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Lin KP, Yeh TK, Chuang YC, Wang LA, Fu YC, Liu PY. Blood Culture Negative Endocarditis: A Review of Laboratory Diagnostic Approaches. Int J Gen Med 2023; 16:317-327. [PMID: 36718144 PMCID: PMC9884005 DOI: 10.2147/ijgm.s393329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Infective endocarditis is a potentially fatal condition, and identifying the pathogen is crucial to optimizing antibiotic treatment. While a blood culture takes time and may yield negative results, it remains the gold standard for diagnosis, blood culture-negative endocarditis, which accounts for up to 20% of infective endocarditis cases, poses a clinical challenge with increasing mortality. To better understand the etiology of blood culture-negative infective endocarditis, we reviewed non-culture-based strategies and compared the results. Serology tests work best in limited pathogens, such as Coxiella burnetii and Bartonella infections. Most of the pathogens identified by broad-range PCR tests are Streptococcus spp, Staphylococcus spp and Propionibacterium spp. adding specific real-time PCR assays to the systematic PCR testing of patients with blood culture-negative endocarditis will increase the efficiency of diagnosis. Recently, metagenomic next-generation sequencing has also shown promising results.
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Affiliation(s)
- Kuan-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Kuang Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Genomic Center for Infectious Diseases, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chuan Chuang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-An Wang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Ching Fu
- Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Correspondence: Yun-Ching Fu; Po-Yu Liu, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Blvd, Xitun District, Taichung City, 40705, Taiwan, Tel +886-4-2359-2525 ext.3110, Fax +886-4-2359-5046, Email ;
| | - Po-Yu Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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2
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Vaca DJ, Dobler G, Fischer SF, Keller C, Konrad M, von Loewenich FD, Orenga S, Sapre SU, van Belkum A, Kempf VAJ. Contemporary diagnostics for medically relevant fastidious microorganisms belonging to the genera Anaplasma, Bartonella, Coxiella, Orientia, and Rickettsia. FEMS Microbiol Rev 2022; 46:6530194. [PMID: 35175353 PMCID: PMC9300619 DOI: 10.1093/femsre/fuac013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 12/02/2022] Open
Abstract
Many of the human infectious pathogens—especially the zoonotic or vector-borne bacteria—are fastidious organisms that are difficult to cultivate because of their strong adaption to the infected host culminating in their near-complete physiological dependence on this environment. These bacterial species exhibit reduced multiplication rates once they are removed from their optimal ecological niche. This fact complicates the laboratory diagnosis of the disease and hinders the detection and further characterization of the underlying organisms, e.g. at the level of their resistance to antibiotics due to their slow growth. Here, we describe the current state of microbiological diagnostics for five genera of human pathogens with a fastidious laboratory lifestyle. For Anaplasma spp., Bartonella spp., Coxiella burnetii, Orientia spp. and Rickettsia spp., we will summarize the existing diagnostic protocols, the specific limitations for implementation of novel diagnostic approaches and the need for further optimization or expansion of the diagnostic armamentarium. We will reflect upon the diagnostic opportunities provided by new technologies including mass spectrometry and next-generation nucleic acid sequencing. Finally, we will review the (im)possibilities of rapidly developing new in vitro diagnostic tools for diseases of which the causative agents are fastidiously growing and therefore hard to detect.
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Affiliation(s)
- Diana J Vaca
- Institute of Medical Microbiology and Infection Control, Goethe University of Frankfurt, Germany
| | - Gerhard Dobler
- Department of Virology and Rickettsiology, Bundeswehr Institute of Microbiology, Germany
| | - Silke F Fischer
- National Consulting Laboratory for Coxiella burnetii, State Health Office Baden-Württemberg, Germany
| | | | - Maik Konrad
- National Consulting Laboratory for Coxiella burnetii, State Health Office Baden-Württemberg, Germany
| | | | | | | | | | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, Goethe University of Frankfurt, Germany
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3
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Oumarou Hama H, Aboudharam G, Barbieri R, Lepidi H, Drancourt M. Immunohistochemical diagnosis of human infectious diseases: a review. Diagn Pathol 2022; 17:17. [PMID: 35094696 PMCID: PMC8801197 DOI: 10.1186/s13000-022-01197-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/18/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Immunohistochemistry (IHC) using monoclonal and polyclonal antibodies is a useful diagnostic method for detecting pathogen antigens in fixed tissues, complementing the direct diagnosis of infectious diseases by PCR and culture on fresh tissues. It was first implemented in a seminal publication by Albert Coons in 1941. MAIN BODY Of 14,198 publications retrieved from the PubMed, Google, Google Scholar and Science Direct databases up to December 2021, 230 were selected for a review of IHC techniques, protocols and results. The methodological evolutions of IHC and its application to the diagnosis of infectious diseases, more specifically lice-borne diseases, sexually transmitted diseases and skin infections, were critically examined. A total of 59 different pathogens have been detected once in 22 different tissues and organs; and yet non-cultured, fastidious and intracellular pathogens accounted for the vast majority of pathogens detected by IHC. Auto-IHC, incorporating patient serum as the primary antibody, applied to diseased heart valves surgically collected from blood culture-negative endocarditis patients, detected unidentified Gram-positive cocci and microorganisms which were subsequently identified as Coxiella burnetii, Bartonella quintana, Bartonella henselae and Tropheryma whipplei. The application of IHC to ancient tissues dated between the ends of the Ptolemaic period to over 70 years ago, have also contributed to paleomicrobiology diagnoses. CONCLUSION IHC plays an important role in diagnostic of infectious diseases in tissue samples. Paleo-auto-IHC derived from auto-IHC, is under development for detecting non-identified pathogens from ancient specimens.
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Affiliation(s)
- Hamadou Oumarou Hama
- IHU Méditerranée Infection, Marseille, France
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Gérard Aboudharam
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- Aix-Marseille-Univ., Ecole de Médecine Dentaire, Marseille, France
| | - Rémi Barbieri
- IHU Méditerranée Infection, Marseille, France
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Hubert Lepidi
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- Laboratoire d'Histologie, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - Michel Drancourt
- IHU Méditerranée Infection, Marseille, France.
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France.
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4
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Patel R, Koran K, Call M, Schnee A. A case of Bartonella henselae native valve endocarditis presenting with crescentic glomerulonephritis. IDCases 2022; 27:e01366. [PMID: 34984170 PMCID: PMC8692998 DOI: 10.1016/j.idcr.2021.e01366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Bartonella endocarditis is often an elusive diagnosis, usually derived from evaluating multiple laboratory tests and assessment of presenting symptoms. Herein we describe a case of Bartonella henselae native mitral valve endocarditis with an initial presentation of volume overload and renal failure. The Bartonella organism is tedious to isolate from culture medium, causing most diagnoses to be delayed. Due to the destructive nature of B. henselae endocarditis, the need for rapid identification remains prudent. This therefore creates an opportunity for Next Generation Sequencing (NGS) to be used. We further summarize the varied presentations that may be associated with B. henselae endocarditis, and hope that this will heighten the clinicians' awareness of this entity when presented with acute onset renal failure and culture negative vegetations.
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Patel S, Richert ME, White R, Lambing T, Saleeb P. A Case of Bartonella Quintana Culture-Negative Endocarditis. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:602-606. [PMID: 31026253 PMCID: PMC6501736 DOI: 10.12659/ajcr.915215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 28 Final Diagnosis: Bartonella endocarditis Symptoms: Abdominal pain • cough • weight loss Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Sonika Patel
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Mary Elizabeth Richert
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rachel White
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Tyler Lambing
- Department of Medicine, Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, MD, USA
| | - Paul Saleeb
- Institute of Human Virology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Williams JM, Parimi M, Sutherell J. Bartonella endocarditis in a child with tetralogy of Fallot complicated by PR3-ANCA positive serology, autoimmune hemolytic anemia, and acute kidney injury. Clin Case Rep 2018; 6:1264-1267. [PMID: 29988634 PMCID: PMC6028408 DOI: 10.1002/ccr3.1589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/03/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022] Open
Abstract
Although the role of ANCA in infective endocarditis is unclear, Bartonella henselae has been implicated as the culprit in cases of PR3-ANCA positive subacute bacterial endocarditis (SBE) with glomerulonephritis. In this case, a Coombs-positive autoimmune hemolytic anemia and glomerulonephritis accompanied a PR3-ANCA positive SBE caused by Bartonella henselae.
