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PubMed1999

Ocular manifestations of cat-scratch disease.

Bartonella henselae has only recently been isolated, characterized, and found to be the principal cause of cat-scratch disease (CSD). The availability of specific serologic investigations has allowed the recognition of a spectrum of ocular CSD syndromes that previously were ill defined and considered idiopathic. The primary inoculation complex causing regional lymphadenopathy is represented in the eye by Parinaud's oculoglandular syndrome; B. henselae is the most common cause. Leber's neuroretinitis has been identified for 80 years, and new data suggest that it is commonly a manifestation of CSD; the extent of the association remains to be determined. CSD optic neuritis is also described. The vitreoretinal manifestations include anterior uveitis, vitritis, pars planitis, focal retinal vasculitis, a characteristic retinal white spot syndrome, Bartonella retinitis, branch retinal arteriolar or venular occlusions, focal choroiditis, serous retinal detachments, and peripapillary angiomatous lesions. The pattern of ocular disease in AIDS-associated B. henselae infections is poorly delineated; unusual manifestations include conjunctival and retinal bacillary angiomatosis. The benefit of antimicrobial therapy for CSD in immunocompetent individuals has been difficult to establish, partly because most infections are self limited. Empirically, azithromycin, ciprofloxacin, rifampin, parenteral gentamicin, or trimethoprim-sulfamethoxazole provide the best therapeutic choices to minimize damage to the eye.

Anti-Bacterial Agents↗
PubMed2006

Bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia.

Bacillary angiomatosis is an opportunistic bacterial infection caused by either Bartonella henselae or B. quintana. The classic histologic presentation of bacillary angiomatosis involves three components: a lobular proliferation of capillaries with enlarged endothelial cells, neutrophilic debris, and clumps of finely granular material identified as bacteria with staining techniques. Pseudoepitheliomatous hyperplasia is a histologic reaction pattern characterized by epithelial proliferation in response to a variety of stimuli, including mycobacterial, fungal, and bacterial infections. We describe a case of bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia in an immunocompromised patient with Acquired Immunodeficiency Syndrome. Histologic examination of a finger lesion demonstrated a capillary proliferation with neutrophilic debris and characteristic amorphous granular deposits. Warthin-Starry and Giemsa staining revealed clumps of coccobacilli. Cervical lymph node tissue also revealed organisms identified as Bartonella with PCR techniques. Stains and cultures for acid fast bacilli, fungus, and bacteria were negative. To our knowledge, there has been only one other report of bacillary angiomatosis presenting with pseudoepitheliomatous hyperplasia. We conclude that the differential diagnosis of entities associated with pseudoepitheliomatous hyperplasia should be expanded to include bacillary angiomatosis.

AIDS-Related Opportunistic Infections↗
PubMed2004

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↗
PubMed2001

Detection of fastidious bacteria in cardiac valves in cases of blood culture negative endocarditis.

The diagnosis of blood culture negative endocarditis is still a problem. Fastidious bacteria such as bartonella and coxiella are responsible for cases of blood culture negative endocarditis, the identification of which is mainly based on serological and DNA studies only available in specialised centres. Therefore, a routine technique is needed in surgical pathology laboratories to detect these bacteria in cardiac valve tissue sections. This report describes a staining technique, the Gimenez stain, feasible and sensitive in detecting bartonella and coxiella in two cases of blood culture negative endocarditis.

Adult↗
PubMed2003

From trench fever to endocarditis.

The case of a 44 year old woman with infective endocarditis due to Bartonella quintana, an organism long recognised to cause a condition known as trench fever, is reported. This case illustrates the lengthy differential diagnosis of "culture negative" endocarditis. In addition the presence of serological cross reactivity of Bartonella spp and Chlamydia spp demonstrates the potential for misdiagnosis in these circumstances.

Adult↗
PubMed2005

Activation of hypoxia-inducible factor-1 in bacillary angiomatosis: evidence for a role of hypoxia-inducible factor-1 in bacterial infections.

