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[Visceral granulomas and pericardial effusion caused by a Bartonella henselae infection].

A 57 year-old woman was seen after a three-week period of upper abdominal pain, nausea, fever, headache and exertional dyspnoea. Laboratory examination showed an elevated ESR and serum gamma-GT activity. The chest X-ray showed cardiomegaly resulting from a pericardial effusion as was demonstrated by echocardiography. An abdominal CT-scan disclosed multiple hypodense lesions in the liver and spleen and lymphadenopathy along the hepatoduodenal ligament. Liver biopsy showed a necrotising granulomatous hepatitis. A recent infection with Bartonella, presumably B. henselae, was demonstrated serologically. The patient was treated with clarithromycin and recovered.

Antibodies, Bacterial↗

Immunopurified extracellular Bartonella henselae antigen for detecting specific antibodies by enzyme immunoassay.

Protein antigens of Bartonella henselae bacterial sonicate supernatant and concentrated cell-free culture filtrate were examined by SDS-PAGE. The sonicate supernatant gave 38 bands and the culture filtrate at least 21, of which 18 were of bacterial origin. Immunoblotting against 13 monoclonal antibodies obtained from mice infected with live B. henselae showed that 10 of these antibodies reacted with a narrow 225 kDa band and varying smears of bands ranging from 36 to 240 kDa in the sonicate, but only with a single 200 kDa band in the culture filtrate. Testing of pre- and post-infection rabbit sera in immunoblotting against culture filtrate demonstrated that the 200 kDa component gave the most prominent specific reaction with post-infection sera. The 200 kDa antigen was isolated by immunoaffinity chromatography of concentrated culture filtrate, and its molecular size determined by size-exclusion chromatography as > 1000 kDa. The immunopurified antigen was compared with bacterial sonicate as coating antigen in EIA for determining humoral immune responses in rabbits inoculated with live B. henselae. The two antigens gave almost identical results for IgM and IgG responses. The specificity of the immunopurified antigen was tested in EIA against hyperimmune rabbit sera and sera of rabbits inoculated with live B. henselae, B. quintana and Afipia felis. Only the hyperimmune serum against B. henselae and the sera of the rabbits inoculated with live B. henselae reacted with the immunopurified antigen, whereas the B. henselae sonicate cross-reacted with hyperimmune and post-infection sera of rabbits inoculated with B. quintana and A. felis.

Animals↗

[Bartonellosis: I. Bartonella henselae].

The recent discovery of the bacterium Bartonella henselae was mainly due to the development of molecular biology techniques adapted to microbial diagnosis and to the description of new human diseases linked to Aids. About 10% of pet cats and 33% of stray cats harbour that bacterium in their blood. In immunocompetent patients, that bacterium is responsible for human cat scratch disease, characterized essentially by a localized lymph nodes enlargement in the vicinity of the entry site of the bacteria. This disease occurs more likely in pet cats less than 1-year-old and infested with fleas. The bacterium is transmitted to humans by scratches or bites; the role of fleas is possible, but is not yet documented. In 5 to 13% of cases, the cat scratch disease appears as more severe, including health impairment, hepatitis, Parinaud's oculo-glandular syndrome, neurological complications or stellate retinitis. In immunocompromised patients, B. henselae is responsible for various clinical presentations: bacillary angiomatosis, bacillary peliosis, recurrent or persistent bacteremia or endocarditis. Diagnosis of infections due to B. henselae can be performed by serological specific testing with sensitivity and specificity values ranging from 75 to 100%. Cultivation of the bacterium is fastidious, particularly in cases of cat scratch disease. The most efficient diagnostic test is the in vitro DNA amplification which has the drawback to require a lymph node sample. Antibiotics are usually inefficient for the treatment of cat scratch disease. By contrast, in immunocompromised patients, these infections are successfully treated for a more or less long time by macrolides or tetracyclines or rifampin.

Animals↗

[Seroepidemiology of Bartonella henselae infection in a risk group].

