Bartonella Information Recent Diagnosis and Treatment Study Errors Seen in Sample Abstracts
Many years ago I read vast crates of books on Bartonella. It was then that I realized this was an immensely dangerous infection, slow to grow and so missed on cultures, and a bacteria which lowered fevers and reduced immune chemicals. I also slowly realized that the 40 alternative, progressive and traditional treatments might stun Bartonella, but none was the magic cure for any species infecting humans in the manner or dose proposed.
Below is merely a fraction of a day's reading. Some errors exist in these abstracts, and some others offer wise cautions, e.g., that treatment should be individualized. True in all of medicine unless one is acting sadistically and treating patients as things.
The sad fact is that people who write articles of post a few pages with Papal authority have never read on this infection full time for months, let alone years. They have not inherited "cured" patients only to see from many sources evidence that Bartonella is alive and well. It is not a mere "cold" as one large lab calls it--a paper in 2010 reports this belief is naive and that this bacteria can be markedly dangerous, and relapse on routine treatments is the norm.
So here is mere few minutes of newer material. Sadly, 1/1000 healers are aware of this mere taste of Bartonella research, but many have opinions that rival the authority of Moses. But without the work required to know Bartonella, or the fascinating experiences this man had many thousands of years ago.
I deeply regret the many times in my past when I thought merely consulting a few articles or textbook entries made me feel I understood an illness.
1. Rev Esp Quimioter. 2010 Sep;23(3):109-14.
[Treatment of human infections caused by Bartonella spp.]
[Article in Spanish]
P�rez-Mart�nez L, Blanco JR, Oteo JA.
Area de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigaci�n Biom�dica de La Rioja (CIBIR), Logro�o, Spain. firstname.lastname@example.org.
Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases. There is not a universal therapy for this infection, therefore treatment should be chosen individually. The aim of this review is to update the therapeutics aspects of this kind of infections.
PMID: 20844840 [PubMed - in process]
1. Rev Esp Quimioter. 2010 Sep;23(3):109-14.
[Treatment of human infections caused by Bartonella spp.]
[Article in Spanish]
P�rez-Mart�nez L, Blanco JR, Oteo JA.
Area de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigaci�n Biom�dica de La Rioja (CIBIR), Logro�o, Spain. email@example.com.
Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases. There is not a universal therapy for this infection, therefore treatment should be chosen individually. The aim of this review is to update the therapeutics aspects of this kind of infections.
PMID: 20844840 [PubMed - in process]
2. BMC Med Genomics. 2010 Sep 13;3(1):40. [Epub ahead of print]
Impairment of circulating endothelial progenitors in Down syndrome.
Costa V, Sommese L, Casamassimi A, Colicchio R, Angelini C, Marchesano V, Milone L, Farzati B, Giovane A, Fiorito C, Rienzo M, Picardi M, Avallone B, Corsi MM, Sarubbi B, Calabro R, Salvatore P, Ciccodicola A, Napoli C.
ABSTRACT: BACKGROUND: Pathological angiogenesis represents a critical issue in the progression of many diseases. Down syndrome is postulated to be a systemic anti-angiogenesis disease model, possibly due to increased expression of anti-angiogenic regulators on chromosome 21. The aim of our study was to elucidate some features of circulating endothelial progenitor cells in the context of this syndrome. METHODS: Circulating endothelial progenitors of Down syndrome affected individuals were isolated, in vitro cultured and analyzed by confocal and transmission electron microscopy. ELISA was performed to measure SDF-1alpha plasma levels in Down syndrome and euploid individuals. Moreover, qRT-PCR was used to quantify expression levels of CXCL12 gene and of its receptor in progenitor cells. The functional impairment of Down progenitors was evaluated through their susceptibility to hydroperoxide-induced oxidative stress with BODIPY assay and the major vulnerability to the infection with human pathogens. The differential expression of crucial genes in Down progenitor cells was evaluated by microarray analysis. RESULTS: We detected a marked decrease of progenitors' number in young Down individuals compared to euploid, cell size increase and some major detrimental morphological changes. Moreover, Down syndrome patients also exhibited decreased SDF-1alpha plasma levels and their progenitors had a reduced expression of SDF-1alpha encoding gene and of its membrane receptor. We further demonstrated that their progenitor cells are more susceptible to hydroperoxide-induced oxidative stress and infection with Bartonella henselae. Further, we observed that most of the differentially expressed genes belong to angiogenesis, immune response and inflammation pathways, and that infected progenitors with trisomy 21 have a more pronounced perturbation of immune response genes than infected euploid cells. CONCLUSIONS: Our data provide evidences for a reduced number and altered morphology of endothelial progenitor cells in Down syndrome, also showing the higher susceptibility to oxidative stress and to pathogen infection compared to euploid cells, thereby confirming the angiogenesis and immune response deficit observed in Down syndrome individuals.
