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Isolation of a new subspecies, Bartonella vinsonii subsp. arupensis, from a cattle rancher: identity with isolates found in conjunction with Borrelia burgdorferi and Babesia microti among naturally infected mice.

Bacteremia with fever due to a novel subspecies of Bartonella vinsonii was found in a cattle rancher. The subspecies shared major characteristics of the genus Bartonella in terms of most biochemical features and cellular fatty acid profile, but it was distinguishable from other subspecies of B. vinsonii by good growth on heart infusion agar supplemented with X factor and by its pattern of enzymatic hydrolysis of peptide substrates. DNA relatedness studies verified that the isolate belonged to the genus Bartonella and that it was genotypically related to B. vinsonii. The highest level of relatedness was observed with recently characterized strains from naturally infected mice that were coinfected with Borrelia burgdorferi and Babesia microti. We propose the name Bartonella vinsonii subsp. arupensis subsp. nov. as the new subspecies to accommodate these human and murine isolates.

Animals↗

[Solitary nontuberculous mycobacterial infection of a cervical lymph node caused by Bartonella henselae (cat scratch disease)].

Cat scratch disease (CSD) is a common cause of subacute regional lymphadenopathy. Cats are the principal reservoir of Bartonella henselae, the etiologic agent in most cases of CSD. Because the histopathological findings are typical but not specific, a wide range of other agents must be considered in differential diagnosis. We report on a patient with a solitary swelling of the neck which remained over months with initial features suggestive of unspecific lymphadenitis, but who, after careful history taking and further serological testing, had cat scratch disease.

Abscess↗

Prevalence of Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum', Bartonella species, Ehrlichia species, and Anaplasma phagocytophilum DNA in the blood of cats with anemia.

Hemoplasmas are known causes of anemia in some cats and some Bartonella species have been associated with anemia in people and in dogs. In this retrospective study, we used polymerase chain reaction (PCR) assays to determine the prevalence rates of Mycoplasma haemofelis, 'Candidatus M haemominutum', A phagocytophilum, Ehrlichia species, and Bartonella species DNA in the blood of cats with anemia and a control group of healthy cats. DNA of the organisms was amplified from 22 of 89 cats with anemia (24.7%) and 20 of 87 healthy cats (23.0%). DNA of a hemoplasma was amplified from 18 of 89 cats with anemia (20.2%) and 13 of 87 healthy cats (14.9%); DNA of a Bartonella species was amplified from five of 89 cats with anemia (5.6%) and seven of 87 healthy cats (8.0%). There were no statistically significant differences detected between groups.

Anaplasma phagocytophilum↗

[Kinetics of Bartonella spp. IgG antibodies in cat-scratch disease and in asymptomatic HIV-infected patients].

BACKGROUND AND OBJECTIVE: Our goal was to investigate the kinetics of serum IgG antibodies against Bartonella spp. in patients with cat-scratch disease and in HIV-infected indiviuals. PATIENTS AND METHOD: Sequential determinations were made in seven patients with cat scratch disease and in seven HIV-infected individuals who were seropositive for this bacteria. RESULTS: In five patients from each group, serum antibodies fell under the positivity threshold within two years. Two HIV coinfected patients harbored Bartonella spp. DNA in bone marrow. CONCLUSIONS: These results suggest that the finding of a positive titer of serum IgG against Bartonella spp. is a marker of acute or recent infection.

Adolescent↗

Bacillary angiomatosis with cytomegaloviral and mycobacterial infections of the palpebral conjunctiva in a patient with AIDS.

We report the clinical and histopathologic findings of bacillary angiomatosis involving the palpebral conjunctiva with concomitant infection by cytomegalovirus and Mycobacterium species in a patient with acquired immune deficiency syndrome. After debulking, the conjunctival tissue was studied with the use of light and electron microscopy; stains for bacteria, acid-fast bacilli, and Bartonella species; and immunohistochemical studies for cytomegalovirus and herpes simplex virus. We observed the typical histopathologic findings of bacillary angiomatosis, the presence of bacilli stained by the Steiner and Steiner method, and the electron microscopic demonstration of bacilli consistent with Bartonella species. Immunohistochemistry confirmed infection with cytomegalovirus, which had been suggested by characteristic cytologic abnormalities. Acid-fast bacilli were also found in the excised tissue. Patients with bacillary angiomatosis of the conjunctiva may have infections with multiple additional microorganisms.

