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Fingerhood S, Neupane P, Breitschwerdt EB, Choi EA. Diagnostic challenge in veterinary pathology: Tri-cavitary effusion in a cat with systemic pyogranulomatous inflammation. Vet Pathol 2024:3009858241226648. [PMID: 38247129 DOI: 10.1177/03009858241226648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
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2
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Taber R, Pankowski A, Ludwig AL, Jensen M, Magsamen V, Lashnits E. Bartonellosis in Dogs and Cats, an Update. Vet Clin North Am Small Anim Pract 2022; 52:1163-1192. [DOI: 10.1016/j.cvsm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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Nivy R, Lavi-Ginzberg Y, de Sousa KCM, Golani Y, Kuzi S, Nachum-Biala Y, Harrus S. Treatment of a cat with presumed Bartonella henselae-associated immune-mediated hemolytic anemia, fever, and lymphadenitis. J Vet Intern Med 2022; 36:1106-1112. [PMID: 35385154 PMCID: PMC9151487 DOI: 10.1111/jvim.16415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/12/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022] Open
Abstract
A 2.5‐year‐old castrated male cat presented with fever and marked generalized lymphadenopathy of 4‐months duration, despite treatment with amoxicillin‐clavulanate/marbofloxacin. Abnormalities were not detected on complete blood count, serum chemistry, and FIV/FeLV test apart from a borderline, non‐regenerative anemia. Peripheral lymph node fine needle aspirations revealed a marked increase in the percentage of intermediate‐ and lymphoblastic‐lymphocytes in addition to reactive macrophages. Three weeks after presentation, the cat developed a severe, regenerative, immune‐mediated hemolytic anemia (IMHA) which responded to immunosuppressive therapy. Fever and lymphadenopathy persisted. Peripheral lymph nodes tested positive for Bartonella henselae DNA in real‐time PCR assay and sequencing. Treatment with pradofloxacin and doxycycline resulted in resolution of clinical signs, and negative PCR tests. Despite its reported low pathogenicity, B. henselae infection should also be considered in cats with protracted unexplained fever, lymphadenitis, and IMHA. Furthermore, a combination of pradofloxacin and doxycycline might be considered in cats with bartonellosis given its apparent clinical efficacy.
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Affiliation(s)
- Ran Nivy
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel.,Ben-Shemen Specialist Referral Center, Ben-Shemen Youth Village, Israel
| | | | | | | | - Sharon Kuzi
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Yaarit Nachum-Biala
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Shimon Harrus
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Álvarez-Fernández A, Maggi R, Martín-Valls GE, Baxarias M, Breitschwerdt EB, Solano-Gallego L. Prospective serological and molecular cross-sectional study focusing on Bartonella and other blood-borne organisms in cats from Catalonia (Spain). Parasit Vectors 2022; 15:6. [PMID: 34983610 PMCID: PMC8729136 DOI: 10.1186/s13071-021-05105-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background There is limited clinical or epidemiological knowledge regarding Bartonella infection in cats, and no serological studies have compared the presence of antibodies against different Bartonella species. Moreover, there are limited feline Bartonella studies investigating co-infections with other vector-borne pathogens and the associated risk factors. Therefore, the objective of this study was to investigate Bartonella spp. infections and co-infections with other pathogens in cats from Barcelona (Spain) based on serological and/or molecular techniques and to determine associated risk factors. Methods We studied colony and owned cats (n = 135). Sera were tested for Bartonella henselae-, Bartonella quintana-, and Bartonella koehlerae-specific antibodies using endpoint in-house immunofluorescence antibody assays. Bartonella real-time PCR (qPCR) and conventional PCR (cPCR) were performed. In addition, cPCR followed by DNA sequencing was performed for other pathogenic organisms (Anaplasma, Babesia, Cytauxzoon, Ehrlichia, Hepatozoon, hemotropic Mycoplasma, and Theileria spp.). Results From 135 cats studied, 80.7% were seroreactive against at least one Bartonella species. Bartonella quintana, B. koehlerae, and B. henselae seroreactivity was 67.4, 77.0, and 80.7%, respectively. Substantial to almost perfect serological agreement was found between the three Bartonella species. Colony cats were more likely to be Bartonella spp.-seroreactive than owned cats. Moreover, cats aged ≤ 2 years were more likely to be Bartonella spp.-seroreactive. Bartonella spp. DNA was detected in the blood of 11.9% (n = 16) of cats. Cats were infected with B. henselae (n = 12), B. clarridgeiae (n = 3), and B. koehlerae (n = 1). Mycoplasma spp. DNA was amplified from 14% (n = 19) of cat blood specimens. Cats were infected with Mycoplasma haemofelis (n = 8), Candidatus M. haemominutum (n = 6), Candidatus Mycoplasma turicensis (n = 4), and Mycoplasma wenyonii (n = 1). Anaplasma, Babesia, Cytauxzoon, Ehrlichia spp., Hepatozoon, and Theileria spp. DNA was not amplified from any blood sample. Of the 16 Bartonella spp.-infected cats based on PCR results, six (37%) were co-infected with Mycoplasma spp. Conclusions Bartonella spp. and hemoplasma infections are prevalent in cats from the Barcelona area, whereas infection with Anaplasma spp., Babesia, Cytauxzoon, Ehrlichia spp., Hepatozoon, and Theileria infections were not detected. Co-infection with hemotropic Mycoplasma appears to be common in Bartonella-infected cats. To our knowledge, this study is the first to document M. wenyonii is infection in cats. Graphical Abstract ![]()
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Affiliation(s)
- Alejandra Álvarez-Fernández
- Department of Animal Medicine and Surgery, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain
| | - Ricardo Maggi
- Department of Clinical Sciences and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC, USA
| | - Gerard Eduard Martín-Valls
- Department of Animal Health and Anatomy, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain
| | - Marta Baxarias
- Department of Animal Medicine and Surgery, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain
| | - Edward Bealmear Breitschwerdt
- Department of Clinical Sciences and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC, USA
| | - Laia Solano-Gallego
- Department of Animal Medicine and Surgery, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain.
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5
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Miralles‐Plaza I, McDonald HR. Cardioversion of supraventricular tachycardia in a cat with suspected Wolff–Parkinson–White syndrome in the absence of structural cardiac disease. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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6
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Kittleson MD, Côté E. The Feline Cardiomyopathies: 3. Cardiomyopathies other than HCM. J Feline Med Surg 2021; 23:1053-1067. [PMID: 34693805 PMCID: PMC8723175 DOI: 10.1177/1098612x211030218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Practical relevance: Although feline hypertrophic cardiomyopathy (HCM) occurs more commonly,
dilated cardiomyopathy (DCM), restrictive cardiomyopathy (RCM),
arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricular
noncompaction (LVNC) and cardiomyopathy – nonspecific phenotype (NCM;
formerly unclassified cardiomyopathy) are all recognized in domestic
cats. Patient group: Any adult domestic cat, of either sex and of any breed, can be affected. Diagnostics: The non-HCM cardiomyopathies are rarely suspected in subclinically affected
cats, so most are first identified when a cat presents with signs of heart
failure or systemic thromboembolic disease. The definitive clinical
confirmatory test for these other feline cardiomyopathies is
echocardiography. Key findings: ‘Cardiomyopathy – nonspecific phenotype’ is a catch-all term that groups
hearts with myocardial changes that either do not meet the criteria for any
one type of cardiomyopathy (HCM, RCM, DCM, ARVC, LVNC) or meet the
echocardiography criteria for more than one type. RCM is characterized by
diastolic dysfunction due to fibrosis that results in a restrictive
transmitral flow pattern on Doppler echocardiography and usually marked left
or biatrial enlargement. DCM is characterized by decreased myocardial
contractility and is rare in cats. When it occurs, it is seldom due to
taurine deficiency. However, since taurine-deficient DCM is usually
reversible, a diet history should be obtained, whole blood and plasma
taurine levels should be measured and taurine should be supplemented in the
diet if the diet is not commercially manufactured. ARVC should be suspected
in adult cats with severe right heart enlargement and right heart failure
(ascites and/or pleural effusion), especially if arrhythmia is present.