BACKGROUND: Bartonella species are the only known bacterial pathogens causing vasculoproliferative disorders in humans (bacillary angiomatosis [BA]). Cellular and bacterial pathogenetic mechanisms underlying the induction of BA are largely unknown. METHODS AND RESULTS: Activation of hypoxia-inducible factor-1 (HIF-1), the key transcription factor involved in angiogenesis, was detected in Bartonella henselae-infected host cells in vitro by immunofluorescence, Western blotting, electrophoretic mobility shift, and reporter gene assays and by immunohistochemistry in BA tissue lesions in vivo. Gene microarray analysis revealed that a B henselae infection resulted in the activation of genes typical for the cellular response to hypoxia. HIF-1 was essential for B henselae-induced expression of vascular endothelial growth factor as shown by inhibition with the use of HIF-1-specific short-interfering RNA. Moreover, infection with B henselae resulted in increased oxygen consumption, cellular hypoxia, and decreased ATP levels in host cells. Infection with a pilus-negative variant of B henselae did not lead to cellular hypoxia or activation of HIF-1 or vascular endothelial growth factor secretion, suggesting a crucial role of this bacterial surface protein in the angiogenic reprogramming of the host cells. CONCLUSIONS: B henselae induces a proangiogenic host cell response via HIF-1. Our data provide for the first time evidence that HIF-1 may play a role in bacterial infections.

Adenosine Triphosphate↗
PubMed2005

Bacterial zoonoses and infective endocarditis, Algeria.

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.

Adolescent↗
PubMed2006

Lymph node biopsy specimens and diagnosis of cat-scratch disease.

We report microbiologic analysis of 786 lymph node biopsy specimens from patients with suspected cat-scratch disease (CSD). The specimens were examined by standard, cell culture, and molecular methods. Infectious agents were found in samples from 391 (49.7%) of 786 patients. The most commonly identified infectious agent was Bartonella henselae (245 patients, 31.2%), the agent of CSD. Mycobacteriosis was diagnosed in 54 patients (6.9%) by culture and retrospectively confirmed by using a specific real-time PCR assay. Neoplasm was diagnosed in 181 specimens suitable for histologic analysis (26.0%) from 47 patients. Moreover, 13 patients with confirmed Bartonella infections had concurrent mycobacteriosis (10 cases) or neoplasm (3 cases). A diagnosis of CSD does not eliminate a diagnosis of mycobacteriosis or neoplasm. Histologic analysis of lymph node biopsy specimens should be routinely performed because some patients might have a concurrent malignant disease or mycobacteriosis.

Adolescent↗
PubMed2000

[Cat-scratch disease].

We report a case of fourteen years old boy with cat scratch disease. He was treated at Pediatric Clinic in January and February 2000. Cat scratch disease is benign infectious chronic disease which appears in all ages. It begins after contact with cat and its scratch. Yearly incidence of this disease for whole population is 0.77-0.86/100.000. The cause is bacillus Bartonella which is also called genus Rochalimaea. It is Gram negative, mobile, aerobe bacillus with ten flagellas on one pole. Our patient was admitted at hospital because of high temperature, paleness, fatigue, bad appetite and pains in his joint. Ultrasound and magnet resonance scans of liver and spleen showed enlarged but regulary contured liver and two focal changes with diameter 16 mm, 12 mm and 7 mm in spleen. All those focal changes were described as abscesses. Diagnose was set up according increasing titre of IF-Bartonella hensalae IgG 1:256 (positive). This diagnostic test was performed at Institute for microbiology and Immunology at Medical Faculty in Ljubljana. Disease had long lasting course, and was cured by antibiotics without surgical intervention.

Adolescent↗
PubMed2001

Cat-scratch disease: epidemiology, aetiology and treatment.

