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Monoclonal and biclonal gammopathy in two patients infected with Bartonella henselae.

Two immunocompetent patients with cat-scratch disease due to infection with Bartonella henselae developed monoclonal and biclonal gammopathy. Neither patient had evidence of any other known cause of plasma cell dyscrasia, and antibiotic eradication of Bartonella henselae infection resulted in the prompt disappearance of the gammopathy. Hence, cat-scratch disease should be added to the list of possible underlying disorders in individuals presenting with monoclonal and biclonal gammopathy.

Adult↗

Duke criteria-negative endocarditis caused by Bartonella quintana.

Bartonella spp. were recently recognized as causative agents of culture-negative endocarditis. Molecular techniques, such as broad-range PCR, are now available to detect fastidious or slow-growing microorganisms, or those which cannot be cultured. Such microorganisms may be responsible for culture-negative endocarditis. Alcoholism and homelessness are known risk factors for Bartonella quintana endocarditis, even in patients without previous valvular disease. We report a case of B. quintana endocarditis diagnosed by PCR amplification on the excised heart valve, in a young non-alcoholic and immunocompetent patient with few clinical signs of infection who did not fulfill the Duke criteria.

Adult↗

Bartonella quintana-induced apoptosis inhibition of human endothelial cells is associated with p38 and SAPK/JNK modulation and with stimulation of mitosis.

Previous studies demonstrated that live Bartonella quintana often induces angioproliferative lesions in humans. It modulates endothelial cell apoptotic and inflammatory patterns, thus inducing a very early overexpression of caspase 8 and Apaf-1 and increasing mRNA production of TNF-alpha, interleukin-8, and E-selectin. However, starting at 10 hours postinfection, the bacteria provoke antiapoptotic effects that induce an increase of bcl-2 gene transcription. To gain further insight into the cellular mechanisms that regulate apoptosis, survival and proliferation, we studied the modulation of mitogen-activated protein kinase (MAPK) and the activation state of cdc2 kinase, which regulates progression into mitosis. Confocal microscopy findings indicated a maximum rate of Bartonella entry into host cells between postinfection hours 6 and 10. Live bacteria caused substantially higher apoptosis of human umbilical vein endothelial cells-cryopreserved (HUVEC-C) than heat- and trypsin-inactivated microorganisms. During the first 6 hours postinfection, B. quintana triggered a peak of apoptosis, induced activation of p38 MAPK and stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK), with bacterial clusters appearing at the cellular surface of the HUVEC-C. However, at 8 to 24 hours postinfection, B. quintana was internalized and inhibited proapoptotic signals such as p38 MAPK and SAPK/JNK while inducing antiapoptotic signals. Indeed, expression of the bcl-2 gene and the increase of the bcl-2 kinase active form was concomitant to activation of mitosis, as shown by cdc2 protein activation. These data thus suggest that mechanisms that induce mitotic activity and inhibit apoptotic signals may contribute to the ability of B. quintana to cause vascular proliferation.

Apoptosis↗

Characterization and expression analysis of the groESL operon of Bartonella bacilliformis.

The groESL operon of Bartonella bacilliformis, a facultative intracellular, Gram-negative bacterium and etiologic agent of Oroya Fever, was characterized. Sequence analysis revealed an operon containing two genes of 294 (groES) and 1632 nucleotides (groEL) separated by a 55-nt intergenic spacer. The operon is preceded by a 72-nt ORF (ORF1) that encodes a hypothetical protein with homology to a portion of the HrcA repressor for groESL. A divergent fumarate hydratase C (fumC) gene lies further upstream. Deduced amino acid sequences for B. bacilliformis GroEL and GroES revealed a high degree of identity with homologues from other Bartonella and alpha-Protebacteria. A single transcriptional start site (TSS) was mapped 79 nucleotides upstream of the groES start codon, regardless of incubation temperature. The TSS was located immediately 5' to a potential controlling inverted repeat of chaperonin expression (CIRCE) element and is preceded by a sigma70-like promoter. The operon is followed by a predicted rho-independent transcriptional terminator. Northern blot analysis indicated that groES and groEL are co-transcribed as a single mRNA of approximately 2.4 kb. A 6-h time course analysis by qRT-PCR showed that groEL expression increases 1.3-fold within 30 min of a temperature upshift from 30 to 37 degrees C, with maximum transcription reached after 60 min (approximately 4.3-fold), followed by a steady decrease to background (30 degrees C) transcription levels by 6 h. Western blot analysis revealed a 1.4- and 1.5-fold increase in GroEL synthesis following a temperature upshift or by inhibiting DNA supercoiling with coumermycin A1, respectively. Functional expression and complementation of temperature-sensitive Escherichia coli groES or groEL mutants with the cloned operon allowed them to grow at otherwise restrictive temperatures.