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Affiliation(s)
- James M. Williams
- Department of Pediatric CardiologySaint Louis University School of MedicineSt. LouisMOUSA
| | - Manoj Parimi
- Department of Pediatric CardiologySaint Louis University School of MedicineSt. LouisMOUSA
| | - Jamie Sutherell
- Department of Pediatric CardiologySaint Louis University School of MedicineSt. LouisMOUSA
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7
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Santos MA, White AA, Pottinger PS. Scratching Beneath the Surface. J Hosp Med 2018; 13:347-352. [PMID: 29444194 DOI: 10.12788/jhm.2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michael A Santos
- Department of Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
- Department of Medicine, WellSpan Good Samaritan Hospital, Lebanon, Pennsylvania, USA
| | - Andrew A White
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Paul S Pottinger
- Division of Allergy and Infectious Diseases, University of Washington Medical Center, Seattle, Washington, USA
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8
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Abstract
Since the reclassification of the genus Bartonella in 1993, the number of species has grown from 1 to 45 currently designated members. Likewise, the association of different Bartonella species with human disease continues to grow, as does the range of clinical presentations associated with these bacteria. Among these, blood-culture-negative endocarditis stands out as a common, often undiagnosed, clinical presentation of infection with several different Bartonella species. The limitations of laboratory tests resulting in this underdiagnosis of Bartonella endocarditis are discussed. The varied clinical picture of Bartonella infection and a review of clinical aspects of endocarditis caused by Bartonella are presented. We also summarize the current knowledge of the molecular basis of Bartonella pathogenesis, focusing on surface adhesins in the two Bartonella species that most commonly cause endocarditis, B. henselae and B. quintana. We discuss evidence that surface adhesins are important factors for autoaggregation and biofilm formation by Bartonella species. Finally, we propose that biofilm formation is a critical step in the formation of vegetative masses during Bartonella-mediated endocarditis and represents a potential reservoir for persistence by these bacteria.
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9
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Fournier PE, Gouriet F, Casalta JP, Lepidi H, Chaudet H, Thuny F, Collart F, Habib G, Raoult D. Blood culture-negative endocarditis: Improving the diagnostic yield using new diagnostic tools. Medicine (Baltimore) 2017; 96:e8392. [PMID: 29381916 PMCID: PMC5708915 DOI: 10.1097/md.0000000000008392] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Blood culture-negative endocarditis (BCNE) may represent up to 70% of all endocarditis cases, depending on series. From 2001 to 2009, we implemented in our laboratory a multimodal diagnostic strategy for BCNE that included systematized testing of blood, and when available, valvular biopsy specimens using serological, broad range molecular, and histopathological assays. A causative microorganism was identified in 62.7% of patients.In this study from January 2010 to December 2015, in an effort to increase the number of identified causative microorganisms, we prospectively added to our diagnostic protocol specific real-time (RT) polymerase chain reaction (PCR) assays targeting various endocarditis agents, and applied them to all patients with BCNE admitted to the 4 public hospitals in Marseille, France.A total of 283 patients with BCNE were included in the study. Of these, 177 were classified as having definite endocarditis. Using our new multimodal diagnostic strategy, we identified an etiology in 138 patients (78.0% of cases). Of these, 3 were not infective (2.2%) and 1 was diagnosed as having Mycobacterium bovis BCG endocarditis. By adding specific PCR assays from blood and valvular biopsies, which exhibited a significantly greater sensitivity (P < 10) than other methods, causative agents, mostly enterococci, streptococci, and zoonotic microorganisms, were identified in an additional 27 patients (14 from valves only, 11 from blood only, and 2 from both). Finally, in another 107 patients, a pathogen was detected using serology in 37, valve culture in 8, broad spectrum PCR from valvular biopsies and blood in 19 and 2, respectively, immunohistochemistry from valves in 3, and a combination of several assays in 38.By adding specific RT-PCR assays to our systematic PCR testing of patients with BCNE, we increased the diagnostic efficiency by 24.3%, mostly by detecting enterococci and streptococci that had not been detected by other diagnostic methods, but also agents requiring specific management such as Mycoplasma hominis and Tropheryma whipplei.
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Affiliation(s)
- Pierre-Edouard Fournier
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
| | - Frédérique Gouriet
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
| | - Jean-Paul Casalta
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
| | - Hubert Lepidi
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
| | - Hervé Chaudet
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
| | | | | | - Gilbert Habib
- Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
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10
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Bartonella henselae is usually not viable in lymph nodes of patients with cat scratch disease. Eur J Clin Microbiol Infect Dis 2017; 36:2207-2213. [PMID: 28669017 DOI: 10.1007/s10096-017-3047-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/18/2017] [Indexed: 12/19/2022]
Abstract
Bartonella henselae, the agent of cat scratch disease (CSD), appears to be a common organism responsible for lymphadenitis in both adults and children. There is a very low isolation rate for B. henselae from lymph nodes of patients with CSD. Our objective was to evaluate B. henselae viability in a large series of lymph nodes from patients with CSD. From January to November 2016, we analyzed lymph node biopsy samples from patients diagnosed with CSD. We used reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to detect B. henselae RNA, as well as cultures, histological analyses, and fluorescence in situ hybridization (FISH). We tested 87 lymph nodes positive for B. henselae DNA but only 8 (9%) presented with B. henselae RNA. We did not find a significant difference for the pap threshold cycle (CT) values between RNA-positive and RNA-negative lymph nodes (p = 0.5). Cultures, histological analyses, and FISH were negative for all the tested samples. We provide evidence that B. henselae are not or are rarely viable in most cases in the lymph nodes of patients with CSD.
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11
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Schnitzer K, Or Z, Sawaed S, Sharoni E, Bisharat N. Rapidly Progressive Bioprosthetic Aortic Valve Stenosis Due to Bartonella Species Endocarditis. Ann Thorac Surg 2017. [PMID: 28633264 DOI: 10.1016/j.athoracsur.2017.01.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rapid progression of valvular stenosis in the setting of infective endocarditis is extremely rare. Here we describe a patient with Bartonella endocarditis on a bioprosthetic aortic valve that caused rapidly progressive aortic stenosis without regurgitation. At operation the bioprosthetic valve was severely fibrotic and calcified, with markedly thickened and distorted leaflets and circular partial detachment from the aortic ring. The patient underwent aortic root replacement with aortic bioprosthesis and aortic grafting with reimplantation of the coronary ostia.
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Affiliation(s)
- Kathy Schnitzer
- Department of Medicine D, Emek Medical Center, Afula, Israel
| | - Zafrir Or
- Department of Cardiology, Emek Medical Center, Afula, Israel
| | - Shtiwi Sawaed
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Naiel Bisharat
- Department of Medicine D, Emek Medical Center, Afula, Israel; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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12
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Competence of Cimex lectularius Bed Bugs for the Transmission of Bartonella quintana, the Agent of Trench Fever. PLoS Negl Trop Dis 2015; 9:e0003789. [PMID: 26000974 PMCID: PMC4441494 DOI: 10.1371/journal.pntd.0003789] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/25/2015] [Indexed: 12/17/2022] Open
Abstract
Background Bartonella quintana, the etiologic agent of trench fever and other human diseases, is transmitted by the feces of body lice. Recently, this bacterium has been detected in other arthropod families such as bed bugs, which begs the question of their involvement in B. quintana transmission. Although several infectious pathogens have been reported and are suggested to be transmitted by bed bugs, the evidence regarding their competence as vectors is unclear. Methodology/Principal Findings Bed bugs at the adult and instar developmental stages were fed three successive human blood meals inoculated with B. quintana bacterium from day one (D1) to D5; subsequently they were fed with pathogen-free human blood until the end of the experiment. Bed bugs and feces were collected in time series, to evaluate their capacities to acquire, multiply and expel viable B. quintana using molecular biology, immunohistochemistry and cultures assays. B. quintana was detected molecularly in 100% of randomly selected experimentally infected bed bug specimens (D3). The monitoring of B. quintana in bed bug feces showed that the bacterium was detectable starting on the 3rd day post-infection (pi) and persisted until day 18±1 pi. Although immunohistochemistry assays localized the bacteria to the gastrointestinal bed bug gut, the detection of B. quintana in the first and second instar larva stages suggested a vertical non-transovarial transmission of the bacterium. Conclusion The present work demonstrated for the first time that bed bugs can acquire, maintain for more than 2 weeks and release viable B. quintana organisms following a stercorarial shedding. We also observed the vertical transmission of the bacterium to their progeny. Although the biological role of bed bugs in the transmission of B. quintana under natural conditions has yet to be confirmed, the present work highlights the need to reconsider monitoring of these arthropods for the transmission of human pathogens. Bartonella quintana, the etiologic agent of trench fever and other human diseases, is known to be transmitted by the feces of body lice. Recently, the DNA of this bacterium has been detected in bed bugs. Several pathogens have been associated and suggested to be transmitted by bed bugs, despite the insufficient evidence to support this vector role. The aim of the present study was to assess the competence of bed bugs in the transmission of B. quintana using an experimental artificial model of infection. To this end, bed bugs were fed with human infected blood meals. On the 3rd day post-infection (dpi) B. quintana was detected molecularly in 100% of experimentally infected bed bug. The bacterium was also detectable in bed bug feces starting on the 3rd dpi and persisted until 18±1 dpi. Although immunohistochemistry assays localized the bacteria to the gastrointestinal bed bug gut, B. quintana was also detected in the first and second instars larva. The present work highlights the need to reconsider monitoring of bed bugs for the transmission of pathogens.