AIDS-Related Opportunistic Infections↗

Relapsing bacteremia after blood transmission of Bartonella henselae to cats.

OBJECTIVES: To determine persistence of bacteremia, pathogenicity, and immunoglobulin kinetics after blood transmission of Bartonella henselae in cats. ANIMALS: 18 specific-pathogen-free (SPF) cats (16 weeks old) received blood or urine from 4 adult cats (2 SPF, 2 naturally infected with B henselae). PROCEDURE: SPF cats were inoculated with blood IV (n = 4), blood IM (n = 4), or urine sediment IM (n = 4) from 2 bacteremic cats (donors A and B). Control cats (2/route) received inoculum from culture-negative, seronegative SPF cats (donors C and D). RESULTS: 6 cats (5 blood, 1 urine) were transiently febrile during the 213-day observation period. Two bacteremic cats developed CNS abnormalities. Transient anemia was the only hematologic abnormality. Bacteremia was induced in 7 of 8 blood recipients by postinoculation day (PID) 11. Urine recipients (n = 6) did not become bacteremic or seroconvert by PID 108, but when challenge exposed IV with blood, 4 of 6 became infected. All infected cats developed relapsing bacteremia. Initially, colony counts for donor-A recipients were 10(3) greater than those for donor-B recipients; however, during relapses, counts were similar. Polymerase chain reaction-restriction fragment length polymorphism analysis of 16S rRNA gene and the intergenic spacer region revealed no differences among isolates derived from recipient cats. Bartonella henselae-specific antibodies were detected between PID 15 and 18 in donor-A, compared with PID 46 and 181 in donor-B recipients. The peak geometric mean titer of donor-A recipients was 1,448, versus 406 for donor-B recipients. CONCLUSIONS AND CLINICAL RELEVANCE: Blood transmission of B henselae induced subtle clinical abnormalities; the biological behavior of the 2 donor strains differed; and relapsing bacteremia can persist in conjunction with variably high antibody titers.

Animals↗

In vitro susceptibilities of Bartonella henselae, B. quintana, B. elizabethae, Rickettsia rickettsii, R. conorii, R. akari, and R. prowazekii to macrolide antibiotics as determined by immunofluorescent-antibody analysis of infected Vero cell monolayers.

The in vitro susceptibilities of Bartonella (Rochalimaea) henselae, B. quintana, B. elizabethae, Rickettsia akari, R. conorii, R. prowazekii, and R. rickettsii to different concentrations of azithromycin, clarithromycin, dirithromycin, erythromycin, and roxithromycin in Vero cell cultures were evaluated. Bartonella and Rickettsia spp. were allowed to initiate infection of the antibiotic-free Vero cell monolayers, which were maintained in 16-chamber microscope slides in the absence of antibiotics at 32 degrees C in a CO2-enriched atmosphere. The monolayers were then incubated for 3 h to allow for initial host cell intracellular penetration by infecting species. After inoculation, inocula were replaced and tested with media containing 12 different concentrations of each antibiotic in replicate (10 wells of each antibiotic dilution) for each species, and the monolayers were reincubated. Tetracycline served as the control. Growth status of Bartonella spp. and Rickettsia spp. was determined by evaluation of immunofluorescent staining bacilli. Five days later, when antibiotic-free, control-infected cell monolayers demonstrated significant fluorescence, media were removed for all cell monolayers, the monolayers were fixed, and all specimens were stained with standard indirect immunofluorescent antibody reagents. Fluorescent foci were enumerated by counting such foci on random fields visualized with an epifluorescence microscope. The extent of antibiotic-induced focus inhibition was recorded for each dilution of antibiotic and compared with that of an antibiotic-negative control. Effective antibiotic dilution endpoints for inhibition of Bartonella and Rickettsia proliferation, as judged by absence of increase of significant fluorescence (as compared with no-growth controls), were enumerated by determining the number of cell culture chambers at various antibiotic dilutions that were negative or positive for significant Bartonella- or Rickettsia-specific fluorescence. All of the macrolide agents tested were readily active against all three Bartonella organisms, and azithromycin, clarithromycin, and roxithromycin may have potential in the treatment of Rickettsia infections. Animal model-based clinical trials are warranted to define the specific treatment role of the newer macrolide antibiotics.