PMID: 20836844 [PubMed - as supplied by publisher]
3. Int J Med Microbiol. 2010 Sep 9. [Epub ahead of print]
Bartonella spp.: Throwing light on uncommon human infections.
Kaiser PO, Riess T, O'Rourke F, Linke D, Kempf VA.
Institut f�r Medizinische Mikrobiologie und Krankenhaushygiene, Universit�tsklinikum, Johann Wolfgang Goethe-Universit�t, Paul Ehrlich-Str. 40, 60596 Frankfurt am Main, Germany.
After 2 decades of Bartonella research, knowledge on transmission and pathology of these bacteria is still limited. Bartonella spp. have emerged to be important pathogens in human and veterinary medicine. For humans, B. henselae is considered to represent the most relevant zoonotic Bartonella species and is responsible for cat scratch disease, bacillary angiomatosis, and other disorders. Over the years, many Bartonella species have been isolated from humans, cats, dogs, and other mammals, and infections range from an asymptomatic state (e.g., animal-specific species) to even life-threatening diseases (e.g., Oroya fever). It is obvious that the analysis of pathogenicity mechanisms underlying Bartonella infections is needed to increase our understanding of how these pathogens adapt to their mammalian hosts resulting in acute or chronic diseases.
PMID: 20833105 [PubMed - as supplied by publisher]
4. J Am Board Fam Med. 2010 Sep-Oct;23(5):685-6.
Cat scratch disease and arthropod vectors: more to it than a scratch?
Mosbacher M, Elliott SP, Shehab Z, Pinnas JL, Klotz JH, Klotz SA.
Third World Veterinary, Fountain Hills, AZ, USA.
PURPOSE: Cat scratch disease is a common infection, particularly in children, and clinicians need to be aware of its potential transmission to humans by arthropod vectors such as fleas and ticks in addition to animal bites and scratches. The absence of a vertebrate bite or scratch does not preclude infection with Bartonella henselae. METHODS: Literature regarding arthropod transmission of B. henselae was reviewed. RESULTS: B. henselae and related bacterial species are transmitted among cats and dogs by arthropod vectors. In the absence of these vectors, disease does not spread amongst the animals. On the other hand, disease can be spread to humans by bite and scratch as well as by arthropod vectors. Animals commonly infected with B. henselae and arthropod vectors are discussed. CONCLUSIONS: Clinicians should be aware that a common illness, cat scratch disease, can be transmitted by arthropod vectors and a history of an animal scratch or bite is not necessary for disease transmission.
PMID: 20823366 [PubMed - in process]
5. Annu Rev Entomol. 2010 Jan 11. [Epub ahead of print]
Arthropod-Borne Disease Associated with Political and Social Disorder.
Facult� de M�decine, Unit� de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-IRD UMR 6236/198, 13385 Marseille cedex 5, France; email: firstname.lastname@example.org.
The living conditions and the crowded situations of the homeless, war refugees, or victims of a natural disaster provide ideal conditions for the spread of lice, fleas, ticks, flies and mites. The consequence of arthropod infestation in these situations is underestimated. Along with louseborne infections such as typhus, trench fever, and relapsing fever, the relationship between Acinetobacter spp.-infected lice and bacteremia in the homeless is not clear. Murine typhus, tungiasis, and myiasis are likely underestimated, and there has been a reemergence of bed bugs. Attempted eradication of the body louse, despite specific measures, has been disappointing, and infections with Bartonella quintana continue to be reported. The efficacy of ivermectin in eradicating the human body louse, although the effect is not sustained, might provide new therapeutic approaches. Arthropod-borne diseases continue to emerge within the deprived population. Public health programs should be engaged rapidly to control these pests and reduce the incidence of these transmissible diseases. Expected final online publication date for the Annual Review of Entomology Volume 56 is December 03, 2010. Please see https://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
PMID: 20822446 [PubMed - as supplied by publisher]
6. Clin Dermatol. 2010 Sep-Oct;28(5):483-8.
Skin diseases associated with Bartonella infection: facts and controversies.
Pi�rard-Franchimont C, Quatresooz P, Pi�rard GE.
Department of Dermatopathology, University Hospital of Li�ge, Li�ge, Belgium.
