Bartonella henselae associated uveitis and HLA-B27

Bartonella rochalimae, a newly recognized pathogen in dogs

Background

Bartonella spp. comprise a genus of bacteria that frequently cause persistent, often subclinical infection. Although many Bartonella spp. have been implicated in a variety of clinical presentations, Bartonella rochalimae has yet to be documented in association with a clinical presentation other than infectious endocarditis (IE) in dogs.

Objectives

To document a spectrum of clinical presentations accompanied by mild hematological abnormalities in B rochalimae‐infected dogs from the United States.

Animals

Eight dogs with documented B rochalimae infection.

Methods

Retrospective 10‐year study of B rochalimae naturally infected dogs. Clinical and clinicopathologic data, including medical history, CBC, serum biochemistry panel, urinalysis, echocardiogram, and comprehensive vector‐borne disease diagnostic panel results, were reviewed.

Results

Eight dogs were diagnosed with B rochalimae via polymerase chain reaction (PCR) amplification. Five dogs were diagnosed with IE. Three dogs, PCR positive for B rochalimae, were diagnosed with seizures or antibiotic responsive lameness or during routine screening of a military working dog.

Conclusions

This case series provides support for an association between B rochalimae and IE and provides documentation of dogs infected with B rochalimae with other clinical diagnoses.

Ocular complications of cat scratch disease

Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud's oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.

Retinal detachment and uveitis at a tertiary center over 10 years: the King Khaled Eye Specialist Hospital (KKESH) Uveitis Survey Study Group

PURPOSE

To evaluate the frequency, etiology, treatment, and visual prognosis of retinal detachment (RD) in patients with uveitis.

METHODS

A retrospective review was performed in 707 consecutive patients (1042 eyes) with uveitis, of whom 97 (13.7%) (157 eyes [15.1%]) had RD.

RESULTS

There were 126 (12.1%) eyes with exudative retinal detachment (ERD), 16 (1.5%) with tractional retinal detachment (TRD), and 15 (1.4%) with rhegmatogenous retinal detachment (RRD). Panuveitis was most commonly associated with RD (144 (91.1%) eyes). Infectious causes were more common in RRD, and non-infectious etiologies were most common in ERD and TRD. Oral prednisone was the initial therapy in ERD. Additionally, in these cases, cyclosporine was prescribed most frequently (47.1% patients), followed by azathioprine (26.4% patients). Fourteen (87.5%) eyes with TRD and all RRD cases underwent surgery. In patients with ERD, the mean best-corrected visual acuity (BCVA) was 1.1 ± 0.7 LogMAR at baseline and 0.6 ± 0.2 LogMAR at last visit (p = 0.001). In patients with TRD, mean BCVA was 0.7 ± 0.4 LogMAR at baseline and 0.6 ± 0.4 LogMAR at last visit (p = 0.056). In patients with RRD, mean BCVA was 1.6 ± 0.9 LogMAR at baseline and 20 1.3 ± 0.9 LogMAR at last visit (p = 0.185).

CONCLUSION

In Saudi Arabia, ERD is observed in 12.1% of the eyes with uveitis, and less than 2% of eyes had TRD or RRD. Visual prognosis is usually good after ERD. Infection is the most frequent cause of RRD associated with uveitis and the visual prognosis is poor.

Bartonella Species, an Emerging Cause of Blood-Culture-Negative Endocarditis

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.

Chronic Lyme Disease and Co-infections: Differential Diagnosis

In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th, i.e. approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with Borrelia burgdorferi by tick bite resulting in multiple infections but a fraction of co-infections occur independently of tick bite. Clinically relevant co-infections are caused by Bartonella species, Yersinia enterocolitica, Chlamydophila pneumoniae, Chlamydia trachomatis, and Mycoplasma pneumoniae. In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in patients not infected by Borrelia burgdorferi can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by Bartonella henselae, Yersinia enterocolitica, and Mycoplasma pneumoniae. Chlamydia trachomatis primarily causes polyarthritis. Chlamydophila pneumoniae not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by Yersinia enterocolitica. For the remaining infections predominantly tetracyclines and macrolides are used. Quinolones are for alternative treatment, particularly gemifloxacin. For Bartonella henselae, Chlamydia trachomatis, and Chlamydophila pneumoniae the combination with rifampicin is recommended. Erythromycin is the drug of choice for Campylobacter jejuni.

Prevalence and levels of serum antibodies to gram negative microorganisms in Turkish patients with HLA-B27 positive acute anterior uveitis and controls

PURPOSE

Acute anterior uveitis (AAU), seronegative spondyloarthropathies such as ankylosing spondylitis and reactive arthritis form the group of "HLA-B27-associated diseases." The aim of this study was to analyze the prevalence and levels of serum antibodies against gram negative bacteria in Turkish patients with AAU.