Amino Acid Sequence↗

Bartonella quintana endocarditis with positive serology for Coxiella burnetii.

Both Bartonella quintana and Coxiella burnetii are known to cause of blood culture negative endocarditis. In such case, the diagnosis is usually established by serology. A case of Bartonella quintana endocarditis is described where the serology was falsely positive for Coxiella burnetii. This case demonstrates the difficulty in distinguishing these two etiologic agents by routine serologic testing.

Bartonella quintana↗

Virulence-associated type IV secretion systems of Bartonella.

Type IV secretion systems (T4SSs) are transport machineries of Gram-negative bacteria that mediate interbacterial DNA-transfer, and secretion of virulence factors into eukaryotic target cells. A growing number of human pathogenic bacteria use T4SSs for intercellular delivery of effector molecules that modify host cellular functions in favour of the pathogen. Recent advances in studying the molecular mechanisms of Bartonella pathogenesis have provided evidence for the central roles of two distinct T4SSs, VirB/VirD4 and Trw, in the ability of the bacteria to colonize, invade and persist within either vascular endothelial cells or erythrocytes, respectively. The identification of VirB/VirD4-transported substrates and the delineation of their secretion signal have paved the way towards understanding the molecular mechanisms underlying Bartonella-host cell interaction and modulation, as well as the exploitation of this system for engineered substrate delivery into mammalian target cells.

Bacterial Proteins↗

High rate of Bartonella henselae infection in HIV-positive outpatients in Johannesburg, South Africa.

The emerging opportunistic pathogen Bartonella henselae has a wide range of clinical presentation, which includes, particularly, bacillary angiomatosis. This non-random pilot survey of outpatients attending HIV clinics in Johannesburg, South Africa, sampled 188 patients, in whom there was a 10% prevalence of Bartonella bacteraemia, as determined by nested polymerase chain reaction.

AIDS-Related Opportunistic Infections↗

Bacillary angiomatosis by Bartonella quintana in an HIV-infected patient.

Bacillary angiomatosis and bacillary peliosis are opportunistic infections caused by Bartonella henselae and Bartonella quintana, which occur in patients with late-stage infection. We report a case of bacillary angiomatosis in an HIV-infected patient with skin, bone, and probably liver involvement, The identification of the agent (B quintana ) was done by polymerase chain reaction in the skin specimen. The patient had complete regression of all lesions after a 6-month regimen of oral erythromycin.

AIDS-Related Opportunistic Infections↗

Rapid and efficient transposon mutagenesis of Bartonella henselae by transposome technology.

Molecular genetics are difficult to perform in Bartonella henselae, the causative agent of cat scratch disease and the vasculoproliferative disorders bacillary angiomatosis and bacillary peliosis. To elucidate the underlying bacterial pathogenic mechanisms, genetic manipulation of B. henselae is the method of choice. We describe how to perform transposon mutagenesis in B. henselae using transposome technology. B. henselae mutants revealed by this technique showed random transpositional insertion into the chromosome. In contrast to transposon mutagenesis by conjugational transfer, transposome technology allows transposon mutagenesis of early passaged Bartonella spp. with approximately 100-fold higher efficiency. The results show that transposome technique is a rapid, efficient and simple method to generate transposon mutants of B. henselae.

Bartonella henselae↗

[Bartonella hensalae encephalopathy].

INTRODUCTION: Bartonella hensalae is a poorly known cause of encephalopathy in young subjects. OBSERVATION: A 17 year-old adolescent was admitted in a state of emergency because of frequent convulsive seizures and inter-critical drowsiness. The diagnosis of encephalopathy was made on the association of these clinical signs and electro-encephalographic abnormalities. The presence of a cat in his home, a right axillary lymph node that had appeared in a context of fever, and positive serological kinetics related this encephalopathy to a bartonellosis. The course was good. DISCUSSION: Diagnosis of a Bartonella hensalae encephalopathy is based on a range of anamnesic, clinical and microbiological arguments. The potential interest of antibiotic therapy and its modalities remains to be established.

Adolescent↗

Gene-sequence-based criteria for species definition in bacteriology: the Bartonella paradigm.

The definition of new species is currently based on polyphasic classification that includes both determination of phenotypic characteristics and DNA-DNA homology. However, none of these techniques is convenient for the rapid characterization of fastidious or non-culturable bacteria. Using sequences available in the GenBank database, we compared the similarities of gene fragments among the currently recognized Bartonella species. This comparison led to both the definition of similarity values that discriminated Bartonella at the species level and assessment of the relative discriminatory power of each gene examined. In this perspective, rpoB and gltA were found to be the most potent.

Bacteriological Techniques↗

Bartonella quintana lipopolysaccharide effects on leukocytes, CXC chemokines and apoptosis: a study on the human whole blood and a rat model.