The genus Bartonella is composed of a series of species and subspecies. Ten of them are responsible for human infections. The best-identified diseases are cat scratch disease (B henselae and possibly B clarridgeiae), trench fever (B quintana), bacillary angiomatosis (B quintana and B henselae), and the spectrum of verruga peruana, Carrion disease, and Oroya fever (B bacilliformis). Controversies exist about the implication of a few other microorganisms being involved in these diseases. Several other conditions have been associated with the presence of Bartonella spp, but these observations await confirmation.
PMID: 20797506 [PubMed - in process]
7. Parasit Vectors. 2010 Aug 24;3:76.
PCR amplification of Bartonella koehlerae from human blood and enrichment blood cultures.
Breitschwerdt EB, Maggi RG, Robert Mozayeni B, Hegarty BC, Bradley JM, Mascarelli PE.
Intracellular Pathogens Research Laboratory and the Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA. email@example.com.
ABSTRACT: BACKGROUND: Cats appear to be the primary reservoir host for Bartonella koehlerae, an alpha Proteobacteria that is most likely transmitted among cat populations by fleas (Ctenocephalides felis). Bartonella koehlerae has caused endocarditis in a dog and in one human patient from Israel, but other clinically relevant reports involving this bacterium are lacking. Despite publication of numerous, worldwide epidemiological studies designed to determine the prevalence of Bartonella spp. bacteremia in cats, B. koehlerae has never been isolated using conventional blood agar plates. To date, successful isolation of B. koehlerae from cats and from the one human endocarditis patient has consistently required the use of chocolate agar plates. RESULTS: In this study, Bartonella koehlerae bacteremia was documented in eight immunocompetent patients by PCR amplification and DNA sequencing, either prior to or after enrichment blood culture using Bartonella alpha Proteobacteria growth medium. Presenting symptoms most often included fatigue, insomnia, joint pain, headache, memory loss, and muscle pain. Four patients were also infected with Bartonella vinsonii subsp. berkhoffii genotype II. After molecular documentation of B. koehlerae infection in these patients, a serological test was developed and serum samples were tested retrospectively. Bartonella koehlerae antibodies were not detected (titers < 1:16) in 30 healthy human control sera, whereas five of eight patient samples had B. koehlerae antibody titers of 1:64 or greater. CONCLUSIONS: Although biased by a study population consisting of individuals with extensive arthropod and animal exposure, the results of this study suggest that B. koehlerae bacteremia is more common in immunocompetent people than has been previously suspected. Future studies should more thoroughly define modes of transmission and risk factors for acquiring infection with B. koehlerae. In addition, studies are needed to determine if B. koehlerae is a cause or cofactor in the development of arthritis, peripheral neuropathies or tachyarrhythmias in patients.
PMCID: PMC2936392 PMID: 20735840 [PubMed - in process]
8. J Clin Microbiol. 2010 Aug 11. [Epub ahead of print]
Human co-infection with Bartonella henselae and two hemotropic mycoplasma variants resembling Mycoplasma ovis.
Sykes JE, Lindsay LL, Maggi RG, Breitschwerdt EB.
Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA (J. Sykes and L. Lindsay) and Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606 (E. Breitschwerdt and R. Maggi).
Two variants of an organism resembling the ovine hemoplasma, Mycoplasma ovis, were detected using PCR in blood samples from a veterinarian in Texas. Coinfection with similar variants has been described in sheep. This represents the first report of human infection with this organism. The veterinarian was co-infected with Bartonella henselae.
PMID: 20702675 [PubMed - as supplied by publisher]
9. Am J Trop Med Hyg. 2010 Aug;83(2):298-300.
Molecular evidence of Bartonella infection in domestic dogs from Algeria, North Africa, by polymerase chain reaction (PCR).
Kernif T, Aissi M, Doumandji SE, Chomel BB, Raoult D, Bitam I.
D�partement de zoologie, Institut National d'Agronomie, El Harrach, Algiers, Algeria.
Bartonella species are being recognized as important bacterial human and canine pathogens, and are associated with multiple arthropod vectors. Bartonella DNA extracted from blood samples was obtained from domestic dogs in Algiers, Algeria. Polymerase chain reaction (PCR) and DNA sequence analyses of the ftsZ gene and the 16S-23S intergenic spacer region (ITS) were performed. Three Bartonella species: Bartonella vinsonii subsp. berkhoffii, Bartonella clarridgeiae, and Bartonells elizabethae were detected infecting Algerian dogs. To our knowledge, this study is the first report of detection by PCR amplification of Bartonella in dogs in North Africa.