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13
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Verdier-Watts F, Peloni JM, Piegay F, Gérôme P, Aussoleil A, Durand-de-Gevigney G, Mioulet D, Griffet V. [An exceptional case of tricuspid infective endocarditis due to Bartonella henseale revealed by an old pulmonary embolism]. Ann Cardiol Angeiol (Paris) 2015; 65:48-50. [PMID: 25869466 DOI: 10.1016/j.ancard.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022]
Abstract
We report a case of blood culture-negative tricuspid infective endocarditis revealed after tick bite by repeated pulmonary infection during one year due to septic pulmonary emboli in a 67-year-old farmer woman. Tricuspid vegetation and pulmonary emboli are calcified. Lyme serology is negative. Serologic test and PCR analysis are positive to Bartonella henselae. The evolution is favorable after antibiotic and anticoagulant treatment. Infective endocarditis due to B. henselae is an exceptional complication of cat scratch disease. You have to think about in case of blood culture-negative endocarditis with calcified valvular lesions even without cat bite, tick seems to be vector of the bacteria.
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Affiliation(s)
- F Verdier-Watts
- Service de cardiologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
| | - J-M Peloni
- Service de pneumologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - F Piegay
- Service de pneumologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - P Gérôme
- Service de biologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - A Aussoleil
- Fédération médicale de cardiologie, hôpital cardiologique Louis-Pradel, 28, avenue Doyen-Lépine, 69500 Lyon, France
| | - G Durand-de-Gevigney
- Fédération médicale de cardiologie, hôpital cardiologique Louis-Pradel, 28, avenue Doyen-Lépine, 69500 Lyon, France
| | - D Mioulet
- Service de cardiologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - V Griffet
- Service de cardiologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
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14
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Bartonella, a common cause of endocarditis: a report on 106 cases and review. J Clin Microbiol 2014; 53:824-9. [PMID: 25540398 DOI: 10.1128/jcm.02827-14] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis cases published in the PubMed database between January 2005 and October 2013. We report here a large series of 106 cases, which include 59 cases that had not previously been reported or mentioned. Indirect immunofluorescence assays, Western blotting, and real-time PCR from total blood, serum, and valve tissue exhibited sensitivities of 58%, 100%, 33%, 36%, and 91%, respectively. The number of cases reported in the literature between 2005 and 2013 increased to reach a cumulative number of 196 cases. The number of cases reported in the literature by other centers is increasing more rapidly than that reported by our French reference center (P < 10(-2)). Currently, there is a lack of criteria for the diagnosis of Bartonella endocarditis. We suggest that a positive PCR result from a cardiac valve or blood specimen, an IgG titer of ≥800 using an immunofluorescence assay, or a positive Western blot assay be considered major Duke criteria for Bartonella endocarditis. There is no real increase in the incidence of these infections but rather a better understanding and interest in the disease resulting from the improvement of diagnostic tools.
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15
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Angelakis E, Raoult D. Pathogenicity and treatment of Bartonella infections. Int J Antimicrob Agents 2014; 44:16-25. [DOI: 10.1016/j.ijantimicag.2014.04.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
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Hammami R, Abid D, Abid L, Znazen A, Hentati M, Hammami A, Kammoun S. [Bartonella endocarditis in Tunisia: lesional and evolutionary characteristics]. Pan Afr Med J 2014; 16:24. [PMID: 24570785 PMCID: PMC3932128 DOI: 10.11604/pamj.2013.16.24.1262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 07/16/2012] [Indexed: 11/13/2022] Open
Abstract
L'endocardite à Bartonalla est une infection ubiquitaire, son diagnostic est difficile vu qu'il s'agit souvent d'endocardite à hémoculture négative. Le but de cette étude est d'analyser les particularités lésionnelles et évolutives de cette entité dans un pays du nord d'Afrique, la Tunisie et de démontrer la gravité de cette infection. Nous avons étudié rétrospectivement les dossiers médicaux de 20 patients atteints d'endocardite à Bartonella, confirmée selon les critères de Dukes modifiés. L’âge moyen de nos patients était 37 ans avec une prédominance masculine (SR=3). Tous nos malades avaient un niveau socio-économique bas. Le motif essentiel de consultation était la dyspnée, 6 patients étaient admis dans un tableau d'insuffisance cardiaque congestive. Une prédilection des lésions au niveau de la valve aortique a été notée (14 cas). Quatorze patients avaient des végétations endocarditiques avec une taille qui dépasse 10 mm chez 8 malades. La majorité des patients (18 patients) présentaient une régurgitation valvulaire massive en rapport principalement avec des mutilations importantes (6 cas de ruptures de cordages mitraux, 2 cas de déchirures des sigmoïdes aortiques, un cas de perforation valvulaire aortique, un cas de désinsertion de prothèse mitrale). Quinze malades (3/4) avaient nécessité une chirurgie à la phase active de la maladie, l'indication majeure était l'insuffisance cardiaque. Une complication neurologique était notée chez 2 malades et une complication rénale chez 3 malades. Treize patients étaient guéris, 5 malades étaient décédés et 2 malades opérés ont présenté une réinfection à staphylococcus aureus et à candida albicans en postopératoire. L'endocardite à Bartonella est une infection grave. Cette Bactérie possède un potentiel destructif important. Le recours à la chirurgie est quasi constant. La morbi-mortalité est élevée. La recherche de cette bactérie devrait être alors systématique chez nos malades suspects d'endocardite d'autant plus que la bartonellose est endémique sur nos terres.
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Affiliation(s)
- Rania Hammami
- Service de Cardiologie, Hopital Hédi Chaker, Sfax,Tunisie
| | - Dorra Abid
- Service de Cardiologie, Hopital Hédi Chaker, Sfax,Tunisie
| | - Leila Abid
- Service de Cardiologie, Hopital Hédi Chaker, Sfax,Tunisie
| | - Abir Znazen
- Laboratoire de Bactériologie, Hopital Habib Bourguiba, Sfax, Tunisie
| | - Mourad Hentati
- Service de Cardiologie, Hopital Hédi Chaker, Sfax,Tunisie
| | - Adnene Hammami
- Laboratoire de Bactériologie, Hopital Habib Bourguiba, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie, Hopital Hédi Chaker, Sfax,Tunisie
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Kernif T, Leulmi H, Socolovschi C, Berenger JM, Lepidi H, Bitam I, Rolain JM, Raoult D, Parola P. Acquisition and excretion ofBartonella quintanaby the cat flea,Ctenocephalides felis felis. Mol Ecol 2014; 23:1204-12. [DOI: 10.1111/mec.12663] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Tahar Kernif
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
- Institut Pasteur d'Algérie; Algiers 16015 Algeria
| | - Hamza Leulmi
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
| | - Cristina Socolovschi
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
| | - Jean-Michel Berenger
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
| | - Hubert Lepidi
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
| | - Idir Bitam
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
- Département de Biologie; Faculté des sciences; Université M'hamed Bougara Boumerdes; Boumerdes 35000 Algérie
| | - Jean-Marc Rolain
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
| | - Didier Raoult
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
| | - Philippe Parola
- Aix Marseille Université; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095; Marseille 13005 France
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Lin EY, Tsigrelis C, Baddour LM, Lepidi H, Rolain JM, Patel R, Raoult D. Candidatus Bartonella mayotimonensis and endocarditis. Emerg Infect Dis 2010; 16:500-3. [PMID: 20202430 PMCID: PMC3321999 DOI: 10.3201/eid1603.081673] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe a new Bartonella species for which we propose the name Candidatus Bartonella mayotimonensis. It was isolated from native aortic valve tissue of a person with infective endocarditis. The new species was identified by using PCR amplification and sequencing of 5 genes (16S rRNA gene, ftsZ, rpoB, gltA, and internal transcribed spacer region).
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Benoit M, Thuny F, Le Priol Y, Lepidi H, Bastonero S, Casalta JP, Collart F, Capo C, Raoult D, Mege JL. The transcriptional programme of human heart valves reveals the natural history of infective endocarditis. PLoS One 2010; 5:e8939. [PMID: 20126625 PMCID: PMC2812508 DOI: 10.1371/journal.pone.0008939] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/10/2010] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis (IE) is an infectious disease that is mainly caused by Staphylococcus aureus and Streptococcus sp. It usually leads to valvular destruction and vegetation formation. Its pathophysiology is badly understood and likely involves immune and coagulation systems with close interactions with the microorganism. Our objective was to evaluate host response by comparing transcriptional profiles of cardiac valves from IE patients with controls. Hierarchical clustering revealed a signature of IE consisting of 146 genes. Among the 89 up-regulated genes, we identified two genes strongly associated with IE: metalloproteinase 12 (MMP-12) and aquaporin-9, a member of the aquaglyceroporin membrane channel family. The up-regulation of MMP-12 gene is strengthened by the down-modulation of the gene encoding its inhibitor TIMP3. In addition, MMP-12 was expressed in macrophages infiltrating EI valves. We also found that aquaporin-9 was expressed in endothelial cells lining neo-vessel lumen, suggesting that aquaporin-9 might be associated with neovascularization of infected valves leading to tissue oedema secondary to the inflammatory process. The Gene Ontology annotation and the resulting functional classification showed that most up-regulated genes account for recruitment of inflammatory cells in vegetations, angiogenesis and remodelling of endocardium tissue. A network analysis confirmed the involvement of molecules related to the remodelling of endocardium tissue and angiogenesis in IE. It also evidenced the role of caspases, especially that of caspase-9 and intrinsic apoptotic pathway in IE. Based on this study we propose a scenario for the natural history of IE in humans. Some parameters identified in this work could become tools for measuring the disease activity and should be tested as biomarkers for diagnosis or prognosis assessment in future studies.
