrobio.2005.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 04/16/2005] [Indexed: 11/20/2022]
Abstract
We report a localized submandibular lymph node infection in a patient with cat scratch disease. Directly performing real-time polymerase chain reaction assay on the biopsy sample, Bartonella henselae DNA was simultaneously detected and identified.
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Affiliation(s)
- Alessandra Ciervo
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy.
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