PMCID: PMC2911174 [Available on 2011/8/5] PMID: 20682871 [PubMed - indexed for MEDLINE]
10. BMC Infect Dis. 2010 Jul 30;10:229.
Human isolates of Bartonella tamiae induce pathology in experimentally inoculated immunocompetent mice.
Colton L, Zeidner N, Lynch T, Kosoy MY.
Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA. firstname.lastname@example.org
BACKGROUND: Bartonella tamiae, a newly described bacterial species, was isolated from the blood of three hospitalized patients in Thailand. These patients presented with headache, myalgia, anemia, and mild liver function abnormalities. Since B. tamiae was presumed to be the cause of their illness, these isolates were inoculated into immunocompetent mice to determine their relative pathogenicity in inducing manifestations of disease and pathology similar to that observed in humans. METHODS: Three groups of four Swiss Webster female mice aged 15-18 months were each inoculated with 10(6-7) colony forming units of one of three B. tamiae isolates [Th239, Th307, and Th339]. A mouse from each experimental group was sampled at 3, 4, 5 and 6 weeks post-inoculation. Two saline inoculated age-matched controls were included in the study. Samples collected at necropsy were evaluated for the presence of B. tamiae DNA, and tissues were formalin-fixed, stained with hematoxylin and eosin, and examined for histopathology. RESULTS: Following inoculation with B. tamiae, mice developed ulcerative skin lesions and subcutaneous masses on the lateral thorax, as well as axillary and inguinal lymphadenopathy. B. tamiae DNA was found in subcutaneous masses, lymph node, and liver of inoculated mice. Histopathological changes were observed in tissues of inoculated mice, and severity of lesions correlated with the isolate inoculated, with the most severe pathology induced by B. tamiae Th239. Mice inoculated with Th239 and Th339 demonstrated myocarditis, lymphadenitis with associated vascular necrosis, and granulomatous hepatitis and nephritis with associated hepatocellular and renal necrosis. Mice inoculated with Th307 developed a deep dermatitis and granulomas within the kidneys. CONCLUSIONS: The three isolates of B. tamiae evaluated in this study induce disease in immunocompetent Swiss Webster mice up to 6 weeks after inoculation. The human patients from whom these isolates were obtained had clinical presentations consistent with the multi-organ pathology observed in mice in this study. This mouse model for B. tamiae induced disease not only strengthens the causal link between this pathogen and clinical illness in humans, but provides a model to further study the pathological processes induced by these bacteria.
PMCID: PMC2920874 PMID: 20673363 [PubMed - indexed for MEDLINE]
11. Zhonghua Bing Li Xue Za Zhi. 2010 Apr;39(4):225-9.
[Application of Warthin-Starry stain, immunohistochemistry and transmission electron microscopy in diagnosis of cat scratch disease.]
[Article in Chinese]
Huang J, Dai L, Lei S, Liao DY, Wang XQ, Luo TY, Chen Y, Hang ZB, Li GD, Dong DD, Xu G, Gu ZC, Hao JL, Hua P, He L, Duan FL.
Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China.
OBJECTIVE: To evaluate the diagnostic utility of Warthin-Starry silver stain, immunohistochemistry and transmission electron microscopy in the detection of human Bartonella henselae infection and pathologic diagnosis of cat scratch disease (CSD). METHODS: The paraffin-embedded lymph node tissues of 77 histologically-defined cases of cat scratch disease collected during the period from January, 1998 to December, 2008 were retrieved and studied using Warthin-Starry silver stain (WS stain) and mouse monoclonal antibody against Bartonella henselae (BhmAB stain). Five cases rich in bacteria were selected for transmission electron microscopy. RESULTS: Under electron microscope, the organisms Bartonella henselae appeared polymorphic, round, elliptical, short rod or bacilliform shapes, ranged from 0.489 to 1.110 microm by 0.333 to 0.534 microm and often clustered together. Black short rod-shaped bacilli arranged in chains or clumps were demonstrated in 61.0% (47/77) of CSD by WS stain. The organisms were located outside the cells and lie mainly in the necrotic debris, especially near the nodal capsule. In 72.7% (56/77) of the cases, dot-like, granular as well as few linear positive signals were observed using BhmAB immunostain and showed similar localization. Positive results for both stains were identified in 59.7% (46/77) of the cases. When applying both stains together, Bartonella henselae was observed in 74.0% (57/77) of the case. The difference between the results obtained by WS stain and BhmAB immunostain was of statistical significance (P < 0.05). CONCLUSIONS: Bartonella henselae is the causative pathogen of cat scratch disease. WS stain, BhmAB immunostain and transmission electron microscopy are helpful in confirming the histologic diagnosis. Immunostaining using BhmAB can be a better alternative than WS stain in demonstrating the organisms.