Feline LVNC is rare; its significance continues to be explored. Treatment of
the consequences of these cardiomyopathies (management of heart failure,
thromboprophylaxis, treatment of systemic arterial thromboembolism) is the
same as for HCM. Conclusions: While these other cardiomyopathies are less prevalent than HCM in cats, their
clinical and radiographic presentation is often indistinguishable from HCM.
Echocardiography is usually the only ante-mortem method to determine which
type of cardiomyopathy is present. However, since treatment and prognosis
are often similar for the feline cardiomyopathies, distinguishing among the
cardiomyopathies is often not essential for determining appropriate
therapy. Areas of uncertainty: The feline cardiomyopathies do not always fit into one distinct category.
Interrelationships among cardiomyopathies in cats may exist and
understanding these relationships in the future might provide critical
insights regarding treatment and prognosis.
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Affiliation(s)
| | - Etienne Côté
- Department of Companion Animals, Atlantic
Veterinary College, University of Prince Edward Island, Charlottetown,
Prince Edward Island, Canada
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7
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Sinzinger S. [Reversible left ventricular hypertrophy and congestive heart failure due to suspected myocarditis in a cat in the course of FLUTD]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2021; 49:220-227. [PMID: 34157764 DOI: 10.1055/a-1483-3342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 2.5-year-old castrated male domestic shorthair cat with a past pertinent history of FLUTD treatment 8 days earlier was presented during the night due to apathy and anorexia. Radiographs, ECG, blood pressure measurement and echocardiography revealed left-sided congestive heart failure, left ventricular concentric hypertrophy, left atrial dilation, severe diastolic dysfunction, hypotension, and vagotonus-associated sinus bradycardia with a first degree AV-block as well as a right bundle brunch block. NT-ProBNP and troponin I concentrations were elevated (NT-ProBNP > 1500 pmol/l, Troponin I 32.87 ng/ml). Presumptive diagnosis was acute myocarditis. Bartonella henselae PCR and Toxoplasma gondii IgM titer were negative. Initial IgG titer amounted to 1:32 (reference range: < 1:32) and on later testing this was negative. FeLV and FIV tests exhibited negative results. Coronavirus testing was not performed because the cat was vaccinated accordingly. A metastatic infection with Proteus mirabilis, which had been isolated from the urine, appeared possible. Alternatively, a hypersensivity reaction to drugs or a stress-induced myocarditis was taken into consideration. The hospitalized cat was treated with furosemide (initialy and in the course of further treatment), theophyllin (initially), continuous infusion with lactated Ringer's solution, pimobendan, and the addition of enrofloxacin to the ongoing amoxicillin/clavulanic acid administration. After 4 days, the cat's general condition improved satisfactorily and blood pressure returned to normal range. Left ventricular hypertrophy resolved, however, diastolic dysfunction as well as left atrial dilation persisted. Within the next 8 weeks, echocardiographic findings and cardiac biomarkers returned to near normal values. All medication was tapered and finally discontinued. During the last recheck examination 7 months following initial presentation, no cardiac changes were apparent.
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8
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Nawrocki CC, Max RJ, Marzec NS, Nelson CA. Atypical Manifestations of Cat-Scratch Disease, United States, 2005-2014. Emerg Infect Dis 2021; 26:1438-1446. [PMID: 32568056 PMCID: PMC7323523 DOI: 10.3201/eid2607.200034] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Atypical manifestations that can be severe and difficult to diagnosis develop in 5%-20% of patients with cat-scratch disease. To clarify the epidemiology of atypical cat-scratch disease in the United States, we analyzed data from the 2005-2014 MarketScan national health insurance claims databases by using the International Classification of Diseases, 9th Revision, Clinical Modification, codes for cat-scratch disease and selected atypical manifestations: retinitis/neuroretinitis, conjunctivitis, neuritis, encephalitis, hepatosplenic disease, osteomyelitis, erythema nodosum, and endocarditis. Atypical cat-scratch disease accounted for 1.5% of all cases, resulting in an average annual incidence of 0.7 cases/100,000 population. Atypical cat-scratch disease was associated with increased risk for hospitalization (risk ratios 8.77, 95% CI 6.56-11.72) and occurred most often in female patients 10-14 years of age. Ocular (48.7%), hepatosplenic (24.6%), and neurologic (13.8%) manifestations were most common among patients. A more comprehensive understanding of atypical cat-scratch disease can improve patient diagnosis and potentially elucidate pathophysiology of the disease.
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Wood J, Reagan KL, Gunther-Harrington C, Sykes JE. Identification of Streptococcus suis in a cat with endomyocarditis. JFMS Open Rep 2021; 7:20551169211012346. [PMID: 34026243 PMCID: PMC8120542 DOI: 10.1177/20551169211012346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 3-year-old neutered male domestic mediumhair cat was evaluated for a 4-month history of a fever that was responsive to pradofloxacin. A grade III/VI left parasternal systolic heart murmur was noted on examination. Findings on thoracic radiography were consistent with left-sided congestive heart failure and findings on echocardiographic examination suggested endomyocarditis. Aerobic blood cultures yielded growth of a Streptococcus species that was identified as Streptococcus suis using both matrix-associated laser desorption ionization-time of flight mass spectrometry and 16S rRNA gene sequencing. The cat was treated but clinically deteriorated and was euthanized 23 days after diagnosis. Relevance and novel information To our knowledge, this is the first report of S suis bacteremia, an emerging pathogen, in association with endomyocarditis in the cat. This case also highlights the role of echocardiography to document progressive hemodynamic changes as a result of valvular erosion in the course of infective endocarditis treatment and the role of blood cultures as a diagnostic tool in cats presenting with fever.