BACKGROUND: Bartonella henselae infections are closely related to a number of clinical conditions of growing interest in our environment. As cats are the reservoir, and their bites and scratches are the main transmission mechanism, we attempted to study the seroepidemiology of the infection caused by this microorganism in a risk group of patients (cat owners) and a control group (blood donors). PATIENTS AND METHODS: October 1977. Measurement of antibody titres to B. henselae at different dilutions (breakpoint > or = 1:64) by indirect immunofluorescence (IFI) in 83 cat owners and 85 blood donors. Also, an epidemiologic investigation was carried out (age, sex, alcohol, intake, common cat exposure, cat bite or cat scratch, number and age of cats, bite or presence of fleas, use of repellents, clinical picture consistent with cat scratch disease [CSD]). RESULTS: Twenty-four cat owners (28.9%) and five blood donors (5.9%) had titres > or = 1:64 (OR: 6.51; 95% CI: 2.32 to 22.9). Also, the logistic regression analysis showed an association with daily alcohol intake and the previous antecedent of lymph node enlargement of unknown origin among cat owners. CONCLUSIONS: A high prevalence of antibodies to B. henselae was demonstrate among cat owners.

Adult↗

Bartonella quintana endocarditis in east Africa.

Bartonella quintana endocarditis is characterized by sub-acute evolution and severe valvular damage, and is associated with homelessness, alcoholism, and lice infestation. We present a case of B. quintana endocarditis in an Ethiopian immigrant without known risk factors for disease acquisition. This is the first case of B. quintana endocarditis reported from east Africa.

Journal Article↗

Bartonella quintana prosthetic valve endocarditis detected by blood culture incubation beyond 10 days.

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.

Journal Article↗

Bartonella henselae as a cause of prolonged fever and fever of unknown origin in children.

A prospective evaluation of 146 children with fever of unknown origin (FUO) and prolonged fever was performed from 1990 to 1996. FUO was defined as a documented daily temperature of > or = 38 degrees C for at least 14 days without diagnostic signs or symptoms. Prolonged fever was defined as fever for at least 14 days and no diagnosis at the time of referral for evaluation. An established diagnosis was made for 84 (57.5%) of 146 patients. The most common infectious disease diagnoses were Epstein-Barr virus infection (22 [15.1%] of 146), osteomyelitis (14 [9.6%] of 146), bartonellosis (7 [4.8%] of 146), and urinary tract infection (6 [4.1%] of 146). Three of seven patients with confirmed Bartonella henselae infection presented with FUO and no ultrasonographic findings compatible with hepatosplenic involvement; two patients presented with FUO and hepatosplenic involvement. The relatively common finding of acute bartonellosis in this population suggests that FUO and prolonged fever in children are other presentations of infection with B. henselae.

Adolescent↗

Survey of the seroprevalence of Bartonella quintana in homeless people.

Trench fever is caused by Bartonella (Rochalimaea) quintana, a small gram-negative rod that is transmitted by body lice. Recently, B. quintana infections in homeless patients have been reported in the United States and Europe. From October 1993 to October 1994, the seroprevalence of antibodies to B. quintana was assessed by indirect immunofluorescence in a prospective study of 221 nonhospitalized homeless people, 43 hospitalized homeless patients (cases), 250 blood donors, and 57 hospitalized matched controls. Four (1.8%) of 221 nonhospitalized homeless people tested had titers of > 1:100. Of the 43 cases, seven (16%) had serological titers of > or = 1:100. None of the 250 serum samples from blood donors contained antibodies to B. quintana. The presence of antibodies to B. quintana in cases was significantly associated with the presence of body lice, exposure to cats, headaches, eastern European origin, and pain in the legs. This study demonstrates the presence of antibodies to B. quintana in the homeless population and should alert physicians that B. quintana might be an etiologic agent of fever in homeless patients.

Animals↗

Does coinfection of Bartonella henselae and FIV induce clinical disorders in cats?

It was found that Bartonella henselae (B. henselae) may induce clinical disorders in cats in natural conditions from a comparison of the serological status for B. henselae with the serostatus for feline immunodeficiency virus (FIV) and several clinical characteristics in 170 domestic cats. Seropositivity for B. henselae was not significantly different between FIV antibody-positive and -negative cats (18.4% vs 16.0%). The incidence of clinical characteristics were compared among four cat groups distinguished by the reactivity of sera against B. henselae and FIV. The incidence of lymph node swelling was lower in only FIV antibody-positive cats (3.0%), but higher in B. henselae antibody-positive cats (13.6%) and significantly higher in both B. henselae and FIV antibody-positive cats (42.9%) compared with the incidence of lymph node swelling in cats which were negative for both antibodies (5.5%). The same relation was also observed for the incidence of gingivitis among the 4 cat groups, suggesting that coinfection of B. henselae and FIV may be associated with gingivitis and lymphadenopathy in cats.

Animals↗

[A case of Bartonella henselae infection from a dog].