PMID: 20654119 [PubMed - in process]
12. Clin Microbiol Infect. 2010 Jul 15. [Epub ahead of print]
Molecular detection of Ehrlichia canis, Anaplasma bovis, Anaplasma platys, Candidatus Midichloria mitochondrii and Babesia canis vogeli in ticks from Israel.
Harrus S, Perlman-Avrahami A, Mumcuoglu KY, Morick D, Eyal O, Baneth G.
Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Clin Microbiol Infect Abstract Ticks are vectors of important pathogens of human and animals. Therefore, their microbial carriage capacity is constantly being investigated. The aim of this study was to characterize the diversity of domestic animal pathogens in ticks collected from vegetation and the ground, from different parts of Israel. Non-engorged questing adult ticks were collected from 13 localities. A total of 1196 ticks in 131 pools-83 pools of Rhipicephalus turanicus and 48 of Rhipicephalus sanguineus (with two to ten ticks per pool)-were included in this study. In addition, 13 single free-roaming Hyalomma spp. ticks were collected. Screening by molecular techniques revealed the presence of Ehrlichia canis, Anaplasma platys, Anaplasma bovis and Babesia canis vogeli DNA in R. turanicus ticks. E. canis, A. bovis, B. canis vogeli and Candidatus Midichloria mitochondrii DNA sequences were detected in R. sanguineus ticks. Candidatus Midichloria mitochondrii DNA was also detected in Hyalomma spp. ticks. Neither Hepatozoon spp. nor Bartonella spp. DNA was detected in any of the ticks examined. This study describes the first detection of E. canis in the tick R. turanicus, which may serve as a vector of this canine pathogen; E. canis was the most common pathogen detected in the collected questing ticks. It also describes the first detection of A. bovis and Candidatus Midichloria mitochondrii in Israel. To the best of the author's knowledge, this is the first report describing the detection of DNA of the latter two pathogens in R. sanguineus, and of A. bovis in R. turanicus.
PMID: 20636417 [PubMed - as supplied by publisher]
13. J Clin Microbiol. 2010 Sep;48(9):3295-300. Epub 2010 Jul 7.
Does a feline leukemia virus infection pave the way for Bartonella henselae infection in cats?
Buchmann AU, Kershaw O, Kempf VA, Gruber AD.
Department of Veterinary Pathology, Freie Universitaet Berlin, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany.
Domestic cats serve as the reservoir hosts of Bartonella henselae and may develop mild clinical symptoms or none after experimental infection. In humans, B. henselae infection can result in self-limiting cat scratch disease. However, immunocompromised patients may suffer from more-severe courses of infection or may even develop the potentially lethal disease bacillary angiomatosis. It was reasoned that cats with immunocompromising viral infections may react similarly to B. henselae infection. The aim of our study was to investigate the influence of the most important viruses known to cause immunosuppression in cats-Feline leukemia virus (FeLV), Feline immunodeficiency virus (FIV), and Feline panleukopenia virus (FPV)-on natural B. henselae infection in cats. Accordingly, 142 cats from animal shelters were necropsied and tested for B. henselae and concurrent infections with FeLV, FIV, or FPV by PCR and immunohistochemistry. A significant association was found between B. henselae and FeLV infections (P = 0.00028), but not between B. henselae and FIV (P = 1.0) or FPV (P = 0.756) infection, age (P = 0.392), or gender (P = 0.126). The results suggest that susceptibility to B. henselae infection is higher in cats with concurrent FeLV infections, regardless of whether the infection is latent or progressive. Histopathology and immunohistochemistry for B. henselae failed to identify lesions that could be attributed specifically to B. henselae infection. We conclude that the course of natural B. henselae infection in cats does not seem to be influenced by immunosuppressive viral infections in general but that latent FeLV infection may predispose cats to B. henselae infection or persistence.
PMID: 20610682 [PubMed - in process]
14. FEMS Immunol Med Microbiol. 2010 Jun 7. [Epub ahead of print]
Molecular typing of Bartonella henselae DNA extracted from human clinical specimens and cat isolates in Japan.
Yanagihara M, Tsuneoka H, Hoshide S, Ishido E, Umeda A, Tsukahara M, Nojima J, Ichihara K, Hino K, Hirai I, Yamamoto Y.
Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Abstract Bartonella henselae is the causative agent of cat scratch disease (CSD). To clarify the population structure and relationship between human and cat strains of B. henselae, 55 specimens isolated in Japan, including 24 B. henselae DNA-positive clinical samples from CSD patients and 31 B. henselae isolates from domestic cats, were characterized by multilocus sequence typing (MLST) and the 16S-23S tRNA-Ala/tRNA-Ile intergenic spacer (S1) sequence, which were used previously for strain typing of B. henselae. Three different sequence types (STs) were identified by MLST, one of which was novel. Fifty-two strains (94.5%), including all strains detected in CSD patients, were assigned to ST-1. Eight S1 genotypes were observed, three of which were novel. The 52 ST-1 strains were classified into seven S1 genotypes, two of which were predominant in both human and cat strains. In addition, 5.5% of the strains (3/55) contained two different intergenic spacer S1 copies. These results indicate that the predominant B. henselae MLST ST-1 in Japan is a significantly genetically diverse population on the basis of the sequence diversity of intergenic spacer S1, and that highly prevalent S1 genotypes among cats are often involved in human infections.
PMID: 20602637 [PubMed - as supplied by publisher]
15. Vet Microbiol. 2010 May 12. [Epub ahead of print]
Enrichment culture and molecular identification of diverse Bartonella species in stray dogs.
Bai Y, Kosoy MY, Boonmar S, Sawatwong P, Sangmaneedet S, Peruski LF.
Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 3150 Rampart Road, Fort Collins, CO 80521, USA.
Using pre-enrichment culture in Bartonella alpha-Proteobacteria growth medium (BAPGM) followed by PCR amplification and DNA sequence identification that targeted a fragment of the citrate synthase gene (gltA), we provide evidence of common bartonella infections and diverse Bartonella species in the blood of stray dogs from Bangkok and Khon Kaen, Thailand. The overall prevalence of all Bartonella species was 31.3% (60/192), with 27.9% (31/111) and 35.8% (29/81) in the stray dogs from Bangkok and Khon Kaen, respectively. Phylogenetic analyzes of gltA identified eight species/genotypes of Bartonella in the blood of stray dogs, including B. vinsonii subsp. arupensis, B. elizabethae, B. grahamii, B. quintana, B. taylorii, and three novel genotypes (BK1, KK1 and KK2) possibly representing unique species with =90.2% similarities to any of the known Bartonella species B. vinsonii subsp. arupensis was the only species detected in dogs from both sites, B. quintana and BK1 were found in the dogs from Bangkok, B. elizabethae, B. taylorii, KK1 and KK2 were found in the dogs from Khon Kaen. We conclude that stray dogs in Thailand are frequently infected with Bartonella species that vary with geographic region. As some Bartonella species detected in the present study are considered pathogenic for humans, stray dogs in Thailand may serve as possible reservoirs for Bartonella causing human illnesses. Further work is needed to determine the role of those newly discovered Bartonella genotypes/species in human and veterinary medicine.
PMID: 20570065 [PubMed - as supplied by publisher]
16. J Infect Chemother. 2010 Jun 22. [Epub ahead of print]
Antimicrobial susceptibility by Etest of Bartonella henselae isolated from cats and human in Japan.
Tsuneoka H, Yanagihara M, Nojima J, Ichihara K.
Department of Clinical Laboratory Science, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan, email@example.com.
Bartonella henselae, a small fastidious Gram-negative bacillus, is the causative agent of cat-scratch disease (CSD). Because of difficulty in isolating the organism, there has been no report on its antibiotic susceptibility in Japan. We determined the minimal inhibitory concentrations (MICs) of eight antimicrobial agents against 32 isolates of B. henselae (31 from cats and one from a human in Japan) by the Etest method. MICs of all 32 isolates were <0.016 mug/ml for minocycline and ranged from =0.016 to 0.064 mug/ml for erythromycin, clarithromycin, azithromycin, ceftriaxone, and amoxicillin. MICs ranges of ciprofloxacin and gentamicin were from 0.064 to 0.25 mug/ml and from 0.5 to 3 mug/ml, respectively. All isolated strains showed high susceptibility to minocycline and macrolides antibiotics, which are currently used in the primary treatment of CSD in Japan. Although in vitro result of B. henselae susceptibility testing may not necessarily correlate with clinical response, these data are relevant in the choice of drugs for CSD treatment.
PMID: 20567991 [PubMed - as supplied by publisher]
17. PLoS Pathog. 2010 Jun 10;6(6):e1000946.
The Trw type IV secretion system of Bartonella mediates host-specific adhesion to erythrocytes.