Animals↗

The expanded spectrum of bartonellosis in children.

Bartonella spp cause various clinical syndromes immunocompetent and immunocompromised hosts. Domestic cats are the natural reservoir, and vectors of B henselae. B henselae infection usually occurs early in childhood, is generally asymptomatic, and in most cases revolves spontaneously. It may, however, produce a wide spectrum of clinical symptoms, the most frequent feature being cat-scratch disease. Disseminated atypical B. henselae infection may follow cat-scratch disease alter a symptom-free period or may present de novo mimicking a wide range of clinical disorders. A careful clinical history researching an intimate contact with a kitten associated with a specific serology and an abdominal ultrasound for typical hepatosplenic involvement may follow a rapid and accurate diagnosis.

Animals↗

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↗

Antibiotic therapy for nontuberculous mycobacterial cervicofacial lymphadenitis.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy of antibiotic treatment of nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis, both as an alternative and as adjuvant to surgical excision. STUDY DESIGN: Retrospective chart review of pediatric patients with NTM cervicofacial lymphadenitis treated from January 1993 to November 2003 at an academic tertiary care children's hospital. METHODS: Fifty-five patients (age range, 15 mo-16 y) with the diagnosis of NTM cervicofacial lymphadenitis by fine-needle aspiration biopsy that had 1) lymph node culture positive for an atypical mycobacteria, 2) histological findings consistent with mycobacterial infection (granulomas) with negative bartonella serological titers, 3) histological stain positive for the presence of acid-fast bacillus in the absence of tuberculous infection, or 4) positive Mantoux tuberculin skin test result with a negative finding on polymerase chain reaction for tuberculous mycobacteria. Clinical response was defined as complete or partial resolution of skin changes and palpable lymphadenopathy in response to antibiotic therapy consisting of macrolide therapy alone or in combination with other anti-mycobacterial pharmaceuticals. RESULTS: Of the 55 children studied, 45 of 55 (82%) with both single and multiple lesions underwent a trial of medical therapy, and 30 of 45 lesions (67%) ranging in size from 1 x 1 to 6 x 5 cm achieved resolution without surgical excision. Of the other 15 patients treated initially with medical therapy, 6 of 15 (40%) responded well to a course of antibiotic therapy before undergoing surgical excision, and 7 of 15 (47%) patients were nonresponsive to antibiotic therapy and required surgical excision to resolve the neck mass. The remaining 2 of 15 patients (13%) proceeded to surgery only after a course of antibiotics of 3 weeks or less. Ten of the 55 patients (18%) underwent surgical excision initially, with 5 of 10 patients (50%) receiving postoperative antibiotics for treatment of residual disease or prevention of recurrence. CONCLUSION: Some NTM cervicofacial lymphadenitis infections appear to respond to medical therapy alone. A trial of antibiotic therapy might be considered in patients with NTM cervicofacial lymphadenitis before surgical excision or as an adjuvant to surgical excision.

Adolescent↗

Serological diagnosis of human babesiosis by IgG enzyme-linked immunosorbent assay.

An enzyme-linked immunosorbent assay (ELISA) for the detection of IgG antibodies to Babesia microti antigen was developed. B. microti antigens were harvested from experimentally infected hamster blood and used as a coating antigen. The sensitivity and specificity of the IgG ELISA relative to immunofluorescent antibody assay (IFA) testing was 95.5% and 94.1%, respectively. According to the receiver operating characteristic curve analysis, the area under the curve was 0.987. No cross-reactivity of serum samples collected from patients infected with Toxoplasma gondii, Borrelia burgdorferi, Anaplasma phagocytophilum, Bartonella quintana, Dengue virus, or West Nile virus was detected. Cross-reactivity was observed with one of 35 sera from patients infected with Bartonella henselae. These results indicate that the established ELISA methods could be utilized as an accurate measure for the clinical diagnosis of human babesiosis.

Animals↗

The Bartonella vinsonii subsp. arupensis immunodominant surface antigen BrpA gene, encoding a 382-kilodalton protein composed of repetitive sequences, is a member of a multigene family conserved among bartonella species.