METHODS

Twenty-five patients each with previously diagnosed HLA-B27 positive and negative AAU and 25 age-and sex-matched healthy control subjects were included in the study. Serum IgM, IgG and IgA antibodies to Yersiniae enterocolitica, Campylobacter jejuni and Chlamydia trachomatis were measured using enzyme linked immunosorbent assay (ELISA). Categorical data were analyzed by chi-square test. Serum levels were analyzed using the Kruskal-Wallis test.

RESULTS

The prevalence of serum IgM, IgG and IgA antibodies did not differ significantly between the HLA-B27 positive AAU, HLA-B27 negative AAU and control groups with the exception of serum IgA antibodies against Yersiniae enterocolitica. IgA antibody against Yersiniae enterocolitica was found to be more frequently positive in the control group. Comparison of serum IgM, IgG and IgA antibody levels did not significantly differ between three groups.

CONCLUSIONS

Serum antibody positivity against Yersiniae enterocolitica, Campylobacter jejuni and Chlamydia trachomatis is not frequent in the HLA-B27 positive and negative AAU patients. Serum levels of IgM, IgG, and IgA antibodies also did not show significant difference between three groups. No association between these microorganisms and the etiology of AAU was evident.

Cat-Scratch Disease (Ocular Bartonellosis) Presenting as Bilateral Recurrent Iridocyclitis

An otherwise healthy 9-year-old girl presented with bilateral recurrent anterior uveitis. Thirteen months later, the diagnosis of cat-scratch disease (ocular bartonellosis) was suspected when neuroretinitis appeared. Confirmation was based on serological test results positive for Bartonella henselae. Antibiotic treatment completely cured the disease, and there have been no further manifestations during a follow-up period of 6 years.

Intraocular detection of Bartonella henselae in a patient with HLA-B27 uveitis

Bartonella henselae uveitis was diagnosed in a 40-year-old woman with underlying HLA-B27 uveitis on the basis of immunodetection and molecular detection of the organism, a Marseilles genogroup and a CAL-1 genotype strain, in the vitreous fluid. This case illustrates that B. henselae should be included in the differential diagnosis of uveitis and the usefulness of immunodetection for rapid and specific diagnosis.

Rhegmatogenous retinal detachment and uveitis

PURPOSE

To evaluate the frequency, high-risk factors, and visual prognosis of rhegmatogenous retinal detachment (RRD) in patients with uveitis.

DESIGN

Retrospective case-control study.

PARTICIPANTS

We included 1387 consecutive patients with uveitis who consulted our uveitis clinic from January 1990 through December 1997 of whom 43 patients (46 eyes) with RRD were identified. The retinal detachment (RD) controls were 212 consecutive patients with RRD (221 eyes, first occurrence of RD, not associated with uveitis) who were admitted for surgery in the period from April 1999 to April 2000. The uveitis control group consisted of 150 age-matched patients (210 eyes) selected from the entire uveitis series.

INTERVENTION

Retrospective analysis of clinical data.

MAIN OUTCOME MEASURES

The presence of RRD and eventual risk factors for RRD, such as myopia, retinal lattice degeneration, prior intraocular surgery, anatomic location of uveitis, its specific diagnosis, and clinical manifestations. Furthermore, the surgical and nonsurgical outcomes of RRD, as well as the results of various treatment regimens, were analyzed.

RESULTS

RRD was identified in 3.1% of the patients with uveitis. RRD was most frequently associated with panuveitis (6.6%). RRD was associated more frequently with infectious (7.6%) than noninfectious uveitis (2.1%). At the onset of RRD, uveitis was active in most (46%) affected eyes. Proliferative vitreoretinopathy was present in 30% of the uveitic RRD eyes at presentation in contrast to 12% of the RRD control eyes. In uveitic RRD, the retina was reattached in 59% of eyes with a single operation; the final anatomic reattachment rate was 88%. Finally, a visual acuity of less than 20/200 was present in 71% of the uveitic RRD eyes, 10% of which had no light perception.

CONCLUSIONS

We discovered a high prevalence of RRD in patients with active panuveitis and infectious uveitis and document that uveitis in itself is a risk factor for the development of RRD. The visual prognosis of RRD in uveitis was poor because of the uveitis itself and the frequent development of proliferative vitreoretinopathy.

Inoculation with Bartonella henselae followed by feline herpesvirus 1 fails to activate ocular toxoplasmosis in chronically infected cats

Infection by Toxoplasma gondii is very common in cats although most remain disease free. The factors that trigger development of uveitis in some cats infected with T gondii have not been elucidated, but infection by more than one organism may be contributory. In this study, cats chronically infected with T gondii were inoculated with Bartonella henselae followed by FHV-1 to test the hypothesis that immune stimulation by multiple infections will reactivate ocular toxoplasmosis. Anterior uveitis and chorioretinitis were not detected in the cats with chronic T gondii infection thus allowing rejection of the hypothesis using this experimental design.