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Affiliation(s)
- James Wood
- William R Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Krystle L Reagan
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Catherine Gunther-Harrington
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Jane E Sykes
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
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10
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Exposure of Domestic Cats to Three Zoonotic Bartonella Species in the United States. Pathogens 2021; 10:pathogens10030354. [PMID: 33802644 PMCID: PMC8002574 DOI: 10.3390/pathogens10030354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 11/16/2022] Open
Abstract
Cat-associated Bartonella species, which include B. henselae, B. koehlerae, and B. clarridgeiae, can cause mild to severe illness in humans. In the present study, we evaluated 1362 serum samples obtained from domestic cats across the U.S. for seroreactivity against three species and two strain types of Bartonella associated with cats (B. henselae type 1, B. henselae type 2, B. koehlerae, and B. clarridgeiae) using an indirect immunofluorescent assay (IFA). Overall, the seroprevalence at the cutoff titer level of ≥1:64 was 23.1%. Seroreactivity was 11.1% and 3.7% at the titer level cutoff of ≥1:128 and at the cutoff of ≥1:256, respectively. The highest observation of seroreactivity occurred in the East South-Central, South Atlantic, West North-Central, and West South-Central regions. The lowest seroreactivity was detected in the East North-Central, Middle Atlantic, Mountain, New England, and Pacific regions. We observed reactivity against all four Bartonella spp. antigens in samples from eight out of the nine U.S. geographic regions.
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11
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Araujo G, Matta E, Lallo M, Machado G, Rocha P. Epicarditis in a cat caused by feline infectious peritonitis virus: case report. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-11359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Feline Infectious Peritonitis (FIP) is a progressive and fatal disease in domestic and wild cats, caused by Feline Infectious Peritonitis Virus (FIPV). The disease is characterized by an immunomediated reaction against the virus in various organs. This work described a case report of fibrinous epicarditis caused by FIPV. A male cat, three years old, died and was received to be necropsied. Grossly, soft, multifocal to coalescing, whitish fibrinous exudate, measuring up the 2 centimeters of thickness, was observed in the epicardium, mostly at the apex of the heart. Microscopically, severe, multifocal to coalescing inflammatory infiltrate was observed in the epicardium, composed mainly by macrophages, plasmocytes and lymphocytes, associated with fibrin deposition. Immunohistochemistry was performed for FIPV and was positive in the areas of inflammation in the epicardium. To the author´s knowledge, this is the second report of epicarditis due to FIPV in a cat. Therefore, epicarditis should be considered a differential diagnosis of cardiac diseases in Feline Medicine.
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12
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Giuliano A, Watson P, Owen L, Skelly B, Davison L, Dobson J, Costantino‐Casas F. Idiopathic sterile pyogranuloma in three domestic cats. J Small Anim Pract 2020; 61:202-205. [PMID: 29761888 PMCID: PMC7166439 DOI: 10.1111/jsap.12853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/29/2018] [Accepted: 03/02/2018] [Indexed: 11/25/2022]
Abstract
Pyogranulomatous inflammation has been extensively described in cats, in particular in cases of feline infectious peritonitis and also associated with Mycobacteria, Actinomyces, Nocardia, Rhodococcus and fungal infections. Idiopathic sterile pyogranulomatous dermatitis has also been described. In this case series we describe the clinical presentation, histopathology and outcome of three cases of feline idiopathic sterile steroid-responsive pyogranuloma with different presentation and different locations of the lesion, but with the common feature of having a mass with no superficial skin involvement.
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Affiliation(s)
- A. Giuliano
- Department of Veterinary MedicineUniversity of CambridgeCambridge, CB3 0ESUK
| | - P. Watson
- Department of Veterinary MedicineUniversity of CambridgeCambridge, CB3 0ESUK
| | - L. Owen
- Department of Veterinary MedicineUniversity of CambridgeCambridge, CB3 0ESUK
| | - B. Skelly
- Department of Veterinary MedicineUniversity of CambridgeCambridge, CB3 0ESUK
| | - L. Davison
- Department of Veterinary MedicineUniversity of CambridgeCambridge, CB3 0ESUK
| | - J. Dobson
- Department of Veterinary MedicineUniversity of CambridgeCambridge, CB3 0ESUK
| | - F. Costantino‐Casas
- Department of Veterinary MedicineUniversity of CambridgeCambridge, CB3 0ESUK
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13
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Raimundo JM, Guimarães A, Amaro GM, da Silva AT, Botelho CFM, Massard CL, de Lemos ERS, Favacho ARM, Baldani CD. Molecular Survey of Bartonella Species in Shelter Cats in Rio De Janeiro: Clinical, Hematological, and Risk Factors. Am J Trop Med Hyg 2020; 100:1321-1327. [PMID: 31017080 DOI: 10.4269/ajtmh.18-0585] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The present study aimed to detect Bartonella DNA in cats belonging to shelters, and to evaluate risk factors, clinical signs, and hematological abnormalities associated with infection. Complete blood counts and screening for the presence of Bartonella DNA were performed on cats' ethylenediamine tetraacetic acid anticoagulant-blood samples. Eighty-three cats (39.9%) were positive for Bartonella species. Bartonella DNA was also detected in fleas and in the blood of cats infested by positive flea. Cats that had not been sterilized, had outdoor access, had histories of fights, and had concurrent flea infestation were more likely to be infected by Bartonella species (P < 0.05). Age and sex were not associated with infection. Fifty-one (38.6%) symptomatic cats were positive to Bartonella species (P > 0.05). Clinical conditions most commonly observed were signs of respiratory abnormality and Sporothrix species coinfection (P > 0.05). Regarding hematological changes, eosinophilia was associated with infection (P < 0.05). A high frequency of Bartonella species infection was found in shelter cats and highlights the importance of adequate flea-control programs to prevent infection in cats and consequently in adopters and other animals.
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Affiliation(s)
- Juliana M Raimundo
- Departament of Veterinary Medicine and Surgery, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - Andresa Guimarães
- Departament of Veterinary Medicine and Surgery, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - Gleice M Amaro
- Departament of Veterinary Medicine and Surgery, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - Aline T da Silva
- Departament of Veterinary Medicine and Surgery, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - Camila F M Botelho
- Departament of Veterinary Medicine and Surgery, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - Carlos L Massard
- Departament of Animal Parasitology, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | | | | | - Cristiane D Baldani
- Departament of Veterinary Medicine and Surgery, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
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14
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Zecca IB, Hodo CL, Slack S, Auckland L, Rodgers S, Killets KC, Saunders AB, Hamer SA. Prevalence of Trypanosoma cruzi infection and associated histologic findings in domestic cats (Felis catus). Vet Parasitol 2019; 278:109014. [PMID: 31972512 DOI: 10.1016/j.vetpar.2019.109014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 01/27/2023]
Abstract
Trypanosoma cruzi is a zoonotic protozoan parasite transmitted by triatomines that infects a wide range of mammals. South Texas is a hotspot for triatomines, T. cruzi-infected dogs and wildlife, and local transmission to humans also occurs. However, little is known about the infection of domestic cats (Felis catus) in the United States. Given the role cats play in the ecology of T. cruzi in Mexico and South America, we hypothesized that T. cruzi infection occurs in cats from south Texas, sometimes associated with cardiac pathology. In 2017, 167 euthanized cats from a south Texas shelter were sampled across winter, spring, and summer. We collected whole blood and hearts from all cats, with additional tissues from a subset. Serum samples were screened for T. cruzi antibodies using two independent rapid immunochromatographic tests and an indirect fluorescent antibody test. Cats were considered seropositive if they were positive on at least two independent serological tests. Blood clot, heart tissue and other tissues were subjected to qPCR for parasite detection and discrete typing unit (DTU) determination. Tissues from selected seropositive or PCR-positive animals and a subset of negative animals were processed routinely for histopathology and examined by a board-certified pathologist. A total of 19 cats (11.4%) were seropositive and three cats (1.8%) - one of which was seropositive - had one or more PCR-positive tissues. Infected tissues included heart, bicep femoris muscle, sciatic nerve, esophagus, and mesentery. Genotyping of the parastite to the level of DTU showed that exclusively DTU TcI was present, despite past studies showing both TcI and TcIV in vectors of the region. Eight of 19 (42.1%) seropositive cats exhibited lymphoplasmacytic inflammation, sometimes with fibrosis, in cardiac tissue compared to 28.6% of 28 seronegative cats (P = 0.10). Domestic cats are affected hosts in the eco-epidemiology of Chagas disease. Future prospective studies are needed to understand disease progression. Veterinarians in the southern United States should consider T. cruzi in their index of suspicion in cats with exposure to vectors and undetermined cardiac abnormalities.