Bartonella proteins that elicit an antibody response during an infection are poorly defined; therefore, to characterize antigens recognized by the host, a Bartonella genomic expression library was screened with serum from an infected mouse. This process led to the discovery of a Bartonella vinsonii subsp. arupensis gene encoding a 382-kDa protein, part of a gene family encoding large proteins, each containing multiple regions of repetitive segments. The genes were termed brpA to -C (bartonella repeat protein) and bore significant similarity to genes encoding the BadA adhesin protein and members of the variably expressed outer membrane protein family of proteins from Bartonella henselae and Bartonella quintana, respectively.

Amino Acid Sequence↗

Bartonella (Rochalimaea) quintana bacteremia in inner-city patients with chronic alcoholism.

BACKGROUND: Bartonella (Rochalimaea) quintana is a fastidious gram-negative bacterium known to cause trench fever, cutaneous bacillary angiomatosis, and endocarditis. Between January and June 1993 in Seattle, we isolated B. quintana from 34 blood cultures obtained from 10 patients not known to be infected with the human immunodeficiency virus (HIV). METHODS: After identifying the isolates as B. quintana by direct immunofluorescence and DNA-hybridization studies, we determined strain hybridization with studies of restriction-fragment-length polymorphisms (RFLPs) of the intergenic spacer (noncoding) region of ribosomal DNA amplified by the polymerase chain reaction (PCR). To characterize the epidemiologic and clinical features of bartonella infections in these patients, we performed a retrospective case-control study using as controls 20 patients with blood cultures obtained at approximately the same time as those obtained from the index patients. RESULTS: B. quintana isolates from the 10 patients were indistinguishable by PCR-RFLP typing. All 10 patients had chronic alcoholism, and 8 were homeless (P = 0.001 for both comparisons with controls). The six patients who underwent HIV testing were seronegative. At the time of their initial presentation, seven patients had temperatures of at least 38.5 degrees C. Six patients had three or more blood cultures that were positive for B. quintana, and in four of these patients B. quintana was isolated from blood cultures obtained 10 or more days apart. Subacute endocarditis developed in two patients and required surgical removal of the infected aortic valve in one of them. Nine patients recovered; one died of sepsis from Streptococcus pneumoniae infection. CONCLUSIONS: B. quintana is a cause of fever, bacteremia, and endocarditis in HIV-seronegative, homeless, inner-city patients with chronic alcoholism.

Adult↗

In vitro susceptibilities of Rickettsia and Bartonella spp. to 14-hydroxy-clarithromycin as determined by immunofluorescent antibody analysis of infected vero cell monolayers.

The in vitro susceptibilities of Rickettsia akari, Rickettsia conorii, Rickettsia prowazekii, Rickettsia rickettsii, Bartonella elizabethae, Bartonella henselae and Bartonella quintana to different concentrations of clarithromycin, 14-hydroxy-clarithromycin (the primary metabolite of clarithromycin) and tetracycline in Vero cell cultures, were determined by enumeration of immunofluorescently-stained bacilli. The extent of antibiotic-induced inhibition of foci was recorded for each dilution of antibiotic and compared with an antibiotic-negative control. Based upon MIC data, clarithromycin alone is highly active against all three Bartonella spp., R. akari and R. prowazekii, while 14-hydroxy-clarithromycin is active against R. conorii, R. prowazekii and R. rickettsii. Further testing is warranted in animal models and human clinical trials, to examine the activity of both clarithromycin and its primary metabolite and to define further the role of clarithromycin in therapy, particularly of infections caused by obligate intracellular bacteria such as Rickettsia and Bartonella spp.

Animals↗

Bartonella seropositivity in children with Henoch-Schonlein purpura.

BACKGROUND: An association between Henoch-Schonlein purpura (HSP) and seropositivity for Bartonella henselae (BH) has been described. The objective of this study was to see if such an association exists in northern Alberta. METHODS: Immunofluorescent antibody testing utilizing an antigen prepared from B. henselae was undertaken on sera from six children with current HSP, 22 children with remote HSP, and 28 controls that were matched for age. Blood from the six children with current HSP was analysed by polymerase chain reaction (PCR) assay with primers derived from the citrate synthase (gltA) gene for the detection of Bartonella DNA. RESULTS: The seropositivity rate for BH was 61% in cases versus 21% in controls (p < 0.03). The PCR assay was negative in all six current cases. CONCLUSION: There is an increased seropositivity rate for BH in children with HSP. However, it is not clear if infection with B. henselae or a related Bartonella species can result in HSP, or if the increased seropositivity is from non-specific or cross-reacting antibodies.