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Affiliation(s)
- Marie Benoit
- Unité de Recherche sur les Maladies Infectieuses Transmissibles et Emergentes, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
| | - Franck Thuny
- Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Yannick Le Priol
- Relation Hôte-Parasites, Pharmacologie et Thérapeutique, Institut de Médecine Tropicale du Service de Santé des Armées, Marseille, France
| | - Hubert Lepidi
- Unité de Recherche sur les Maladies Infectieuses Transmissibles et Emergentes, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
| | - Sonia Bastonero
- Unité de Recherche sur les Maladies Infectieuses Transmissibles et Emergentes, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
| | - Jean-Paul Casalta
- Unité de Recherche sur les Maladies Infectieuses Transmissibles et Emergentes, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
| | - Frédéric Collart
- Service de Chirurgie Cardiaque, Hôpital de la Timone, Marseille, France
| | - Christian Capo
- Unité de Recherche sur les Maladies Infectieuses Transmissibles et Emergentes, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses Transmissibles et Emergentes, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
| | - Jean-Louis Mege
- Unité de Recherche sur les Maladies Infectieuses Transmissibles et Emergentes, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
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Standardisation et prise en charge multidisciplinaire des endocardites. Stratégie du CHU de Marseille. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.antib.2009.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Angelakis E, Lepidi H, Canel A, Rispal P, Perraudeau F, Barre I, Rolain JM, Raoult D. Human case of Bartonella alsatica lymphadenitis. Emerg Infect Dis 2009; 14:1951-3. [PMID: 19046532 PMCID: PMC2634634 DOI: 10.3201/eid1412.080757] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Renesto P, Rovery C, Schrenzel J, Leroy Q, Huyghe A, Li W, Lepidi H, François P, Raoult D. Rickettsia conorii transcriptional response within inoculation eschar. PLoS One 2008; 3:e3681. [PMID: 18997861 PMCID: PMC2577010 DOI: 10.1371/journal.pone.0003681] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 10/20/2008] [Indexed: 02/07/2023] Open
Abstract
Background Rickettsia conorii, the causative agent of the Mediterranean spotted fever, is transmitted to humans by the bite of infected ticks Rhipicephalus sanguineus. The skin thus constitutes an important barrier for the entry and propagation of R. conorii. Given this, analysis of the survival strategies used by the bacterium within infected skin is critical for our understanding of rickettsiosis. Methodology/Principal Findings Here, we report the first genome-wide analysis of R. conorii gene expression from infected human skin biopsies. Our data showed that R. conorii exhibited a striking transcript signature that is remarkably conserved across patients, regardless of genotype. The expression profiles obtained using custom Agilent microarrays were validated by quantitative RT-PCR. Within eschars, the amount of detected R. conorii transcripts was of 55%, this value being of 74% for bacteria grown in Vero cells. In such infected host tissues, approximately 15% (n = 211) of the total predicted R. conorii ORFs appeared differentially expressed compared to bacteria grown in standard laboratory conditions. These genes are mostly down-regulated and encode proteins essential for bacterial replication. Some of the strategies displayed by rickettsiae to overcome the host defense barriers, thus avoiding killing, were also pointed out. The observed up-regulation of rickettsial genes associated with DNA repair is likely to correspond to a DNA-damaging agent enriched environment generated by the host cells to eradicate the pathogens. Survival of R. conorii within eschars also involves adaptation to osmotic stress, changes in cell surface proteins and up-regulation of some virulence factors. Interestingly, in contrast to down-regulated transcripts, we noticed that up-regulated ones rather exhibit a small nucleotide size, most of them being exclusive for the spotted fever group rickettsiae. Conclusion/Significance Because eschar is a site for rickettsial introduction, the pattern of rickettsial gene expression observed here may define how rickettsiae counteract the host defense.
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Affiliation(s)
- Patricia Renesto
- Unité des Rickettsies, IRD-CNRS UMR 6236, Faculté de Médecine, Marseille, France.
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23
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Richet H, Casalta JP, Thuny F, Mérrien J, Harlé JR, Weiller PJ, Habib G, Raoult D. Development and assessment of a new early scoring system using non-specific clinical signs and biological results to identify children and adult patients with a high probability of infective endocarditis on admission. J Antimicrob Chemother 2008; 62:1434-40. [PMID: 18952617 PMCID: PMC2583066 DOI: 10.1093/jac/dkn423] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this study was to assess whether non-specific clinical signs or biological results can identify patients with a high probability of infective endocarditis (IE) to improve outcome. Patients and methods All patients tested for IE were included in a cohort and classified according to the modified Duke criteria. Patients with rejected endocarditis served as controls. Univariate and multivariate analyses were performed, and a score was calculated by adding 1 when a variable independently associated with IE (excluding major Duke criteria) was present and 0 when the variable was absent. A second score for patients with prior valvular damage (PVD) was also used. Scores were evaluated using the ROC curve method. Results IE was diagnosed in 402 of 2039 participants (19.7%). By multivariate analysis, PVD, fever, emboli, stroke, splenomegaly, finger clubbing, leucocytosis and erythrocyte sediment rate >50 were independently associated with IE. The rate of IE increased significantly from 4% (10/254) for a score of 0 to 83% (10/12) for a score of 6 in all patients, and from 9.5% (23/241) to 100% (10/10) in patients with PVD. The area under the ROC curve was 0.75 for the first score and 0.7 for the second. In a prospective study of 117 patients with suspicion of IE, the proportion of confirmed IE was 19% and the area under the ROC curve was 0.72. Conclusions This simple score can be used to identify patients with a high probability of IE, in the emergency room or on admission, to speed up diagnosis, or to initiate empirical antimicrobial therapy without replacing the modified Duke criteria.
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Affiliation(s)
- Hervé Richet
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France
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Lejko-Zupanc T, Slemenik-Pusnik C, Kozelj M, Klokocovnik T, Avsic-Zupanc T, Dolenc-Strazar Z, Benko D, Duh D, Rojko T. Native valve endocarditis due to Bartonella henselae in an immunocompetent man. Wien Klin Wochenschr 2008; 120:246-9. [PMID: 18500601 DOI: 10.1007/s00508-008-0951-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 02/06/2008] [Indexed: 11/28/2022]
Abstract
Culture-negative endocarditis accounts for 2.5-31% of all endocarditis cases and remains a diagnostic and therapeutic challenge. Bartonella spp. has only recently been recognized as an important cause of culture-negative endocarditis. We report a case of Bartonella henselae endocarditis occurring in an immunocompetent man who owned a cat and had previously been diagnosed with valvulopathy. Diagnosis was made only after prolonged diagnostic work-up with serology and with PCR and subsequent sequencing to identify the microorganism in the excised valves. The duration of treatment in patients with bartonella endocarditis is not clearly defined, and we decided to treat our patient with a prolonged course of antibiotic. Surgical treatment is usually necessary and was also successful in our patient. To our knowledge, this is the first case of bartonella endocarditis occurring in our geographic area.
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Affiliation(s)
- Tatjana Lejko-Zupanc
- Department of Infectious Diseases, University Medical Center, Ljubljana, Slovenia.
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25
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Eyzaguirre E, Haque AK. Application of immunohistochemistry to infections. Arch Pathol Lab Med 2008; 132:424-31. [PMID: 18318584 DOI: 10.5858/2008-132-424-aoiti] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Pathologists play an important role in the diagnosis or exclusion of infectious diseases. Traditionally, the diagnosis of infectious diseases rely on serologic assays and cultures. Serologic results may be difficult to interpret in the setting of immunosuppression, fresh tissue is not always available for culture, and culture of fastidious pathogens can be difficult and may take weeks or months to yield a result. Although some microorganisms or their cytopathic effects may be readily identifiable on routine and/or histochemical stains, often these changes are not specific or are sparse in the sample evaluated. In these cases, additional immunohistochemical stains are often needed to establish the diagnosis of infection. OBJECTIVE To review the current value and limitations of the use of immunohistochemistry in the diagnosis of infectious diseases in formalin-fixed tissue samples. DATA SOURCES Literature in Medline and the authors' own experience. CONCLUSIONS Immunohistochemistry has proven to be a useful tool in the diagnosis of infectious diseases in tissue samples. Immunohistochemistry is especially useful in the identification of microorganisms that are present in low numbers, stain poorly, are fastidious to grow, are noncultivable, or exhibit an atypical morphology. Finally, it is important to remember that there may be widespread occurrence of common antigens among bacteria and pathogenic fungi and both monoclonal and polyclonal antibodies must be tested for possible cross-reactivity with other organisms.