A 50-year-old male with left cervical lymphadenopathy visited our hospital. Infectious and lymphomatous diseases were suspected in the patient. Since the patient owned a dog, which often licked the patient's face, Bartonella infection was also suspected. Histopathological examination in the lymph node biopsy revealed the epithelioid granuloma, but B. henselae was not detected from the culture of the lymphnode. B. henselae DNA also was not detected from the lymph node. Since the antibody titer (lgG) to B. henselae showed 1:128 by immunofluorescent antibody technique (IFA), he was serdogicalg diagnosed as cat-scratch disease. 'Cat-scratch disease' is named after cat scratch, however we propose 'B. henselae infection' which is more appropriate since other animals could serve as a cause of infection.

Animals↗

Detection of Bartonella (Rochalimaea) quintana by routine acridine orange staining of broth blood cultures.

Bartonella quintana was isolated from 34 BACTEC nonradiometric aerobic resin blood cultures for 10 adults. Nine patients were initially diagnosed by routine acridine orange staining of routine cultures that had been incubated for 8 days. All subcultures grew on chocolate agar within 3 to 12 days (median, 6 days). The PLUS 26 high-volume aerobic resin medium, combined with acridine orange stain and subculture, is an effective system for detection and isolation of B. quintana from blood.

Acridine Orange↗

Experimental transmission of Bartonella henselae by the cat flea.

Bartonella henselae is an emerging bacterial pathogen, causing cat scratch disease and bacillary angiomatosis. Cats bacteremic with B. henselae constitute a large reservoir from which humans become infected. Prevention of human infection depends on elucidation of the natural history and means of feline infection. We studied 47 cattery cats in a private home for 12 months to determine the longitudinal prevalence of B. henselae bacteremia, the prevalence of B. henselae in the fleas infesting these cats, and whether B. henselae is transmitted experimentally to cats via fleas. Vector-mediated transmission of B.henselae isolates was evaluated by removing fleas from the naturally bacteremic, flea-infested cattery cats and transferring these fleas to specific-pathogen-free (SPF) kittens housed in a controlled, arthropod-free University Animal Facility. B. henselae bacteremia was detected in 89% of the 47 naturally infected cattery cats. A total of 132 fleas were removed from cats whose blood was simultaneously cultured during different seasons and were tested individually for the presence of B. henselae DNA by PCR. B. henselae DNA was detected in 34% of 132 fleas, with seasonal variation, but without an association between the presence or the level of bacteremia in the corresponding cat. Cat fleas removed from bacteremic cattery cats transmitted B. henselae to five SPF kittens in two separate experiments; however, control SPF kittens housed with highly bacteremic kittens in the absence of fleas did not become infected. These data demonstrate that the cat flea readily transmits B. henselae to cats. Control of feline infestation with this arthropod vector may provide an important strategy for the prevention of infection of both humans and cats.

Adult↗

Autochthonous epidemic typhus associated with Bartonella quintana bacteremia in a homeless person.

Trench fever, a louse-borne disease caused by Bartonella quintana, is reemerging in homeless persons. Epidemic typhus is another life-threatening louse-borne disease caused by Rickettsia prowazekii and known to occur in conditions of war, famine, refugee camps, cold weather, poverty, or lapses in public health. We report the first case of seroconversion to R. prowazekii in a homeless person of Marseilles, France. This was associated with B. quintana bacteremia. Although no outbreaks of typhus have been notified yet in the homeless population, this disease is likely to reemerge in such situation.

Bacteremia↗

[Other infections (Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Salmonella spp., Campylobacter spp., Nocardia asteroides, Rhodococcus equi and Bartonella spp.)].

People infected with human immunodeficiency virus (HIV) are at increased risk for bacterial infections due to HIV-associated immunologic defects. Bacterial infections were found to be, both a predictor of progression to AIDS and a substantial cause of mortality in pre-AIDS stages. Most bacterial infections are caused by Streptococcus pneumoniae, Haemophilus influenzae, Salmonella spp. and Pseudomonas aeruginosa. Rhodococcus equi, Nocardia spp., Campylobacter spp. and Bartonella spp. are less common. Data derived from two AIDS Clinical Trials Group studies showed that the most common bacterial infections were sinusitis (8.5 per 100 episodes per person years [py]), bacterial pneumonia (5.0 per 100 py), bronchitis (4.1 per 100 py) and soft tissue infections (3.5 per 100 py). In this review clinical characteristics and treatment recommendations according to data available in the literature for these infections are summarized.

AIDS-Related Opportunistic Infections↗