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Affiliation(s)
- Italo B Zecca
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Carolyn L Hodo
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA; The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, 650 Cool Water Drive, Bastrop, TX, 78602, USA
| | - Sarah Slack
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Lisa Auckland
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Sandy Rodgers
- Texas A&M University Veterinary Medical Diagnostic Laboratory, 483 Agronomy Rd, College Station, TX, 77843, USA
| | - Keswick C Killets
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Ashley B Saunders
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Sarah A Hamer
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA.
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15
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Ernandes MA, Cantoni AM, Armando F, Corradi A, Ressel L, Tamborini A. Feline coronavirus-associated myocarditis in a domestic longhair cat. JFMS Open Rep 2019; 5:2055116919879256. [PMID: 31636915 PMCID: PMC6787879 DOI: 10.1177/2055116919879256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary A 9-month-old entire male domestic longhair indoor cat presented with a
3-week history of fluctuating fever, weight loss and small intestine
diarrhoea, which was unresponsive to antibiotics and supportive treatment.
Abdominal ultrasound revealed severe jejunal and ileocolic junction
intestinal wall thickening with loss of layering. An enterectomy was
performed and histopathology revealed severe pyogranulomatous enteritis with
vasculitits, compatible with the diagnosis of feline infectious peritonitis
(FIP). Four days after surgery, the cat re-presented with anorexia and acute
onset of expiratory dyspnoea. Echocardiography showed left ventricular
hypertrophy and bilateral atrial enlargement. Congestive heart failure
caused by hypertrophic cardiomyopathy was suspected and treatment with
furosemide was started, which led to amelioration of the clinical signs. The
following day, four-limb ataxia, hypermetria and bilateral uveitis were
evident. Given the persistent anorexia and worsening of the clinical signs,
the cat was humanely euthanized and a post-mortem examination was performed.
Necropsy revealed multifocal pyogranulomatous lesions involving multiple
organs (adrenal glands, kidneys, lungs, brain, myocardium, lymph nodes,
liver), compatible with the diagnosis of FIP. Immunohistochemistry performed
on the myocardium revealed feline coronavirus-positive macrophages
associated with pyogranulomatous lesions, justifying a diagnosis of feline
coronavirus-associated myocarditis. Relevance and novel information To the authors’ knowledge, the case described here represents the first
published report of feline coronavirus-associated myocarditis. This should
be considered as a possible differential diagnosis in cats presenting with
cardiac-related signs and other clinical signs compatible with FIP.
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Affiliation(s)
| | - Anna M Cantoni
- General Pathology and Veterinary Pathological Anatomy Unit, Department of Veterinary Science, University of Parma, Parma, Italy
| | - Federico Armando
- General Pathology and Veterinary Pathological Anatomy Unit, Department of Veterinary Science, University of Parma, Parma, Italy
| | - Attilio Corradi
- General Pathology and Veterinary Pathological Anatomy Unit, Department of Veterinary Science, University of Parma, Parma, Italy
| | - Lorenzo Ressel
- Department of Veterinary Pathology and Public Health, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Alice Tamborini
- Department of Internal Medicine, Dick White Referrals, Six Mile Bottom, UK
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16
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Santilli RA, Giacomazzi F, Porteiro Vázquez DM, Perego M. Indications for permanent pacing in dogs and cats. J Vet Cardiol 2019; 22:20-39. [PMID: 30709617 PMCID: PMC7185536 DOI: 10.1016/j.jvc.2018.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/25/2022]
Abstract
Pacemaker implantation is considered as a standard procedure for treatment of symptomatic bradycardia in both dogs and cats. Advanced second-degree and third-degree atrioventricular blocks, sick sinus syndrome, persistent atrial standstill, and vasovagal syncope are the most common rhythm disturbances that require pacing to either alleviate clinical signs or prolong survival. Most pacemakers are implanted transvenously, using endocardial leads, but rarely epicardial leads may be necessary. To decide whether a patient is a candidate for pacing, as well as which pacing modality should be used, the clinician must have a clear understanding of the etiology, the pathophysiology, and the natural history of the most common bradyarrhythmias, as well as what result can be achieved by pacing patients with different rhythm disturbances. The goal of this review was, therefore, to describe the indications for pacing by evaluating the available evidence in both human and veterinary medicine. We described the etiology of bradyarrhythmias, clinical signs and electrocardiographic abnormalities, and the choice of pacing modality, taking into account how different choices may have different physiological consequences to selected patients. It is expected that this review will assist veterinarians in recognizing arrhythmias that may require permanent pacing and the risk-benefit of each pacing modality and its impact on outcome.
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Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy; Department of Clinical Sciences, Cornell University, Ithaca, NY, USA.
| | - F Giacomazzi
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | | | - M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
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17
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Álvarez-Fernández A, Breitschwerdt EB, Solano-Gallego L. Bartonella infections in cats and dogs including zoonotic aspects. Parasit Vectors 2018; 11:624. [PMID: 30514361 PMCID: PMC6280416 DOI: 10.1186/s13071-018-3152-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022] Open
Abstract
Bartonellosis is a vector-borne zoonotic disease with worldwide distribution that can infect humans and a large number of mammals including small companion animals (cats and dogs). In recent years, an increasing number of studies from around the world have reported Bartonella infections, although publications have predominantly focused on the North American perspective. Currently, clinico-pathological data from Europe are more limited, suggesting that bartonellosis may be an infrequent or underdiagnosed infectious disease in cats and dogs. Research is needed to confirm or exclude Bartonella infection as a cause of a spectrum of feline and canine diseases. Bartonella spp. can cause acute or chronic infections in cats, dogs and humans. On a comparative medical basis, different clinical manifestations, such as periods of intermittent fever, granulomatous inflammation involving the heart, liver, lymph nodes and other tissues, endocarditis, bacillary angiomatosis, peliosis hepatis, uveitis and vasoproliferative tumors have been reported in cats, dogs and humans. The purpose of this review is to provide an update and European perspective on Bartonella infections in cats and dogs, including clinical, diagnostic, epidemiological, pathological, treatment and zoonotic aspects.