Bartonella quintana, an emerging gram-negative pathogen, may cause trench fever, endocarditis, cerebral abscess and bacillary angiomatosis usually with the absence of septic shock in humans. B. quintana lipopolysaccharide (LPS), a deep rough endotoxin with strong reactivity in the limulus amebocyte lysate (LAL)-assay, was studied in human whole blood and in a rat model. A significant (P<0.05) increase of interleukin-8 (IL-8) concentration, comparable to the level induced by enterobacterial LPS, was stimulated in the human whole blood by B. quintana LPS. Isolated human neutrophils delayed their apoptotic behavior in the presence of B. quintana LPS. In the rat, B. quintana LPS induced a significant (P<0.001) increase in white blood cell count, both 30 and 60 min after intravenous injection. Such leukocytosis was inhibited by pretreatment with prazosin, an alpha-adrenergic antagonist. B. quintana LPS did not significantly change heart rate (HR), hematocrit (HCT) and platelet count in the above reported in vivo model, and regarding mean blood pressure (MAP) only a very early (5 min after LPS) and mild (yet significant) hypotension was observed. In contrast, a long-lasting decrease of MAP was found in Salmonella minnesota R595 LPS-treated animals. Blood TNFalpha levels did not change significantly from the baseline in rats injected with either saline or with B. quintana LPS, on the contrary S. minnesota R595 LPS-injected animals showed substantial increase of TNFalpha levels up to 2924 pg/ml at 60 min after LPS injection. B. quintana LPS as well as Salmonella LPS-injected rats exhibited an increase of the blood levels of GRO/CINC-1, particularly at 240 min after LPS administration. Apical part of rat gut villi showed several TUNEL-positive cells in tissue sections from B. quintana LPS-treated animals. Taken together, our data demonstrates that B. quintana LPS is able to selectively stimulate some inflammatory mediators. B. quintana LPS-induced leukocytosis appears mediated by an alpha-adrenergic receptor. The delayed apoptotic process of leukocytes and the chemokine increase may explain the apoptotic cells found in the rat gut and the inflammatory reactions in some human Bartonella diseases. This peculiar inflammatory pattern induced by B. quintana LPS, may partially account for the lack of severe septic shock, observed in human B. quintana infections.

Animals↗

Activation of Rac, Cdc42 and other downstream signalling molecules by Bartonella bacilliformis during entry into human endothelial cells.

Bartonella bacilliformis is an intracellular bacterial pathogen of human endothelial cells. In vitro incubation of B. bacilliformis with human endothelial cells leads to the formation of filamentous actin extensions (filopodia) within 30 min, followed by formation of membrane rufflings or lamellipodia within 1 h of incubation. By immunofluorescence, F-actin phalloidin staining and anti-Rac antibodies were shown to co-localize in the membrane rufflings, indicating the recruitment of activated Rac at lamellipodia. Preincubation of endothelial cells with the Clostridial toxin, TcdB-10463, which inactivates the Rho-family GTPases, Rho, Rac and Cdc42, inhibited the entry of B. bacilliformis by 50-90%. Preincubation of endothelial cells with the Clostridial toxin, TcsL-1522, which specifically inactivates Rac and, to a lesser extent, Cdc42, but not Rho, inhibited entry by 30-40%. A 3.4-5.0-fold increase in activated (GTP-bound) -intracellular Rac and Cdc42 was observed in affinity precipitation assays. Increased kinase activity of p21-activated kinase (PAK), a specific downstream effector of activated Rac/Cdc42 was also observed during the time course of infection. Activation of SAPK/JNK-1 and 2, and p38 MAPKs in signalling pathways, was also detected during infection with Bartonella, as was increased binding activity of AP-1 transcription factor.

Actins↗

Cure of bartonella endocarditis of a prosthetic aortic valve without surgery: value of serologic follow-up.

Bartonella species are emerging as an important cause of blood culture-negative endocarditis, but the optimal management of this disease has not been fully defined. We describe a case of subacute Bartonella henselae endocarditis of a prosthetic aortic valve in an immunocompetent woman that was cured with long-term antibiotic therapy alone. In addition, we demonstrate that follow-up of serologic titers against B. henselae was helpful in assessing definitive cure of the infection.

Aged↗

Experimental infection of specific pathogen free (SPF) cats with two different strains of bartonella henselae type I: a comparative study.