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Affiliation(s)
- Eduardo Eyzaguirre
- Division of Surgical Pathology, Department of Pathology, The University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77555-0588, USA.
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Gescher DM, Mallmann C, Kovacevic D, Schmiedel D, Borges AC, Schweickert B, Göbel UB, Moter A. A view on Bartonella quintana endocarditis—confirming the molecular diagnosis by specific fluorescence in situ hybridization. Diagn Microbiol Infect Dis 2008; 60:99-103. [PMID: 17889492 DOI: 10.1016/j.diagmicrobio.2007.07.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 07/18/2007] [Accepted: 07/20/2007] [Indexed: 11/26/2022]
Abstract
Culture-negative endocarditis is a frequent problem in cardiology, especially if caused by fastidious organisms. Among these, the diagnostic tools for the detection of Bartonella quintana are still unsatisfactory. In a culture-negative case of suspected endocarditis undergoing aortic valve replacement, polymerase chain reaction amplification and sequencing of the 16S rRNA gene indicated B. quintana infection. To develop a new diagnostic tool, independent from culture and amplification techniques, we designed and optimized an oligonucleotide fluorescence in situ hybridization (FISH) probe specific for B. quintana and suitable for FISH. FISH succeeded in simultaneous visualization and identification of vital microorganisms directly within the aortic valve tissue and in fast and univocal diagnosis of B. quintana endocarditis.
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Affiliation(s)
- Dorothee Maria Gescher
- Institut für Mikrobiologie und Hygiene, Charité-Universitätsmedizin Berlin, D-10117 Berlin, Germany
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27
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Kelly P, Rolain JM, Maggi R, Sontakke S, Keene B, Hunter S, Lepidi H, Breitschwerdt KT, Breitschwerdt EB. Bartonella quintana endocarditis in dogs. Emerg Infect Dis 2007; 12:1869-72. [PMID: 17326937 PMCID: PMC3291365 DOI: 10.3201/eid1212.060724] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
TOC summary line: PCR and sequencing provide the first evidence that B. quintana can be pathogenic in dogs. We provide the first evidence that Bartonella quintana can infect dogs and cause typical signs of endocarditis. Using PCR and sequencing, we identified B. quintana in the blood of a dog from the United States with aortic valve endocarditis and probably also in the mitral valve of a dog from New Zealand with endocarditis.
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Affiliation(s)
- Patrick Kelly
- Ross University, Basseterre, Saint Kitts, West Indies.
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From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection. BMC Infect Dis 2007; 7:30. [PMID: 17442105 PMCID: PMC1868026 DOI: 10.1186/1471-2334-7-30] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 04/18/2007] [Indexed: 11/10/2022] Open
Abstract
Background Most patients with infectious endocarditis (IE) due to Bartonella henselae have a history of exposure to cats and pre-existing heart valve lesions. To date, none of the reported patients have had a history of typical cat scratch disease (CSD) which is also a manifestation of infection with B. henselae. Case presentation Here we report the case of a patient who had CSD and six months later developed IE of the mitral valve caused by B. henselae. Conclusion Based on this unique case, we speculate that CSD represents the primary-infection of B. henselae and that IE follows in patients with heart valve lesions.
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Lepidi H, Fournier PE, Raoult D. Histologic features and immunodetection of African tick-bite fever eschar. Emerg Infect Dis 2006; 12:1332-7. [PMID: 17073080 PMCID: PMC3294730 DOI: 10.3201/eid1209.051540] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Immunohistochemical detection of rickettsial antigens may be useful in diagnosis. African tick-bite fever (ATBF) is a rickettsiosis caused by Rickettsia africae. We describe histologic features and immunodetection of R. africae in cutaneous inoculation eschars from 8 patients with ATBF, which was diagnosed by culture or association of positive PCR detection and positive serologic results. We used quantitative image analysis to compare the pattern of inflammation of these eschars with those from Mediterranean spotted fever. We evaluated the diagnostic value of immunohistochemical techniques by using a monoclonal antibody to R. africae. ATBF eschars were histologically characterized by inflammation of vessels composed mainly of significantly more polymorphonuclear leukocytes than are found in cases of Mediterranean spotted fever (p<0.05). Small amounts R. africae antigens were demonstrated by immunohistochemical examination in 6 of 8 patients with ATBF. Neutrophils in ATBF are a notable component of the host reaction, perhaps because ATBF is a milder disease than the other rickettsioses. Immunohistochemical detection of rickettsial antigens may be useful in diagnosing ATBF.
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30
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Jayatilake JAMS, Samaranayake YH, Cheung LK, Samaranayake LP. Quantitative evaluation of tissue invasion by wild type, hyphal and SAP mutants of Candida albicans, and non-albicans Candida species in reconstituted human oral epithelium. J Oral Pathol Med 2006; 35:484-91. [PMID: 16918600 DOI: 10.1111/j.1600-0714.2006.00435.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral candidiasis is a common problem in compromised patients. Although several non-albicans Candida species have emerged as pathogens the majority of candidal infections are caused by Candida albicans. Morphogenesis from the blastospore to filamentous phase, and production of secretory aspartyl proteinases (SAP) are two major virulence attributes of these opportunistic yeast. Histopathology of oral candidiasis is characterized by fungal invasion of the superficial epithelium although the invasive potentials of different Candida species vary. Computerized image analysis systems (IAS) utilizing immunohistochemistry have been successfully employed for quantification of such histopathological features. The purpose of this study was to evaluate quantitatively the in vitro invasive potential of C. albicans and its hyphal and SAP mutants, and five other non-albicans Candida species using a computerized IAS. METHODS In vitro human oral candidiasis was produced using five wild type and one reference C. albicans isolates, hyphal and SAP mutants of C. albicans SC 5314, and one wild type and one reference isolate each of C. tropicalis, C. dubliniensis, C. glabrata, C. parapsilosis and C. krusei in a reconstituted human oral epithelium (RHOE) model. The infected tissues were examined histologically at 12, 24 and 48 h. Invading fungal elements were visualized by periodic acid-Schiff (PAS) staining and quantitatively evaluated as a percentage of total tissue invasive area, using a computerized IAS. RESULTS All C. albicans isolates including hyphal mutant cph1/cph1 and SAP mutants; sap 1-3, sap 4-6 produced hyphae and differentially (P < 0.05) invaded the tissue over 48 h. The invasive potential of hyphal mutant cph1/cph1 and SAP mutants (sap 1-3, sap 4-6) were similar to the parent wild-type isolate at 12 h although after 24 h their invasion was dissimilar (P < 0.05). Non-albicans Candida species and hyphal mutants; efg1/efg1, efg1/efg1 cph1/cph1 were all non-invasive. CONCLUSIONS RHOE model in combination with computerized image analysis permits for the first time, the assessment of invasive potential of Candida species in a quantitative manner. The differential tissue invasive patterns of various C. albicans isolates, their mutants and other Candida species are also described.
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Affiliation(s)
- J A M S Jayatilake
- Division of Microbiology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Sondermeijer HP, Claas ECJ, Orendi JM, Tamsma JT. Bartonella quintana prosthetic valve endocarditis detected by blood culture incubation beyond 10 days. Eur J Intern Med 2006; 17:441-3. [PMID: 16962956 DOI: 10.1016/j.ejim.2006.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 02/06/2006] [Accepted: 02/20/2006] [Indexed: 11/20/2022]
Abstract
We describe the case of a 45-year-old man with mitral and aortic prosthetic valve replacement who presented with symptoms of subacute bacterial endocarditis. Bartonella quintana was grown from blood after prolonged culture. The course of the disease was complicated by splenic infarction, glomerulonephritis resulting in progressive renal insufficiency, and cerebroventricular hemorrhage. Notably, cardiac ultrasonography showed no extensive vegetations but a strand-like lesion. Culture-positive B. quintana prosthetic valve endocarditis in a formerly healthy subject represents a newly observed entity. It should be added to the differential diagnosis of prosthetic valve endocarditis, especially when it presents with features suggesting subacute bacterial endocarditis.
