Seroprevalence of Bartonella henselae and Bartonella quintana Infection and Impact of Related Risk Factors in People from Eastern Slovakia

Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: a case report and literature review

BACKGROUND

Cat-scratch disease (CSD) is caused by Bartonella henselae infection. In atypical cases of CSD, pathogen determination is challenging. We report a case of Bartonella neuroretinitis with neither a clear history of scratches nor typical general symptoms. The diagnosis was made using metagenomic next-generation sequencing (mNGS), a high-throughput sequencing technology.

CASE PRESENTATION

A female patient presented to the ophthalmologist with complaint of blurred vision in her right eye. Although with history of raising a cat, she reported no clear history of scratches or typical general symptoms, except a fever of unknown origin which resolved spontaneously. The best corrected visual acuity (BCVA) of the right eye was count fingers. Fundus examination showed optic disc oedema, macular exudates and inferior exudative retinal detachment. Laboratory examination results showed increased value of serum C-reactive protein and erythrocyte sedimentation rate. Ocular involvement of toxoplasmosis, syphilis and tuberculosis were excluded. To identify the possible causative pathogen of the disease, mNGS of aqueous humour sample was performed and 521 reads of B. henselae were identified. Serological test results further showed a positive immunoglobulin G (IgG) titre of 1:64. Taking the contact history, clinical manifestations, mNGS and serological results into consideration, the diagnosis of Bartonella neuroretinitis (ocular CSD) was made. After appropriate treatment, the BCVA of the right eye improved to 20/25 in the last follow-up. Fundus examination showed a normal optic disc and macula, and the exudates had reduced.

CONCLUSION

mNGS, a fast and unbiased method, can be used to detect B. henselae (if present) in intraocular fluid samples.; however, the results should be interpreted together with the clinical symptoms and other auxiliary test results.

Blood Supplementation Enhances Bartonella henselae Growth and Molecular Detection of Bacterial DNA in Liquid Culture

Bacteria of the genus Bartonella, a member of the Alphaproteobacteria, are fastidious, Gram-negative, aerobic bacilli that comprise numerous species, subspecies, and genotypes. Bartonella henselae, with a worldwide distribution, infects cats, dogs, horses, humans, and other mammals. Diagnostically, direct detection of Bartonella henselae in patient blood specimens by culture or molecular methods is required to confirm infection with this bacterium. Enrichment blood culture combined with quantitative PCR (qPCR) or ddPCR enhances the sensitivity of direct detection. The addition of sheep blood to liquid culture media increased the Bartonella henselae DNA concentration compared to controls, additionally improving PCR direct detection sensitivity. IMPORTANCE This study aims to improve diagnostic detection of Bartonella henselae. Patient samples are combined with enriched bacterial cultures aimed at growing Bartonella henselae for the best possible chance at detection. However, current Bartonella growth methods could be improved. The DNA extraction method used by most laboratories should also be optimized. Sheep blood was added to increase the growth of Bartonella henselae and multiple DNA extraction methods were to be compared to each other.

Bartonella, Rickettsia, Babesia, and Hepatozoon Species in Fleas (Siphonaptera) Infesting Small Mammals of Slovakia (Central Europe)

Fleas (Siphonaptera) as obligate, blood-feeding ectoparasites are, together with ticks, hosted by small mammals and can transmit causative agents of serious infections. This study aimed to determine and characterize the presence and genetic diversity of Bartonella, Rickettsia, and apicomplexan parasites (Babesia, Hepatozoon) in fleas feeding on small mammals from three different habitat types (suburban, natural, and rural) in Slovakia. The most common pathogen in the examined fleas was Bartonella spp. (33.98%; 95% CI: 30.38-37.58), followed by Rickettsia spp. (19.1%; 95% CI: 16.25-22.24) and apicomplexan parasites (4.36%; 95% CI: 2.81-5.91). Bartonella strains belonging to B. taylorii, B. grahamii, B. elizabethae, Bartonella sp. wbs11, and B. rochalimae clades were identified in Ctenophthalmus agyrtes, C. congener, C. assimilis, C. sciurorum, C. solutus, C. bisoctodentatus, Palaeopsylla similis, Megabothris turbidus, and Nosopsyllus fasciatus within all habitats. The presence of Rickettsia helvetica, R. monacensis, and rickettsiae, belonging to the R. akari and R. felis clusters, and endosymbionts with a 96-100% identity with the Rickettsia endosymbiont of Nosopsyllus laeviceps laeviceps were also revealed in C. agyrtes, C. solutus, C. assimilis, C. congener, M. turbidus, and N. fasciatus. Babesia and Hepatozoon DNA was detected in the fleas from all habitat types. Hepatozoon sp. was detected in C. agyrtes, C. assimilis, and M. turbidus, while Babesia microti was identified from C. agyrtes, C. congener, and P. similis. The present study demonstrated the presence of zoonotic pathogens in fleas, parasitizing the wild-living small mammals of southwestern and central Slovakia and widens our knowledge of the ecology and genomic diversity of Bartonella, Rickettsia, Babesia, and Hepatozoon.