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Affiliation(s)
- Alejandra Álvarez-Fernández
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Edward B. Breitschwerdt
- Department of Clinical Sciences and the Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr, Raleigh, NC 27607 USA
| | - Laia Solano-Gallego
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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18
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Elsmo EJ, Fenton H, Cleveland CA, Shock B, Cunningham M, Howerth EW, Yabsley MJ. Necrotizing interstitial pneumonia and suppurative myocarditis associated with Bartonella henselae infection in three Florida pumas. J Vet Diagn Invest 2018; 30:728-732. [PMID: 30027827 PMCID: PMC6505792 DOI: 10.1177/1040638718789226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Three Florida pumas ( Puma concolor coryi) that had spent time in captivity prior to being released in the wild were found exhibiting respiratory signs and reluctance to move. All 3 pumas died shortly after immobilization, despite supportive veterinary care. Significant autopsy findings included necrotizing interstitial pneumonia, with pulmonary edema and hyaline membranes, and suppurative myocarditis. Organisms morphologically consistent with Bartonella henselae were identified in intravascular histiocytes in the lung of one of the pumas on histopathology and confirmed via transmission electron microscopy. B. henselae was detected in fresh lung tissue and confirmed by PCR and sequence analysis (16S-23S spacer region, pap31, and rpoB genes) from one of the affected pumas. In all affected pumas, B. henselae was detected by PCR in formalin-fixed, paraffin-embedded lung tissue, and positively staining organisms were identified in sections of lung by immunohistochemistry for B. henselae. In situ hybridization detected B. henselae DNA in lung tissue from 2 of 3 affected pumas. Our case series suggests that B. henselae can be associated with a fatal disease syndrome in Florida pumas. The cause of susceptibility to fatal disease associated with B. henselae infection in these pumas remains unknown.
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Affiliation(s)
- Elizabeth J. Elsmo
- Elizabeth J. Elsmo, Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, 589 D.W. Brooks Drive, Athens, GA 30602.
| | - Heather Fenton
- Departments of Population Health (Elsmo, Fenton, Cleveland, Shock, Yabsley), College of Veterinary Medicine, University of Georgia, Athens, GA
- Veterinary Pathology (Elsmo, Howerth), College of Veterinary Medicine, University of Georgia, Athens, GA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA (Cleveland, Shock, Yabsley)
- Department of Biology, Lincoln Memorial University, Harrogate, TN (Shock)
- Florida Fish and Wildlife Conservation Commission, Gainesville, FL (Cunningham)
| | - Christopher A. Cleveland
- Departments of Population Health (Elsmo, Fenton, Cleveland, Shock, Yabsley), College of Veterinary Medicine, University of Georgia, Athens, GA
- Veterinary Pathology (Elsmo, Howerth), College of Veterinary Medicine, University of Georgia, Athens, GA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA (Cleveland, Shock, Yabsley)
- Department of Biology, Lincoln Memorial University, Harrogate, TN (Shock)
- Florida Fish and Wildlife Conservation Commission, Gainesville, FL (Cunningham)
| | - Barbara Shock
- Departments of Population Health (Elsmo, Fenton, Cleveland, Shock, Yabsley), College of Veterinary Medicine, University of Georgia, Athens, GA
- Veterinary Pathology (Elsmo, Howerth), College of Veterinary Medicine, University of Georgia, Athens, GA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA (Cleveland, Shock, Yabsley)
- Department of Biology, Lincoln Memorial University, Harrogate, TN (Shock)
- Florida Fish and Wildlife Conservation Commission, Gainesville, FL (Cunningham)
| | - Mark Cunningham
- Departments of Population Health (Elsmo, Fenton, Cleveland, Shock, Yabsley), College of Veterinary Medicine, University of Georgia, Athens, GA
- Veterinary Pathology (Elsmo, Howerth), College of Veterinary Medicine, University of Georgia, Athens, GA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA (Cleveland, Shock, Yabsley)
- Department of Biology, Lincoln Memorial University, Harrogate, TN (Shock)
- Florida Fish and Wildlife Conservation Commission, Gainesville, FL (Cunningham)
| | - Elizabeth W. Howerth
- Departments of Population Health (Elsmo, Fenton, Cleveland, Shock, Yabsley), College of Veterinary Medicine, University of Georgia, Athens, GA
- Veterinary Pathology (Elsmo, Howerth), College of Veterinary Medicine, University of Georgia, Athens, GA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA (Cleveland, Shock, Yabsley)
- Department of Biology, Lincoln Memorial University, Harrogate, TN (Shock)
- Florida Fish and Wildlife Conservation Commission, Gainesville, FL (Cunningham)
| | - Michael J. Yabsley
- Departments of Population Health (Elsmo, Fenton, Cleveland, Shock, Yabsley), College of Veterinary Medicine, University of Georgia, Athens, GA
- Veterinary Pathology (Elsmo, Howerth), College of Veterinary Medicine, University of Georgia, Athens, GA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA (Cleveland, Shock, Yabsley)
- Department of Biology, Lincoln Memorial University, Harrogate, TN (Shock)
- Florida Fish and Wildlife Conservation Commission, Gainesville, FL (Cunningham)
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19
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Donovan TA, Balakrishnan N, Carvalho Barbosa I, McCoy T, Breitschwerdt EB, Fox PR. Bartonella spp. as a Possible Cause or Cofactor of Feline Endomyocarditis-Left Ventricular Endocardial Fibrosis Complex. J Comp Pathol 2018; 162:29-42. [PMID: 30060840 DOI: 10.1016/j.jcpa.2018.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/02/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
Endomyocarditis is a commonly detected post-mortem finding in domestic cats presenting for sudden onset cardiovascular death, yet the aetiology remains unresolved. Cats are documented reservoir hosts for Bartonella henselae, the infectious cause of cat scratch disease in man. Various Bartonella spp. have been associated with culture-negative endocarditis, myocarditis and sudden death in man and animals. We hypothesized that Bartonella spp. DNA could be amplified more often from the hearts of cats with feline endomyocarditis-left ventricular endocardial fibrosis (FEMC-LVEF) complex compared with cats with hypertrophic cardiomyopathy (HCM) or cats with grossly and microscopically unremarkable hearts (designated non-cardiac disease controls). Formalin-fixed and paraffin wax-embedded, cardiac tissues from 60 domestic and purebred cats aged 3 months to 18 years were examined, and histological features were recorded. Cardiac tissue sections were tested for Bartonella DNA using multiple 16-23S intergenic transcribed spacer region polymerase chain reaction (PCR) primer sets, including two Bartonella genera, a Bartonella koehlerae species-specific and a Bartonella vinsonii subsp. berkhoffii-specific assay, followed by DNA sequence confirmation of the species or genotype. Special precautions were taken to avoid DNA cross-contamination between tissues. Bartonella spp. DNA was amplified by PCR and sequenced from 18 of 36 cats (50%) with FEMC-LVEF and 1/12 (8.3%) cats with HCM. Bartonella spp. DNA was not amplified from any non-cardiac disease control hearts. Based on PCR/DNA sequencing, one Bartonella spp. was amplified from 10 cats, while the remaining eight were coinfected with more than one Bartonella spp. To our knowledge, this study represents the first documentation of B. vinsonii subsp. berkhoffii genotype I infection in cats (n = 11). Fluorescence in-situ hybridization testing facilitated visualization of Bartonella bacteria within the myocardium of four of seven PCR-positive FEMC-LVEF hearts. Collectively, these findings support the hypothesis that Bartonella spp. may play a primary role or act as a cofactor in the pathogenesis of FEMC-LVEF. Studies involving cats from other geographical regions and definitive demonstration of Bartonella spp. within regions of inflammation are needed to confirm an association between Bartonella spp. and FEMC-LVEF induced morbidity and mortality in cats.