Cat-scratch disease (CSD) is a clinical syndrome that usually presents as a self-limiting lymphadenopathy associated with a cat scratch or bite. Commonly affecting children and young adults, it has a worldwide distribution. In temperate climates, higher rates are reported in the autumn and winter, which can be attributed to the seasonal breeding of the domestic cat. The organism responsible was identified in 1983, having eluded detection for 50 years. Initially, Afipia felis was thought to be the cause; however, subsequent study failed to confirm a link. During the 1990s, it was demonstrated conclusively that Rochalimaea henselae, later reclassified as Bartonella henselae, was the cause of CSD. B. henselae has been isolated from bacteraemic cats, with transmission among cats thought to be via the cat flea. Although other Bartonella species are transmitted by arthropod vectors, it is unlikely that the cat flea is involved directly in human infection, but plays a role in amplifying the reservoir. B. henselae is difficult to culture, and either serology or the polymerase chain reaction are considered to be the best methods of detection. Genetic variation occurs amongst B. henselae strains, perhaps explaining the inconsistency of some diagnostic techniques. A separate serogroup (Marseilles) has been reported in a seronegative patient with CSD, and B. clarridgeiae has the potential to cause the disease. Atypical presentation is seen in up to 25% of cases, and manifests itself as ocular involvement, encephalopathy, granulomatous hepatitis, hepatosplenic infection, endocarditis and osteomyelitis. The majority of CSD cases resolve spontaneously and do not require antibiotic treatment. In complicated CSD, treatment with trimethoprim-sulphamethoxazole, ciprofloxacin or azithromycin is recommended, with gentamicin being reserved for the severely ill patient.

Animals↗
PubMed1975

[Blood parasites of small wild mammals in Czechoslovakia].

The author investigated 4,853 specimens of wild living small mammals (43 species: Insectivora, Chiroptera, Lagomorpha, Rodentia, Carnivora) from Czechoslovakia for blood parasites. Trypanosomes were found in Talpa europaea, Sorex alpinus, Crocidura suaveolens, Myotis myotis, Apodemus sylvaticus, Apodemus flavicollis, Mus musculus, Rattus norvegicus, Clethrionomys glareolus and Microtus agrestis. Babesia was detected in Myotis emarginatus, Myotis myotis, Clethrionomys glareolus, Microtus arvalis and Microtus agrestis. Grahaemella was found in Talpa europaea, Sorex araneus, Neomys fodiens, Neomys anomalus, Myotis emarginatus, Myotis myotis, Apodemus sylvaticus, Apodemus flavicollis, Apodemus microps, Apodemus agrarius, Mus musculus, Clethrionomys glareolus, Arvicola terrestris, Pitymys subterraneus, Microtus arvalis, Microtus agrestis, and Microtus oeconomus. Spontaneous Bartonella-infection was ascertained in one Microtus arvalis and, in erythrocytes of one Sorex araneus, parasitic organisms very similar to Bartonella were found.

Animals↗
PubMed2001

[Acute generalized cat scratch disease in myelodysplastic syndrome].

In patients with normal immunity, cat scratch disease typically develop a papule at the portal of entry and no other cutaneous features. A 73 year old male patient with a myelodysplastic syndrome developed generalized petechial, papular and, vasculitic skin lesions in association with cat scratch disease. After the diagnosis was established by identifying the causative organism in a lymph node biopsy, the patient was treated with erythromycin for three weeks resulting in progressive clearance of the skin lesions. Apart from the soluble IL-2 receptor, no other serologic inflammatory parameters were elevated. IgG antibodies against Bartonella henselae and Bartonella quintana increased only slightly during acute exacerbation of the disease, but significantly increased some months later. The diagnosis was established by the positive staining of the lymph node biopsy using the Warthin-Starry stain.

Administration, Oral↗
PubMed2002

Cat-scratch disease in an immunocompromised host.

BACKGROUND: The main causative agents of cat-scratch disease are Bartonella henselae, tiny, gram-negative bacilli. The disease usually has a benign course with the development of a papule at the inoculation site, followed by regional lymphadenopathy. In most cases, complete resolution occurs, but in immunocompromised hosts, the course of the disease can be aggravated. CASE REPORT: A patient received methotrexate and corticosteroids for 3 months due to rheumatoid arthritis. He developed fever, exanthema and leukopenia under methotrexate therapy. Dark red indurations with central ulcerations at his right thigh revealed a further problem apart from the methotrexate-induced leucopenia and immunosuppression. The ulcerations were the remainders of recurrent scratches from the patient's cat. The patient's antibody titers against Bartonella henselae remained low and inguinal lymph node swelling was only for a short time to be observed, this reaction obviously weakened as a result of the immunosuppression. However, the typical course, the exclusion of other reasons for the exanthema and the rapid improvement of the patient's condition after antibiotic treatment ascertained the diagnosis. CONCLUSIONS: In immunocompromised hosts, diseases with a typically benign course can become severe and life-threatening illnesses. Ownership of pets should be taken into consideration before onset of an immunosuppressive therapy.