Bartonella Infections↗

Concurrent infection of the central nervous system by Borrelia burgdorferi and Bartonella henselae: evidence for a novel tick-borne disease complex.

OBJECTIVES: To investigate Bartonella henselae as a potential human tick-borne pathogen and to evaluate its role as a coinfecting agent of the central nervous system in the presence of neuroborreliosis. DESIGN: Case report study. SETTING: A primary health care center in Flemington, NJ, and the Department of Research and Development at Medical Diagnostic Laboratories LLC in Mt Laurel, NJ. SUBJECTS: Two male patients (aged 14 and 36 years) and 2 female patients (aged 15 and 30 years, respectively) with a history of tick bites and Lyme disease. MAIN OUTCOME MEASURES: Laboratory and diagnostic findings before and after antimicrobial therapy. RESULTS: Patients residing in a Lyme-endemic area of New Jersey with ongoing symptoms attributed to chronic Lyme disease were evaluated for possible coinfection with Bartonella species. Elevated levels of B henselae-specific antibodies were found in these patients using the immunofluorescent assay. Bartonella henselae-specific DNA was detected in their blood. None of these patients exhibited the clinical characteristics of cat-scratch disease. Findings of cerebrospinal fluid analysis revealed the presence of both B henselae- and Borrelia burgdorferi-specific DNA. Bartonella henselae-specific DNA was also detected in live deer ticks obtained from the households of 2 of these patients. CONCLUSIONS: Our data implicate B henselae as a potential human tick-borne pathogen. Patients with a history of neuroborreliosis who have incomplete resolution of symptoms should be evaluated for B henselae infection.

Adult↗

Clinical impact of persistent Bartonella bacteremia in humans and animals.

Bartonella spp. are emerging vector-borne pathogens that cause persistent, often asymptomatic bacteremia in their natural hosts. As our knowledge progresses, it appears that chronic infection may actually predispose the host to mild, insidious nonspecific manifestations or induce, in selected instances, severe diseases. Persistent asymptomatic bacteremia is most common in animals that serve as the main reservoir for the specific Bartonella. In humans, these organisms are B. bacilliformis and B. quintana. Other Bartonella species, for which humans are not the natural reservoir, tend to cause persistent bacteremia only in immunodeficient individuals. In some of these individuals, endothelial cell proliferation may create lesions such as bacillary angiomatosis or bacillary peliosis. In cats, bacteremia of variable level and continuity may last for years. Some strains of B. henselae may induce clinical manifestations, including fever, mild neurological signs, reproductive disorders, whereas others do not induce clinically obvious disease. Reproductive disorders have also been reported in mice experimentally infected with B. birtlesii. Finally, canids constitute the most interesting naturally occurring animal model for the human disease. Like immunocompetent people, healthy dogs only occasionally demonstrate long-term bacteremia when infected with Bartonella spp. However, some dogs develop severe clinical manifestations, such as endocarditis, and the pathologic spectrum associated with Bartonella spp. infection in domestic dogs is rapidly expanding and resembles the infrequently reported clinical entities observed in humans. In coyotes, persistent bacteremia is more common than in domestic dogs. It will be of interest to determine if coyotes develop clinical or pathological indications of infection.

Animals↗

Use of the polymerase chain reaction and DNA sequencing for detection of Bartonella quintana in the aortic valve of a patient with culture-negative infective endocarditis.

We used the polymerase chain reaction (PCR) and broad-range bacterial primers, combined with DNA sequencing, to identify Bartonella quintana as the etiologic agent in a case of culture-negative infective endocarditis; all blood cultures, as well as the bacterial cultures of the resected aortic valve and vegetations, remained negative. PCR was used to amplify bacterial 16S rDNA from a template prepared from the aortic valve vegetation. The amplified 16S rDNA produced a nucleotide sequence that was 99.79% identical to the B. quintana rDNA sequence. The patient had a highly elevated level of serum antibodies to Bartonella antigen (1:8,192).

Antibodies, Bacterial↗