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Affiliation(s)
- T A Donovan
- Department of Anatomic Pathology, The Animal Medical Center, New York, New York, USA.
| | - N Balakrishnan
- Clinical Microbiology Unit, State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - I Carvalho Barbosa
- Department of Clinical Sciences, and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - T McCoy
- Department of Clinical Sciences, and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - E B Breitschwerdt
- Department of Clinical Sciences, and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - P R Fox
- Department of Cardiology, The Animal Medical Center, New York, New York, USA
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20
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Oxford EM, Giacomazzi FB, Moïse NS, Santilli RA. Clinical and electrocardiographic presentations of transient trifascicular block in three cats. J Vet Cardiol 2018; 20:204-212. [DOI: 10.1016/j.jvc.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
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21
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Joseph JL, Oxford EM, Santilli RA. Transient myocardial thickening in a Bartonella henselae-positive cat. J Vet Cardiol 2018; 20:198-203. [PMID: 29730195 DOI: 10.1016/j.jvc.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 02/07/2023]
Abstract
A 3-year-old castrated male domestic shorthair presented to the Cornell University Hospital for Animals for acute onset respiratory distress. Thoracic radiographs, echocardiogram, and electrocardiogram (ECG) revealed left-sided congestive heart failure, myocardial thickening with left atrial dilation, and sinus rhythm conducted with a left bundle branch block, respectively. Cardiac troponin I was elevated and continued to increase over 36 h (1.9 ng/mL, 3.1 ng/mL, and 3.5 ng/mL, sequentially every 12 h). The cat tested positive for Bartonella henselae and was treated with azithromycin (30 mg/kg by mouth (PO) every 24 h for 30 days), along with furosemide (1 mg/kg PO every 24 h), benazepril (0.4 mg/kg PO every 24 h), pimobendan (0.23 mg/kg PO every 12 h), and clopidogrel (18.75 mg PO every 24 h). Reevaluation at 6 weeks revealed normal respiratory rate on physical examination, normal cardiac structures and function on echocardiogram, resolution of left bundle branch block on ECG, and normal cardiac troponin I levels (0.06 ng/mL). All medications were discontinued at this time, and the cat continued to do well 5 months after reevaluation. Here, we report a case of transient myocardial thickening in a cat that was also positive for B. henselae.
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Affiliation(s)
- J L Joseph
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY 14853, USA
| | - E M Oxford
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY 14853, USA; Veterinary Medical Center of Central New York, 5841 Bridge St, East Syracuse, NY 13057, USA.
| | - R A Santilli
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY 14853, USA; Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
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22
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Breitschwerdt EB. Bartonellosis, One Health and all creatures great and small. Vet Dermatol 2017; 28:96-e21. [PMID: 28133871 DOI: 10.1111/vde.12413] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bartonellosis is a zoonotic infectious disease of worldwide distribution, caused by an expanding number of recently discovered Bartonella spp. OBJECTIVES This review serves as an update on comparative medical aspects of this disease, including the epidemiology, pathogenesis, clinical diagnosis, treatment and challenges. RESULTS Of comparative medical importance, Bartonella spp. are transmitted by several arthropod vectors, including fleas, keds, lice, sand flies, ticks and, potentially, mites and spiders. Prior to 1990, there was only one named Bartonella species (B. bacilliformis), whereas there are now over 36, of which 17 have been associated with an expanding spectrum of animal and human diseases. Recent advances in diagnostic techniques have facilitated documentation of chronic bloodstream and dermatological infections with Bartonella spp. in healthy and sick animals, in human blood donors, and in immunocompetent and immunocompromised human patients. The field of Bartonella research remains in its infancy and is rich in questions, for which patient relevant answers are badly needed. Directed Bartonella research could substantially reduce a spectrum of chronic and debilitating animal and human diseases, and thereby reduce suffering throughout the world. CONCLUSION A One Health approach to this emerging infectious disease is clearly needed to define disease manifestations, to establish the comparative infectious disease pathogenesis of this stealth pathogen, to validate effective treatment regimens and to prevent zoonotic disease transmission.
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Affiliation(s)
- Edward B Breitschwerdt
- Department of Clinical Sciences, The Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
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23
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24
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Scorpio DG. Do cats serve as good sentinels for Bartonella species infection risk in people and animals? Vet Rec 2017; 180:322-324. [PMID: 28364072 DOI: 10.1136/vr.j1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Diana G Scorpio
- Animal Program Director, National Institutes of Health, Vaccine Research Center, Building 40 Bethesda, Maryland, USA; e-mail:
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25
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Donovan TA, Fox PR, Balakrishnan N, Ericson M, Hooker V, Breitschwerdt EB. Pyogranulomatous Pancarditis with Intramyocardial Bartonella henselae San Antonio 2 (BhSA2) in a Dog. J Vet Intern Med 2016; 31:142-148. [PMID: 27883248 PMCID: PMC5259629 DOI: 10.1111/jvim.14609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 09/21/2016] [Accepted: 10/18/2016] [Indexed: 12/27/2022] Open
Affiliation(s)
- T A Donovan
- Department of Pathology, The Animal Medical Center, New York, NY
| | - P R Fox
- Department of Cardiology, The Animal Medical Center, New York, NY
| | - N Balakrishnan
- Department of Clinical Sciences, Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - M Ericson
- University of Minnesota Imaging Center, Minneapolis, MN
| | - V Hooker
- The Animal Medical Center, New York, NY
| | - E B Breitschwerdt
- Department of Clinical Sciences, Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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26
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Palerme JS, Jones AE, Ward JL, Balakrishnan N, Linder KE, Breitschwerdt EB, Keene BW. Infective endocarditis in 13 cats. J Vet Cardiol 2016; 18:213-225. [PMID: 27283084 DOI: 10.1016/j.jvc.2016.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION To describe the clinical presentation, clinicopathological abnormalities and outcomes of a series of cats diagnosed with infective endocarditis (IE) at two tertiary care referral institutions. ANIMALS Thirteen client-owned cats presenting to the cardiology or emergency services of tertiary referral institutions with a diagnosis of endocarditis based on the modified Duke criteria. MATERIALS AND METHODS Retrospective case series. Medical records were reviewed to extract relevant data. In addition, cases that had cardiac tissue available were evaluated by polymerase chain reaction for the presence of Bartonella DNA. RESULTS Prevalence of feline IE was 0.007%. Cats with endocarditis tended to be older (median age: 9 years, range: 2-12 years) and no sex or breed was overrepresented. Commonly encountered clinical signs included respiratory distress (n = 5) and locomotor abnormalities of varying severity (n = 5). Echocardiographic examination detected valvular lesions consistent with endocarditis on the aortic (n = 8) or mitral (n = 5) valves. Nine cats were diagnosed with congestive heart failure at the time of endocarditis diagnosis. Overall, prognosis was grave with a median survival time of 31 days. CONCLUSIONS In contrast to dogs, cats with IE typically present with clinical signs consistent with cardiac decompensation and locomotor abnormalities suggestive of either thromboembolic disease or inflammatory arthritis. Given the advanced state of disease when diagnosis typically occurs, prognosis is grave.