Vayssier-Taussat M, Le Rhun D, Deng HK, Biville F, Cescau S, Danchin A, Marignac G, Lenaour E, Boulouis HJ, Mavris M, Arnaud L, Yang H, Wang J, Quebatte M, Engel P, Saenz H, Dehio C.
Unit� Sous Contrat Bartonella, INRA, Maisons-Alfort, France. firstname.lastname@example.org
Bacterial pathogens typically infect only a limited range of hosts; however, the genetic mechanisms governing host-specificity are poorly understood. The alpha-proteobacterial genus Bartonella comprises 21 species that cause host-specific intraerythrocytic bacteremia as hallmark of infection in their respective mammalian reservoirs, including the human-specific pathogens Bartonella quintana and Bartonella bacilliformis that cause trench fever and Oroya fever, respectively. Here, we have identified bacterial factors that mediate host-specific erythrocyte colonization in the mammalian reservoirs. Using mouse-specific Bartonella birtlesii, human-specific Bartonella quintana, cat-specific Bartonella henselae and rat-specific Bartonella tribocorum, we established in vitro adhesion and invasion assays with isolated erythrocytes that fully reproduce the host-specificity of erythrocyte infection as observed in vivo. By signature-tagged mutagenesis of B. birtlesii and mutant selection in a mouse infection model we identified mutants impaired in establishing intraerythrocytic bacteremia. Among 45 abacteremic mutants, five failed to adhere to and invade mouse erythrocytes in vitro. The corresponding genes encode components of the type IV secretion system (T4SS) Trw, demonstrating that this virulence factor laterally acquired by the Bartonella lineage is directly involved in adherence to erythrocytes. Strikingly, ectopic expression of Trw of rat-specific B. tribocorum in cat-specific B. henselae or human-specific B. quintana expanded their host range for erythrocyte infection to rat, demonstrating that Trw mediates host-specific erythrocyte infection. A molecular evolutionary analysis of the trw locus further indicated that the variable, surface-located TrwL and TrwJ might represent the T4SS components that determine host-specificity of erythrocyte parasitism. In conclusion, we show that the laterally acquired Trw T4SS diversified in the Bartonella lineage to facilitate host-restricted adhesion to erythrocytes in a wide range of mammals.
PMCID: PMC2883598 PMID: 20548954 [PubMed - in process]
18. Clin Infect Dis. 2010 Jul 15;51(2):131-40.
Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases.
Fournier PE, Thuny F, Richet H, Lepidi H, Casalta JP, Arzouni JP, Maurin M, C�lard M, Mainardi JL, Caus T, Collart F, Habib G, Raoult D.
Unit� de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Centre National de la Recherche Scientifique-Institut de Recherche pour le D�veloppement, Unit� Mixte de Recherche 6236, Facult� de M�decine, Universit� de la M�diterran�e, France.
Comment in: Clin Infect Dis. 2010 Jul 15;51(2):141-2.
BACKGROUND. Blood culture-negative endocarditis (BCNE) may account for up to 31% of all cases of endocarditis. METHODS. We used a prospective, multimodal strategy incorporating serological, molecular, and histopathological assays to investigate specimens from 819 patients suspected of having BCNE. RESULTS. Diagnosis of endocarditis was first ruled out for 60 patients. Among 759 patients with BCNE, a causative microorganism was identified in 62.7%, and a noninfective etiology in 2.5%. Blood was the most useful specimen, providing a diagnosis for 47.7% of patients by serological analysis (mainly Q fever and Bartonella infections). Broad-range polymerase chain reaction (PCR) of blood and Bartonella-specific Western blot methods diagnosed 7 additional cases. PCR of valvular biopsies identified 109 more etiologies, mostly streptococci, Tropheryma whipplei, Bartonella species, and fungi. Primer extension enrichment reaction and autoimmunohistochemistry identified a microorganism in 5 additional patients. No virus or Chlamydia species were detected. A noninfective cause of endocarditis, particularly neoplasic or autoimmune disease, was determined by histological analysis or by searching for antinuclear antibodies in 19 (2.5%) of the patients. Our diagnostic strategy proved useful and sensitive for BCNE workup. CONCLUSIONS. We highlight the major role of zoonotic agents and the underestimated role of noninfective diseases in BCNE. We propose serological analysis for Coxiella burnetii and Bartonella species, detection of antinuclear antibodies and rheumatoid factor as first-line tests, followed by specific PCR assays for T. whipplei, Bartonella species, and fungi in blood. Broad-spectrum 16S and 18S ribosomal RNA PCR may be performed on valvular biopsies, when available.