Domestic cats are the reservoir of Bartonella henselae, the main causative agent of cat scratch disease. We compared B. henselae type I infection characteristics in 6 SPF cats infected with a feline strain (4.8 x 10(7) colony-forming units (CFU)/mL) and in 6 SPF cats infected with the reference Houston I strain (6.6 x 10(6) CFU/mL to 9.6 x 10(7) /mL). All the cats inoculated with the feline strain, but none of the cats inoculated with B. henselae Houston I, developed a fever within 2-12 days (mean: 5.8 days) post inoculation (PI), which lasted for 1-2 weeks. However, all 12 cats became bacteremic. The duration of bacteremia was significantly longer in the cats inoculated with the feline strain (mean: 237 days) than in the cats inoculated with Houston I strain (mean: 60 days) (p < 0.01). Five (83%) cats inoculated with the feline strain and none of the six cats inoculated with B. henselae Houston I had relapsing bacteremia (p = 0.02). IgG antibodies were detected by IFA within 1-2 weeks for both strains, but peaked later (week 10 versus week 3 PI) for the feline strain. By ELISA, using antigens of each B. henselae strain, all 12 cats developed Bartonella specific IgM and IgG antibodies, but the cats infected with B. henselae Houston I antigen yielded significantly lower optical density values (p < 0.05). By SDS-PAGE, PFGE and Western blotting, protein profile differences (84 to 89% homology) were observed between the two strains. If a feline vaccine is to be developed in order to prevent human infection, the choice of the vaccine strain will be critical, since major differences were identified even between strains belonging to the same sero/genotype.

Animals↗

Bartonella henselae IgG antibodies are prevalent in dogs from southeastern USA.

In contrast to the large body of literature regarding Bartonella henselae in humans and cats, there is little information about B. henselae as an infectious agent in dogs. Due to the paucity of information regarding the B. henselae serology in dogs, we performed a cross-sectional serosurvey using B. henselae antigen in order to compare the seroprevalence between sick and healthy dogs from the south-eastern USA. Ninety-nine sera were collected from clinically healthy dogs. Three hundred and one sera from sick dogs were submitted to North Carolina State University for serologic screening against a panel of arthropod-transmitted organisms. Serological tests were performed using B. henselae (Bh), Rickettsia rickettsii (Rr), Ehrlichia canis (Ec), Bartonella vinsonii subspecies berkhoffii (Bvb), Babesia canis (Bc) and Borrelia burgdorferi (Bb) antigens. Serum B. henselae IgG antibodies were detected in 10.1% of healthy dogs and in 27.2% of sick dogs. The difference in seroprevalence between the two groups was statistically significant. The majority of seroreactive dogs (80%) had low titers of 1:64 or 1:128. In healthy dogs, seroprevalence for Rr was 14.1% and for Bvb was 1%. In sick dogs, Rr seroprevalence was 29.7%, Ec 6.5%, Bvb 4.7%, Bb 1.7% and Bc was 0.85%. Of the sick dogs that were seroreactive to B. henselae antigens, 40.6% were also seroreactive to Rr, 15.0% reactive to Bvb antigens, 14.8% reactive to Ec antigens, 1.8% reactive to Bc antigens and 1.75% reactive to Bb antigens. Sera from dogs experimentally infected with B. vinsonii subsp. berkhoffii, E. canis or R. rickettsii did not cross react with B. henselae antigens, by IFA testing. This study indicates that B. henselae IgG antibodies are prevalent in healthy and sick dogs living in the south-eastern USA. Nevertheless, further studies are needed to evaluate the epidemiological, clinical and zoonotic relevance of B. henselae infection in dogs.

Angiomatosis, Bacillary↗

Bartonella quintana and Mycobacterium tuberculosis coinfection in an HIV-infected patient with lymphadenitis.

Cat scratch disease (CSD) is usually associated with Bartonella henselae infection in patients with a history of cat exposure, but Bartonella quintana may also be a cause of chronic lympadenopathy in patients with cat or flea contact. The lymph node histopathology of CSD and tuberculosis may be indistinguishable. We report herein the first description of lymph node coinfection with B. quintana and M. tuberculosis in a 32-year HIV-infected woman. Culture of lymph node biopsy material on Columbia agar with sheep blood and on human endothelial cells in shell vial allowed us to isolate not only B. quintana, but also M. tuberculosis hominis.

Adult↗

[Disciform keratatis caused by Bartonella henselae infection: detection of a rare ocular complication of cat-scratch disease with PCR].

BACKGROUND: Cat scratch disease (CSD) is a common infectious disease, however its association with a disciforme keratitis is to our knowledge a previously unreported ocular complication. PATIENT: A 65-year old female was treated unsuccessfully with topical antibiotics, acyclovir and corticosteroids for several weeks because of a disciforme keratitis. Repeatedly, microbiological investigations (microscopy and culture) were negative. 16S rDNA-PCR with subsequent DNA-sequencing on material obtained by corneal scrape identified Bartonella henselae. Based on this result we have initiated a treatment with topical cephotaxim and within a short period of time the cornea healed with a paracentral scar. CONCLUSION: 16S rDNA-PCR was very helpful in identifying the intracellular sited bacterium Bartonella henselae as the causative pathogen of an unusual form of disciforme keratitis.

Aged↗