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Affiliation(s)
- Jean-Sébastien Palerme
- Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, 1809 South Riverside Drive, Ames, IA 50011, USA.
| | - Ashley E Jones
- Angell Animal Medical Center, 350 South Huntington Avenue, Boston, MA 02130, USA
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, 1809 South Riverside Drive, Ames, IA 50011, USA
| | - Nandhakumar Balakrishnan
- Department of Clinical Sciences and the Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, North Carolina State University, College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Keith E Linder
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Edward B Breitschwerdt
- Department of Clinical Sciences and the Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, North Carolina State University, College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Bruce W Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
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Rolim VM, Casagrande RA, Wouters ATB, Driemeier D, Pavarini SP. Myocarditis caused by Feline Immunodeficiency Virus in Five Cats with Hypertrophic Cardiomyopathy. J Comp Pathol 2016; 154:3-8. [PMID: 26797583 PMCID: PMC7094316 DOI: 10.1016/j.jcpa.2015.10.180] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 11/15/2022]
Abstract
Viral infections have been implicated as the cause of cardiomyopathy in several mammalian species. This study describes hypertrophic cardiomyopathy (HCM) and myocarditis associated with feline immunodeficiency virus (FIV) infection in five cats aged between 1 and 4 years. Clinical manifestations included dyspnoea in four animals, one of which also exhibited restlessness. One animal showed only lethargy, anorexia and vomiting. Necropsy examination revealed marked cardiomegaly, marked left ventricular hypertrophy and pallor of the myocardium and epicardium in all animals. Microscopical and immunohistochemical examination showed multifocal infiltration of the myocardium with T lymphocytes and fewer macrophages, neutrophils and plasma cells. An intense immunoreaction for FIV antigen in the cytoplasm and nucleus of lymphocytes and the cytoplasm of some macrophages was observed via immunohistochemistry (IHC). IHC did not reveal the presence of antigen from feline calicivirus, coronavirus, feline leukaemia virus, feline parvovirus, Chlamydia spp. or Toxoplasma gondii. The results demonstrate the occurrence of FIV infection in inflammatory cells in the myocardium of five cats with myocarditis and HCM.
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Affiliation(s)
- V Machado Rolim
- Department of Veterinary Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - R Assis Casagrande
- Department of Veterinary Pathology, Universidade do Estado de Santa Catarina, Lages, Brazil
| | | | - D Driemeier
- Department of Veterinary Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - S Petinatti Pavarini
- Department of Veterinary Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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28
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Breitschwerdt EB, Broadhurst JJ, Cherry NA. Bartonella henselae as a cause of acute-onset febrile illness in cats. JFMS Open Rep 2015; 1:2055116915600454. [PMID: 28491382 PMCID: PMC5362002 DOI: 10.1177/2055116915600454] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/15/2022] Open
Abstract
Case series summary At different time points spanning 6 months, three adopted feral flea-infested cats, residing in the household of a veterinary technician, became acutely anorexic, lethargic and febrile. Enrichment blood culture/PCR using Bartonella alpha Proteobacteria growth medium (BAPGM) confirmed initial infection with the same Bartonella henselae genotype in all three cases. With the exception of anemia and neutropenia, complete blood counts, serum biochemical profiles and urinalysis results were within reference intervals. Also, tests for feline leukemia virus, feline immunodeficiency virus, Toxoplasma gondii and feline coronavirus antibodies were negative. Serial daily temperature monitoring in one case confirmed a cyclic, relapsing febrile temperature pattern during 1 month, with resolution during and after treatment with azithromycin. Bartonella henselae Western immunoblot (WB) results did not consistently correlate with BAPGM enrichment blood culture/PCR results or B henselae indirect fluorescent antibody (IFA) titers, and WB titration results were not informative for establishing antibiotic treatment failure. During the respective follow-up periods, no illnesses or additional febrile episodes were reported, despite repeat documentation of B henselae bacteremia in two cats available for follow-up (one with the same genotype and the other with a different B henselae genotype); one cat was, unfortunately, killed by dogs before follow-up testing. Relevance and novel information We conclude that microbiological diagnosis and treatment of B henselae infection in cats can be challenging, that antibody titration results and resolution of clinical abnormalities may not correlate with a therapeutic cure, and that fever and potentially neutropenia should be differential diagnostic considerations for young cats with suspected bartonellosis.
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Affiliation(s)
- Edward B Breitschwerdt
- Intracellular Pathogens Research Laboratory and the Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Friedenberg SG, Balakrishnan N, Guillaumin J, Cooper ES, Lewis K, Russell DS, Breitschwerdt EB. Splenic vasculitis, thrombosis, and infarction in a febrile dog infected withBartonella henselae. J Vet Emerg Crit Care (San Antonio) 2015; 25:789-94. [DOI: 10.1111/vec.12367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 03/04/2014] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Steven G. Friedenberg
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Nandhakumar Balakrishnan
- the Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University; Raleigh NC 27607
| | - Julien Guillaumin
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Edward S. Cooper
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Kristin Lewis
- the Department of Veterinary Biosciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Duncan S. Russell
- the Department of Veterinary Biosciences; College of Veterinary Medicine, The Ohio State University, Columbus; OH 43210
| | - Edward B. Breitschwerdt
- the Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University; Raleigh NC 27607
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Möstl K, Addie DD, Boucraut-Baralon C, Egberink H, Frymus T, Gruffydd-Jones T, Hartmann K, Hosie MJ, Lloret A, Lutz H, Marsilio F, Pennisi MG, Radford AD, Thiry E, Truyen U, Horzinek MC. Something old, something new: Update of the 2009 and 2013 ABCD guidelines on prevention and management of feline infectious diseases. J Feline Med Surg 2015; 17:570-82. [PMID: 26101308 PMCID: PMC11148927 DOI: 10.1177/1098612x15588448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OVERVIEW The ABCD has published 34 guidelines in two Special Issues of the Journal of Feline Medicine and Surgery (JFMS): the first in July 2009 (Volume 11, Issue 7, pages 527-620) and the second in July 2013 (Volume 15, Issue 7, pages 528-652). The present article contains updates and new information on 18 of these (17 disease guidelines and one special article 'Prevention of infectious diseases in cat shelters'). For detailed information, readers are referred to the guidelines published in the above-mentioned JFMS Special Issues.