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Affiliation(s)
- Hugo P Sondermeijer
- Department of Surgery, Columbia University Medical Center, New York, NY 10032 USA
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Abstract
Sterile blood cultures are noted in one third of patients with infectious endocarditis. Although in half of cases this is due to previous antibiotic therapy, in the other half, the aetiology of culture-negative endocarditis is intracellular bacteria such as Coxiella burnetii or fastidious growing bacteria. Although it was previously considered that the prevalence of such organisms was identical throughout the world, recent investigations on Bartonella endocarditis clearly showed that the aetiology of culture-negative endocarditis is likely to be strongly related to epidemiology of the agent in each country. During the past decade the use of molecular techniques such as PCR with subsequent sequencing to detect or to identify bacteria in valves from patients with infectious endocarditis have considerably improved the aetiological diagnosis. This is especially true in the case of culture-negative endocarditis following earlier antibiotic therapy. However, the fact that DNA remnants of past endocarditis can be detected some time after the acute episode, when the patient has been cured, suggests that the predictive value of these techniques along with the traditional histology and culture need to be evaluated closely.
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Affiliation(s)
- Philippe Brouqui
- Service des Maladies Infectieuses et Tropicales, CHU Nord AP-HM & Unité des rickettsies, Faculté de Médecine, Université de la Méditérranée, Marseilles, France.
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Rovery C, Rolain JM, Lepidi H, Zandotti C, Moreau J, Brouqui P. Bartonella quintana coinfection with Mycobacterium avium complex and CMV in an AIDS patient: case presentation. BMC Infect Dis 2006; 6:89. [PMID: 16732891 PMCID: PMC1488855 DOI: 10.1186/1471-2334-6-89] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 05/29/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a greater number of HIV-infected patients survive despite profound immunodepression due to medical progress, we face complex infection with multiple agents in AIDS-patients. CASE PRESENTATION We report the case of an AIDS patient with a primary clinical presentation suggestive of bacillary angiomatosis. We also found in cutaneous lesions Mycobacterium avium complex and cytomegalovirus. CONCLUSION This clinical case illustrates the possibility of multiple coinfections in AIDS patients and the need to be exhaustive in evaluating infectious diseases in severely immunocompromised patients.
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Affiliation(s)
- Clarisse Rovery
- Service de maladies infectieuses et de médecine tropicale, hôpital Nord, APHM, Marseille, France
| | - Jean Marc Rolain
- Unité des Rickettsies, IFR 48, CNRS UMR 6020, Université de la Méditerranée, Faculté de médecine, Marseille, France
| | - Hubert Lepidi
- Unité des Rickettsies, IFR 48, CNRS UMR 6020, Université de la Méditerranée, Faculté de médecine, Marseille, France
| | - Christine Zandotti
- Laboratoire de Microbiologie, Hôpital de la Timone, APHM, Marseille, France
| | - Jacques Moreau
- Service de maladies infectieuses et de médecine tropicale, hôpital Nord, APHM, Marseille, France
| | - Philippe Brouqui
- Service de maladies infectieuses et de médecine tropicale, hôpital Nord, APHM, Marseille, France
- Unité des Rickettsies, IFR 48, CNRS UMR 6020, Université de la Méditerranée, Faculté de médecine, Marseille, France
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Abstract
The pathogen is reemerging in the United States and Europe and is responsible for a number of clinical conditions. Bartonella quintana, a pathogen that is restricted to human hosts and louse vectors, was first characterized as the agent of trench fever. The disease was described in 1915 on the basis of natural and experimental infections in soldiers. It is now recognized as a reemerging pathogen among homeless populations in cities in the United States and Europe and is responsible for a wide spectrum of conditions, including chronic bacteremia, endocarditis, and bacillary angiomatosis. Diagnosis is based on serologic analysis, culture, and molecular biology. Recent characterization of its genome allowed the development of modern diagnosis and typing methods. Guidelines for the treatment of B. quintana infections are presented.
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Lepidi H, Casalta JP, Fournier PE, Habib G, Collart F, Raoult D. Quantitative Histological Examination of Bioprosthetic Heart Valves. Clin Infect Dis 2006; 42:590-6. [PMID: 16447102 DOI: 10.1086/500135] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 10/16/2005] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The histological features that characterize infective endocarditis in bioprosthetic valves are not accurately defined. Moreover, bioprosthetic valves may have a noninfective, degenerative evolution associated with calcifications, vegetation-like lesions, and inflammatory infiltrates. Such histological findings may be misdiagnosed as infective endocarditis. METHODS Pathologic analysis of inflamed bioprosthetic valve tissues was conducted retrospectively for 21 patients who underwent surgical removal of a bioprosthetic valve because of suspected infective endocarditis and for 67 patients who underwent surgical removal of a bioprosthetic valve because of noninfective dysfunction. To better define the histological criteria for infective endocarditis, we used quantitative image analysis to compare these 2 groups of patients with respect to vegetations, calcifications, and patterns of inflammation. RESULTS Histologically, infective endocarditis in patients with bioprostheses was characterized by demonstration of microorganisms, vegetations, and neutrophil-rich, inflammatory infiltrates. Valve tissue specimens from patients whose bioprosthetic valves were removed because of noninfective complications showed, in 30% of cases, inflammatory infiltrates mainly composed of macrophages and lymphocytes. Inflammatory adherent thrombi that can occur to the surface of noninfective degenerative bioprostheses are differentiated because their vegetations have macrophage-rich content. A neutrophil surface area with a cutoff value of > or =1.5% of the total valve tissue surface area is highly specific (94%) for infective endocarditis. CONCLUSIONS When no microorganisms are detected and vegetations are not found in bioprosthetic valve tissues during the histological examination, a neutrophil-rich inflammation might better define the term "active endocarditis" in the Duke criteria and would allow differentiation between infective endocarditis and inflammatory, noninfective valve processes in patients with bioprosthetic valves.
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Affiliation(s)
- Hubert Lepidi
- Unité des Rickettsies et des Pathogènes Emergents, Faculté de Médecine, Université de la Méditerranée, Marseille, France
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Lin YY, Hsiao CH, Hsu YH, Lee CC, Tsai HJ, Pan MJ. Immunohistochemical Study of Lymph Nodes in Patients with Cat Scratch Disease. J Formos Med Assoc 2006; 105:911-7. [PMID: 17098692 DOI: 10.1016/s0929-6646(09)60176-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE Bartonella henselaeis the causative agent of cat scratch disease (CSD), manifesting as fever and acute regional lymphadenopathy. Although serologic testing is the reference method for diagnosis, successful use of immunohistochemical (IHC) stain of regional lymph nodes for the diagnosis of CSD has been reported. To determine the characterization and diagnostic potential of IHC in lymphadenopathy of CSD, lymph nodes were excised from patients with suspected CSD for further evaluation. METHODS Polyclonal antibody-based IHC studies were performed for the detection of B. henselae. Between January 2001 and December 2004, the reference laboratory of the Center for Disease Control, Taiwan, received a total of 377 sera from 352 reported suspected CSD cases. Twenty-three formalin-fixed paraffin-embedded lymph nodes from 16 patients and two skin biopsies from two patients suspected of having CSD were included in this study. Nine of them were serologically confirmed to have CSD and the others were seronegative but suspected to have CSD by the attending physicians. Seven lymph node specimens were obtained from tuberculosis patients for comparison. RESULTS We demonstrated that the microorganisms existed in the cytoplasm of histiocytes within the granulomatous lesions in nine lymph nodes and one skin biopsy. Among the nine lymph nodes with IHC (+) stains, three were seronegative. On the other hand, three cases were IHC (+) and six cases were IHC (-) among nine seronegative patients. In addition, two seronegative patients with skin biopsy showed one IHC (+) and one IHC (-). CONCLUSION IHC can contribute to the etiologic diagnosis of B. henselaelymphadenopathy when serology and molecular techniques are not available.
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Affiliation(s)
- Ying-You Lin
- Graduate Institute of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
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38
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Levy I, Rolain JM, Lepidi H, Raoult D, Feinmesser M, Lapidoth M, Ben-Amitai D. Is pyogenic granuloma associated with Bartonella infection? J Am Acad Dermatol 2005; 53:1065-6. [PMID: 16310070 DOI: 10.1016/j.jaad.2005.08.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 08/25/2005] [Accepted: 08/28/2005] [Indexed: 11/19/2022]
Abstract
Lobular capillary hemangioma and bacillary angiomatosis due to Bartonella infection share several clinical and histopathologic characteristics. We sought to determine whether lobular capillary hemangioma is caused by the same agent as bacillary angiomatosis. Forty-five pathology specimens with a histologic diagnosis of lobular capillary hemangioma obtained from patients with the same clinical diagnosis were tested by immunohistochemistry and polymerase chain reaction for the presence of DNA elements of Bartonella spp. None of the 45 lobular capillary hemangioma specimens tested positive for Bartonella spp. We conclude that lobular capillary hemangioma is not associated with Bartonella spp infection. Further research is required to determine the etiologic agent.