Aged↗
PubMed2002

Cat-scratch disease in children--Texas, September 2000-August 2001.

Cat-scratch disease (CSD), a bacterial infection caused by Bartonella henselae, has emerged as a relatively common and occasionally serious zoonotic disease among children and adults. To illustrate the spectrum of clinical manifestations of CSD observed during a 1-year period, Texas Children's Hospital (TCH) in Houston reviewed the medical records of 32 children evaluated at TCH during September 2000-August 2001 whose antibody titers indicated recent Bartonella infection. This report summarizes the evaluations of these cases and highlights four manifestations of infection with this pathogen in children. The findings emphasize that although CSD is generally a mild, self-limited illness, the differential diagnosis often includes more serious conditions (e.g., lymphoma, carcinoma, mycobacterial or fungal infection, or neuroblastoma) that might result in protracted hospital stays and lengthy treatments before diagnosis. Timely assessment of CSD is important, particularly when invasive diagnostic measures are being considered.

Bartonella henselae↗
PubMed1995

[Cat scratch (?) disease].

The case of a 24 year old female student who developed typical cat scratch disease following an insect sting invited to review the literature. Over the last two years, Rocalimaea henselae could be identified and is now considered to be responsible for the majority of infected cases. It is related to Rochalimaea quintana that provokes trench fever and to Bartonella bacilliformis, known as the inciting agent of the verruca peruana and of Oroya fever. Recently, it has been proposed to integrate Rochalimaea and Bartonella into the family of Bartonellaceae. The diverse and fascinating array of clinical syndromes caused by R. henselae as well as their treatment are described. Capability to affect organs other than skin and lymph nodes is primarily but not exclusively associated with immunodeficiencies. In countries like Switzerland little information on these clinical pictures is available. However, it is important to recognize the typical symptoms and signs in order to initiate the appropriate and necessary examinations.

Adult↗
PubMed1996

Unknown species of rickettsiae isolated from Ixodes ricinus tick in Wałcz.

Ticks Ixodes ricinus have been harvested in park down-town Wałcz in June 1994. Presence of Borrelia burgdorferi and rickettsiae has been tested with PCR. B. burgdorferi and Coxiella burnetii have not been detected in any tick whereas characteristic for other rickettsiae DNA fragment of gene encoding citrate-synthase has been found. Bacterial strain has been cultured from the tick. Biochemical properties of isolated strain has strongly suggested that these bacteria belong to genus Bartonella (Rochalimaea). Further identification of bacterial DNA with RFLP-PCR (restriction fragment length polymorphism-PCR) has shown characteristics of Bartonella bacilliformis species not recognised in Poland until recently.

Animals↗
PubMed1997

[Cat-scratch disease--an overlooked disease in Denmark?].

Only one patient with cat-scratch disease (CSD) has been reported in Denmark. A case and retrospective investigation among patients admitted to the ward is presented. Over a period of 3.5 years, six patients were found to have suffered from CSD. The yearly incidence was calculated to 2.6/100,000. The patients were tested for antibodies against Bartonella (Rochalimaea) henselae with a new test developed at the Danish Serum Institute. Only two of the patients with CSD had titres of antibodies higher than 400 (positive). Tested again with an improved test five of the six patients were found to have antibodies against B. henselae. It is assumed that CSD is found with the same incidence as the USA and Holland. It is recommended that examination for chronic lymphadenopathy includes questions about cat contact and testing for antibodies against Bartonella henselae.

Animals↗
PubMed1998

Cat-scratch disease osteomyelitis from a dog scratch.

Osteomyelitis is a rare manifestation of cat-scratch disease in patients who do not have AIDS. The clinical presentation and non-specific subacute course of the disease make diagnosis difficult. We present a child with osteomyelitis of a metacarpal following a dog scratch. Bartonella henselae was found to be the aetiological agent. The bone healed after treatment with antibiotics. Increased awareness and a comprehensive medical history are needed to identify patients with suspected Bartonella henselae osteomyelitis.

Animals↗