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Tomas A, Pultorak EL, Gruen ME, Breitschwerdt EB, Lascelles BDX. Relationship between degenerative joint disease, pain, and Bartonella spp. seroreactivity in domesticated cats. J Vet Intern Med 2014; 29:21-7. [PMID: 25327962 PMCID: PMC4407694 DOI: 10.1111/jvim.12495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/14/2014] [Accepted: 09/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background Recently, a potential association was identified between Bartonella exposure and arthritides in mammalian species other than cats. Hypothesis/Objectives We hypothesized that Bartonella exposure is associated with more severe degenerative joint disease (DJD) and a greater burden of DJD‐associated pain in client‐owned cats. Animals Ninety‐four client‐owned cats (6 months to 20 years old), ranging from clinically unaffected to severely lame because of DJD. Methods Using physical examination and radiography, pain and radiographic scores were assigned to each part of the bony skeleton. Sera were tested for Bartonella henselae, B. koehlerae, and B. vinsonii subsp. berkhoffii (genotypes I, II, and III) antibodies using immunofluorescence antibody assays. Variables were categorized and logistic regression used to explore associations. Results Seropositivity to Bartonella was identified in 33 (35.1%) cats. After multivariate analysis controlling for age, total DJD score (OR, 0.51; 95% CI, 0.26–0.97; P = .042), appendicular pain score (OR, 0.33; 95% CI, 0.17–0.65; P = .0011), and total pain score (OR, 0.35; 95% CI, 0.17–0.72; P = .0045) were significantly inversely associated with Bartonella seroreactivity status, indicating that cats with higher DJD and pain scores were less likely to be Bartonella seropositive. Conclusions and Clinical Importance Based upon this preliminary study, Bartonella spp. seropositivity was associated with decreased severity of DJD and decreased DJD‐associated pain in cats. Additional studies are needed to verify these findings, and if verified, to explore potential mechanisms.
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Affiliation(s)
- A Tomas
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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Breitschwerdt EB. Bartonellosis: One Health Perspectives for an Emerging Infectious Disease. ILAR J 2014; 55:46-58. [DOI: 10.1093/ilar/ilu015] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Wolf LA, Cherry NA, Maggi RG, Breitschwerdt EB. In Pursuit of a Stealth Pathogen: Laboratory Diagnosis of Bartonellosis. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.clinmicnews.2014.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Drut A, Bublot I, Breitschwerdt EB, Chabanne L, Vayssier-Taussat M, Cadoré JL. Comparative microbiological features of Bartonella henselae infection in a dog with fever of unknown origin and granulomatous lymphadenitis. Med Microbiol Immunol 2013; 203:85-91. [DOI: 10.1007/s00430-013-0318-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
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Pennisi MG, Marsilio F, Hartmann K, Lloret A, Addie D, Belák S, Boucraut-Baralon C, Egberink H, Frymus T, Gruffydd-Jones T, Hosie MJ, Lutz H, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek MC. Bartonella species infection in cats: ABCD guidelines on prevention and management. J Feline Med Surg 2013; 15:563-9. [PMID: 23813816 PMCID: PMC11148970 DOI: 10.1177/1098612x13489214] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OVERVIEW Over 22 Bartonella species have been described in mammals, and Bartonella henselae is most common worldwide. Cats are the main reservoir for this bacterium. B henselae is the causative agent of cat scratch disease in man, a self-limiting regional lymphadenopathy, but also of other potentially fatal disorders in immunocompromised people. INFECTION B henselae is naturally transmitted among cats by the flea Ctenocephalides felis felis, or by flea faeces. A cat scratch is the common mode of transmission of the organism to other animals, including humans. Blood transfusion also represents a risk. DISEASE SIGNS Most cats naturally infected by B henselae do not show clinical signs but cardiac (endocarditis, myocarditis) or ocular (uveitis) signs may be found in sporadic cases. B vinsonii subspecies berkhoffii infection has reportedly caused lameness in a cat affected by recurrent osteomyelitis and polyarthritis. DIAGNOSIS Isolation of the bacterium is the gold standard, but because of the high prevalence of infection in healthy cats in endemic areas, a positive culture (or polymerase chain reaction) is not confirmatory. Other compatible diagnoses must be ruled out and response to therapy gives a definitive diagnosis. Serology (IFAT or ELISA) is more useful for exclusion of the infection because of the low positive predictive value (39-46%) compared with the good negative predictive value (87-97%). Laboratory testing is required for blood donors. DISEASE MANAGEMENT Treatment is recommended in the rare cases where Bartonella actually causes disease.
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Abstract
PRACTICAL RELEVANCE Bartonellae are small, vector-transmitted Gram-negative intracellular bacteria that are well adapted to one or more mammalian reservoir hosts. Cats are the natural reservoir for Bartonella henselae, which is a (re-)emerging bacterial pathogen. It can cause cat scratch disease in humans and, in immunocompromised people, may lead to severe systemic diseases, such as bacillary angiomatosis. Cats bacteraemic with B henselae constitute the main reservoir from which humans become infected. Most cats naturally infected with B henselae show no clinical signs themselves, but other Bartonella species for which cats are accidental hosts appear to have more pathogenicity. GLOBAL IMPORTANCE Several studies have reported a prevalence of previous or current Bartonella species infection in cats of up to 36%. B henselae is common in cats worldwide, and bacteraemia can be documented by blood culture in about a quarter of healthy cats. The distribution of B henselae to various parts of the world has largely occurred through humans migrating with their pet cats. The pathogen is mainly transmitted from cat to cat by fleas, and the majority of infected cats derive from areas with high flea exposure. No significant difference in B henselae prevalence has been determined between male and female cats. In studies on both naturally and experimentally infected cats, chronic bacteraemia has mainly been found in cats under the age of 2 years, while those over 2 years of age are rarely chronically bacteraemic. EVIDENCE BASE This article reviews published studies and case reports on bartonellosis to explore the clinical significance of the infection in cats and its impact on humans. The article also discusses possible treatment options for cats and means of minimising the zoonotic potential.
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Affiliation(s)
- Bianca Stützer
- Clinic for Small Animal Medicine, LMU University of Munich, 80539 Munich, Germany
| | - Katrin Hartmann
- Clinic for Small Animal Medicine, LMU University of Munich, 80539 Munich, Germany
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VanderHeyden TR, Yong SL, Breitschwerdt EB, Maggi RG, Mihalik AR, Parada JP, Fimmel CJ. Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient. BMC Infect Dis 2012; 12:17. [PMID: 22269175 PMCID: PMC3287964 DOI: 10.1186/1471-2334-12-17] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/23/2012] [Indexed: 11/15/2022] Open
Abstract
Background Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis. Due to the fastidious growth characteristics of the bacteria, the limited sensitivity of histopathological stains, and the non-specific histological findings on liver biopsy, the diagnosis of hepatic bartonellosis can be difficult to establish. Furthermore, the optimal treatment of established hepatic bartonellosis remains controversial. Case presentation We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five cm right hepatic lobe mass on CT scan. The patient underwent a right hepatic lobectomy. Surgical pathology revealed florid necrotizing granulomatous hepatitis, favoring an infectious etiology. Despite extensive histological and serological evaluation a definitive diagnosis was not established initially. Thirteen months after initial presentation, hepatic bartonellosis was diagnosed by PCR studies from surgically excised liver tissue. Interestingly, the hepatic granulomas persisted and Bartonella henselae was isolated from the patient's enriched blood culture after several courses of antibiotic therapy. Conclusion The diagnosis of hepatic bartonellosis is exceedingly difficult to establish and requires a high degree of clinical suspicion. Recently developed, PCR-based approaches may be required in select patients to make the diagnosis. The optimal antimicrobial therapy for hepatic bartonellosis has not been established, and close follow-up is needed to ensure successful eradication of the infection.
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Affiliation(s)
- Thomas R VanderHeyden
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.
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