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Affiliation(s)
- Itzhak Levy
- Department of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
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39
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Raoult D, Casalta JP, Richet H, Khan M, Bernit E, Rovery C, Branger S, Gouriet F, Imbert G, Bothello E, Collart F, Habib G. Contribution of systematic serological testing in diagnosis of infective endocarditis. J Clin Microbiol 2005; 43:5238-42. [PMID: 16207989 PMCID: PMC1248503 DOI: 10.1128/jcm.43.10.5238-5242.2005] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Despite progress with diagnostic criteria, the type and timing of laboratory tests used to diagnose infective endocarditis (IE) have not been standardized. This is especially true with serological testing. Patients with suspected IE were evaluated by a standard diagnostic protocol. This protocol mandated an evaluation of the patients according to the modified Duke criteria and used a battery of laboratory investigations, including three sets of blood cultures and systematic serological testing for Coxiella burnetii, Bartonella spp., Aspergillus spp., Legionella pneumophila, and rheumatoid factor. In addition, cardiac valvular materials obtained at surgery were subjected to a comprehensive diagnostic evaluation, including PCR aimed at documenting the presence of fastidious organisms. The study included 1,998 suspected cases of IE seen over a 9-year period from April 1994 to December 2004 in Marseilles, France. They were evaluated prospectively. A total of 427 (21.4%) patients were diagnosed as having definite endocarditis. Possible endocarditis was diagnosed in 261 (13%) cases. The etiologic diagnosis was established in 397 (93%) cases by blood cultures, serological tests, and examination of the materials obtained from cardiac valves, respectively, in 348 (81.5%), 34 (8%), and 15 (3.5%) definite cases of IE. Concomitant infection with streptococci and C. burnetii was seen in two cases. The results of serological and rheumatoid factor evaluation reclassified 38 (8.9%) possible cases of IE as definite cases. Systematic serological testing improved the performance of the modified Duke criteria and was instrumental in establishing the etiologic diagnosis in 8% (34/427) cases of IE.
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Affiliation(s)
- D Raoult
- Unité des Rickettsies, Hôpital de la Timone, Faculté de Médicine, Université de la Méditerranée, 13385 Marseille cedex 05, France.
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40
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Kreisel D, Pasque MK, Damiano RJ, Medoff G, Kates A, Kreisel FH, Lawton JS. Bartonella species-induced prosthetic valve endocarditis associated with rapid progression of valvular stenosis. J Thorac Cardiovasc Surg 2005; 130:567-8. [PMID: 16077432 DOI: 10.1016/j.jtcvs.2004.12.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Kreisel
- Division of Cardiothoracic Surgery, Washington University, St Louis, MO 63110, USA
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41
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Houpikian P, Raoult D. Blood culture-negative endocarditis in a reference center: etiologic diagnosis of 348 cases. Medicine (Baltimore) 2005; 84:162-173. [PMID: 15879906 DOI: 10.1097/01.md.0000165658.82869.17] [Citation(s) in RCA: 285] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To identify the current etiologies of blood culture-negative infective endocarditis and to describe the epidemiologic, clinical, laboratory, and echocardiographic characteristics associated with each etiology, as well as with unexplained cases, we tested samples from 348 patients suspected of having blood culture-negative infective endocarditis in our diagnostic center, the French National Reference Center for Rickettsial Diseases, between 1983 and 2001. Serology tests for Coxiella burnettii, Bartonella species, Chlamydia species, Legionella species, and Aspergillus species; blood culture on shell vial; and, when available, analysis of valve specimens through culture, microscopic examination, and direct PCR amplification were performed. Physicians were asked to complete a questionnaire, which was computerized. Only cases of definite infective endocarditis, as defined by the modified Duke criteria, were included. A total of 348 cases were recorded-to our knowledge, the largest series reported to date. Of those, 167 cases (48%) were associated with C. burnetii, 99 (28%) with Bartonella species, and 5 (1%) with rare, fastidious bacterial agents of endocarditis (Tropheryma whipplei, Abiotrophia elegans, Mycoplasma hominis, Legionella pneumophila). Among 73 cases without etiology, 58 received antibiotic drugs before the blood cultures. Six cases were right-sided endocarditis and 4 occurred in patients who had a permanent pacemaker. Finally, no explanatory factor was found for 5 remaining cases (1%), despite all investigations.Q fever endocarditis affected males in 75% of cases, between 40 and 70 years of age. Ninety-one percent of patients had a previous valvulopathy, 32% were immunocompromised, and 70% had been exposed to animals. Our study confirms the improved clinical presentation and prognosis of the disease observed during the last decades. Such an evolution could be related to earlier diagnosis due to better physician awareness and more sensitive diagnostic techniques. As for Bartonella species, B. quintana was recorded more frequently than B. henselae (53 vs 17 cases). For 18 patients with Bartonella endocarditis, the responsible species was not identified. Species determination was achieved through culture and/or PCR in 49 cases and through Western immunoblotting in 22. Comparison of B. quintana and B. henselae endocarditis revealed distinct epidemiologic patterns. The 2 cases due to T. whipplei reflect the emerging role of this agent as a cause of infective endocarditis. Because identification of the bacterium was possible only through analysis of excised valves by histologic examination, PCR, and culture on shell vial, the prevalence of the disease might be underestimated. Among patients who received antibiotic drugs before blood cultures, 4 cases (7%) were found to be associated with Streptococcus species (2 S. bovis and 2 S. mutans) through 16S rDNA gene amplification directly from the valve, which shows the usefulness of this technique in overcoming the limitations of previous antibiotic treatment. Right-sided endocarditis occurred classically in young patients (mean age, 36 yr), intravenous drug users in 50% of cases, and suffering more often from embolic complications. Finally, 5 cases without etiology or explaining factors were all immunocompetent male patients with previous aortic valvular lesions, and 3 of the 5 presented with an aortic abscess. Further investigations should be focused on this group to identify new agents of infective endocarditis.
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Affiliation(s)
- Pierre Houpikian
- From Unitué des Rickettsies, Université de la Méditerraneé, Faculté de médecine, CNRS UPRES A 6020, 27 Boulevard Jean Moulin 13385 Marseille Cedex 05, France
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Benslimani A, Fenollar F, Lepidi H, Raoult D. Bacterial zoonoses and infective endocarditis, Algeria. Emerg Infect Dis 2005; 11:216-24. [PMID: 15752438 PMCID: PMC3320429 DOI: 10.3201/eid1102.040668] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Blood culture–negative endocarditis is common in Algeria. We describe the etiology of infective endocarditis in this country. Samples from 110 cases in 108 patients were collected in Algiers. Blood cultures were performed in Algeria. Serologic and molecular analysis of valves was performed in France. Infective endocarditis was classified as definite in 77 cases and possible in 33. Causative agents were detected by blood cultures in 48 cases. All 62 blood culture–negative endocarditis cases were tested by serologic or molecular methods or both. Of these, 34 tested negative and 28 had an etiologic agent identified. A total of 18 infective endocarditis cases were caused by zoonotic and arthropodborne bacteria, including Bartonella quintana (14 cases), Brucella melitensis (2 cases), and Coxiella burnetii (2 cases). Our data underline the high prevalence of infective endocarditis caused by Bartonella quintana in northern Africa and the role of serologic and molecular tools for the diagnosis of blood culture–negative endocarditis.
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43
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Stein A, Louveau C, Lepidi H, Ricci F, Baylac P, Davoust B, Raoult D. Q fever pneumonia: virulence of Coxiella burnetii pathovars in a murine model of aerosol infection. Infect Immun 2005; 73:2469-77. [PMID: 15784593 PMCID: PMC1087393 DOI: 10.1128/iai.73.4.2469-2477.2005] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Q fever is a worldwide zoonosis caused by Coxiella burnetii, a strictly intracellular bacterium that is a potential bioweapon. Humans usually acquires Q fever after inhalation of dust infected by subclinical animals. We used an aerosol exposure apparatus to challenge immunocompetent (BALB/c) and severe combined immunodeficient (SCID) mice with two different strains (strain Nine Mile and strain Q 212) of C. burnetii at two different inocula. Pathological lesions and dissemination of the bacteria were related to the size of the inoculum. SCID mice showed major pulmonary lesions, whereas similarly infected BALB/c mice were more able to eliminate the bacteria. Pathological differences were found between the strains, with Nine Mile showing more severe histological lesions and quantified spread of bacteria. Our animal model could provide a new tool for the study of acute Q fever pneumonia, the development of Q fever in immunodeficient hosts, and the differentiation of pathogenicity among C. burnetii isolates.
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Affiliation(s)
- Andreas Stein
- Unité des Rickettsies, Centre National de la Recherche Scientifique, UMR 6020, IFR 48, Faculté de Médecine, Université de la Méditerranée, Marseille, France
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44
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Fournier PE, Gouriet F, Brouqui P, Lucht F, Raoult D. Lymphangitis-associated rickettsiosis, a new rickettsiosis caused by Rickettsia sibirica mongolotimonae: seven new cases and review of the literature. Clin Infect Dis 2005; 40:1435-44. [PMID: 15844066 DOI: 10.1086/429625] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 01/12/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Rickettsia sibirica mongolotimonae has been found in Hyalomma ticks in Inner Mongolia (in China) and Niger and in humans in France and South Africa. To date, only 3 cases of human infection have been reported. METHODS Patients received a diagnosis of R. sibirica mongolotimonae infection on the basis of culture and/or PCR results plus serological test results. RESULTS From January 2000 to June 2004, R. sibirica mongolotimonae infection was diagnosed in 7 patients. In 3 patients, the bacterium was cultivated from the inoculation eschar. The other 4 patients had cases that were diagnosed with use of PCR of samples obtained from the eschar (2 patients) or blood (2 patients), plus specific Western blot before (2 patients) and after (2 patients) cross-adsorption. The clinical presentation included fever (temperature, >38.5 degrees C), a maculopapular rash, and > or =1 inoculation eschar in 6 patients, enlarged regional lymph nodes in 4 patients, and lymphangitis in 3 patients. On the basis of the study of 9 cases, R. sibirica mongolotimonae infection differed from other tick-borne rickettsioses in the Mediterranean area in the following ways: it involved a specific incidence in the spring, the presence of 2 eschars in 2 (22%) of the patients, the presence of a draining lymph node in 5 (55%) of the patients, and lymphangitis expanding from the inoculation eschar to the draining node in 4 (44%) of the patients. The most recent patient in our series received a clinical diagnosis on the basis of such findings. All patients recovered without any sequelae. CONCLUSIONS We propose that this new rickettsiosis be named "lymphangitis-associated rickettsiosis." Lymphangitis-associated rickettsiosis should be considered in the differential diagnosis of tick-borne rickettsioses in Europe, Africa, and Asia.
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Affiliation(s)
- Pierre-Edouard Fournier
- Unité des Rickettsies, Université de la Méditerranée, Faculté de Médecine, Marseille, France
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45
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Lepidi H, Casalta JP, Fournier PE, Habib G, Collart F, Raoult D. Quantitative Histological Examination of Mechanical Heart Valves. Clin Infect Dis 2005; 40:655-61. [PMID: 15714409 DOI: 10.1086/427504] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 10/12/2004] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Histological demonstration of microorganisms, vegetations, or active endocarditis in cardiac valve tissue is included in the Duke criteria and is considered to be a criterion of confirmed infective endocarditis. However, the histological features that characterize infective endocarditis are not accurately defined at the qualitative and quantitative levels. METHODS Pathologic analysis of tissue adjoining mechanical cardiac valves was undertaken retrospectively for 21 patients who underwent surgical removal of a mechanical valve because of suspected infective endocarditis and 69 patients who underwent surgical removal of a mechanical valve because of noninfectious dysfunction. To better define the histological criteria for infective endocarditis, we used quantitative image analysis to compare these 2 groups of patients with respect to valvular fibrosis, calcifications, vegetations, patterns of inflammation, and vascularization. RESULTS Histologically, infective endocarditis in patients with mechanical valves was characterized by the demonstration of microorganisms, vegetations, and significant neutrophil-rich inflammatory infiltrates with extensive neovascularization. In contrast, valve tissue specimens from patients with mechanical valves that were removed because of noninfectious complications showed significant rates of extensive fibrosis and, when present, inflammatory infiltrates that were mainly composed of macrophages and lymphocytes. A neutrophil surface area with a cutoff value of > or =2% of the total valve tissue surface is highly predictive of (90%) and specific for (98%) infective endocarditis. CONCLUSIONS When no microorganisms are detected and vegetations are lacking in tissue adjacent to a mechanical valve, neutrophil-rich inflammation and extensive neovascularization might better histologically define the term "active endocarditis" in the Duke criteria. This definition would allow differentiation between infective endocarditis and inflammatory noninfectious valve processes in patients with mechanical cardiac valves.
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Affiliation(s)
- Hubert Lepidi
- Unité des Rickettsies et des Pathogènes Emergents, Faculté de Médecine, Université de la Méditerranée, Marseille, France
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Albrich WC, Kraft C, Fisk T, Albrecht H. A mechanic with a bad valve: blood-culture-negative endocarditis. THE LANCET. INFECTIOUS DISEASES 2004; 4:777-84. [PMID: 15567127 DOI: 10.1016/s1473-3099(04)01226-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 33-year-old man with a known bicuspid aortic valve presented with fever, chills, progressive fatigue, anorexia, and night sweats. Echocardiography confirmed aortic-valve endocarditis, but blood cultures remained negative. Bartonella henselae endocarditis was ultimately confirmed by serology as well as by immunohistochemistry and PCR testing of the excised valve. The patient recovered with appropriate antibiotic therapy. B henselae is a common cause of culture-negative endocarditis. It predominantly affects men with underlying valvular disease, and has a predilection for aortic valves. Diagnosis is usually made serologically and with either tissue culture, immunohistochemistry, or PCR. Treatment of this destructive endocarditis consists of a combination of long-term antibiotic therapy and surgical valve repair. This case is used to discuss the approach towards the treatment of patients with endocarditis that is blood-culture negative.
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Affiliation(s)
- Werner C Albrich
- Division of Infectious Diseases, Emory University Medical School, Altlanta, GA, USA.
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47
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Drancourt M, Bodaghi B, Lepidi H, Le Hoang P, Raoult D. Intraocular detection of Bartonella henselae in a patient with HLA-B27 uveitis. J Clin Microbiol 2004; 42:1822-5. [PMID: 15071060 PMCID: PMC387588 DOI: 10.1128/jcm.42.4.1822-1825.2004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Michel Drancourt
- Unité des Rickettsies, CNR UMR 6020, IFR 48, Faculté de Médecine, Marseille, France
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48
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Honstettre A, Ghigo E, Moynault A, Capo C, Toman R, Akira S, Takeuchi O, Lepidi H, Raoult D, Mege JL. Lipopolysaccharide fromCoxiella burnetiiIs Involved in Bacterial Phagocytosis, Filamentous Actin Reorganization, and Inflammatory Responses through Toll-Like Receptor 4. THE JOURNAL OF IMMUNOLOGY 2004; 172:3695-703. [PMID: 15004173 DOI: 10.4049/jimmunol.172.6.3695] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of Toll-like receptors (TLRs) in the recognition of extracellular and facultative intracellular bacteria by the innate immune system has been extensively studied, but their role in the recognition of obligate intracellular organisms remains unknown. Coxiella burnetii, the agent of Q fever, is an obligate intracellular bacterium that specifically inhabits monocytes/macrophages. We showed in this study that C. burnetii LPS is involved in the uptake of virulent organisms by macrophages but not in that of avirulent variants. The uptake of virulent organisms was dependent on TLR4 because it was reduced in macrophages from TLR4(-/-) mice. In addition, LPS was responsible for filamentous actin reorganization induced by virulent C. burnetii, which was prevented in TLR4(-/-) macrophages. In contrast, the intracellular fate of C. burnetii was not affected in TLR4(-/-) macrophages, suggesting that TLR4 does not control the maturation of C. burnetii phagosome and the microbicidal activity of macrophages. These results are consistent with in vivo experiments because the pattern of tissue infection and the clearance of C. burnetii were similar in wild-type and TLR4(-/-) mice. We also showed that the number of granulomas was decreased in the liver of infected TLR4(-/-) mice, and the formation of splenic granulomas was only transient. The impaired formation of granulomas was associated with decreased production of IFN-gamma and TNF. Taken together, these results demonstrate that TLR4 controls early events of C. burnetii infection such as macrophage phagocytosis, granuloma formation, and cytokine production.
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Affiliation(s)
- Amélie Honstettre
- Unité des Rickettsies, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6020, Institut Federatif de Recherche 48 Université de la Méditerranée, Marseille, France
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Smarick SD, Jandrey KE, Chomel BB, Thomas WP, Aldrich J. Aortic valvular endocarditis caused byBartonella vinsoniisubsp.berkhoffiiin 2 dogs presenting for fulminant pulmonary edema. J Vet Emerg Crit Care (San Antonio) 2004. [DOI: 10.1111/j.1534-6935.2004.00099.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ghidoni JJ. Role of Bartonella henselae endocarditis in the nucleation of aortic valvular calcification. Ann Thorac Surg 2004; 77:704-6. [PMID: 14759468 DOI: 10.1016/j.athoracsur.2003.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2003] [Indexed: 10/26/2022]
Abstract
A 6-year-old boy presented with fatigability, shortness of breath, and bulging neck veins. Echocardiography revealed large vegetations, aortic insufficiency, a dilated left ventricle, and bicuspid aortic valve. There was no history of immunocompromise, fevers, or feline exposures. Blood cultures were negative; antibodies against Bartonella henselae were positive. Gentamicin was administered intravenously. Ross procedure was performed and patient was discharged on antibiotics in 5 days. Native valve was thickened by scar and fibrinous vegetations. Warthin-Starry stain demonstrated coccobacilli. Light and ultrastructural morphology, and monoclonal staining implicated B. henselae. Bacterial membranes contain calcium apatite crystals. Antigenic material was present in bacteria and calcified nodules. This case illustrates calcified protobacteria becoming incorporated into scar tissue during endocarditis.
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Affiliation(s)
- John J Ghidoni
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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