PMID: 20540619 [PubMed - indexed for MEDLINE]
19. Med Vet Entomol. 2010 Sep;24(3):258-65. Epub 2010 Jun 1.
Phylogenetics and population genetics of the louse fly, Lipoptena mazamae, from Arkansas, USA.
Trout RT, Steelman CD, Szalanski AL.
Department of Entomology, University of Arkansas, Fayetteville, AR 72701, USA. email@example.com
Louse flies, also known as deer keds (Lipoptena mazamae Rondani), infest cervids such as white-tailed deer, Odocoileus virginianus and vector pathogens such as Anaplasma and Bartonella schoenbuchensis to cattle and humans, respectively. The population genetic structure of 30 L. mazamae collected from white-tailed deer in four regions of Arkansas, U.S.A., designated by county boundaries, was examined using DNA sequences of a 259-bp region of the mitochondrial DNA rRNA 16S gene. Of the 259 nucleotide characters, 33 were variable and 6 haplotypes were identified. Two haplotypes occurred only once (haplotype 3 and 4), whereas two other haplotypes occurred in 43% (haplotype 1 in two regions) and 40% (haplotype 6 in three regions) of the samples. Phylogenetic relationships of the six L. mazamae haplotypes were constructed with other Hippoboscid and Glossinid samples and two clades resulted. Clade 1 was located in the north and western Ozarks whereas clade 2 was found in the northern and eastern Ozarks. Results from the present study indicate that Lipoptena may be a polyphyletic genus; consequently, more research into genetic variation within this genus is necessary.
PMID: 20534010 [PubMed - in process]
20. Am J Trop Med Hyg. 2010 Jun;82(6):1140-5.
Identification of Bartonella infections in febrile human patients from Thailand and their potential animal reservoirs.
Kosoy M, Bai Y, Sheff K, Morway C, Baggett H, Maloney SA, Boonmar S, Bhengsri S, Dowell SF, Sitdhirasdr A, Lerdthusnee K, Richardson J, Peruski LF.
Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80521, USA. firstname.lastname@example.org
To determine the role of Bartonella species as causes of acute febrile illness in humans from Thailand, we used a novel strategy of co-cultivation of blood with eukaryotic cells and subsequent phylogenetic analysis of Bartonella-specific DNA products. Bartonella species were identified in 14 blood clots from febrile patients. Sequence analysis showed that more than one-half of the genotypes identified in human patients were similar or identical to homologous sequences identified in rodents from Asia and were closely related to B. elizabethae, B. rattimassiliensis, and B. tribocorum. The remaining genotypes belonged to B. henselae, B. vinsonii, and B. tamiae. Among the positive febrile patients, animal exposure was common: 36% reported owning either dogs or cats and 71% reported rat exposure during the 2 weeks before illness onset. The findings suggest that rodents are likely reservoirs for a substantial portion of cases of human Bartonella infections in Thailand.
PMCID: PMC2877425 [Available on 2011/6/1] PMID: 20519614 [PubMed - indexed for MEDLINE]
21. Emerg Infect Dis. 2010 Jun;16(6):1025-7.
Who is this man?
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. email@example.com
PMID: 20507765 [PubMed - indexed for MEDLINE]
22. BMC Infect Dis. 2010 May 20;10:121.
Seroprevalence of Bartonella in Eastern China and analysis of risk factors.
Sun J, Fu G, Lin J, Song X, Lu L, Liu Q.
Department of Vector Biology and Control,State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
BACKGROUND: Bartonella infections are emerging in the Zhejiang Province of China. However, there has been no effort to date to explore the epidemiology of these infections in this region, nor to identify risk factors associated with exposure to Bartonella. The aim of this study was to investigate the seroprevalence of Bartonella in both patients bitten by dogs and blood donors (for control) in Eastern China, and to identify risk factors associated with exposure to Bartonella. As no previous data for this region have been published, this study will provide baseline data useful for Bartonella infection surveillance, control, and prevention. METHODS: Blood samples were collected from industrial rabies clinic attendees and blood donors living in eight areas of the Zhejiang Province of China, between December 2005 and November 2006. An indirect immunofluorescent antibody test was used to determine the presence of Bartonella in these samples. Risk factors associated with Bartonella exposure were explored using Chi-square tests and logistic regression analysis of epidemiological data relating to the study's participants. RESULTS: Bartonella antibodies were detected in 19.60% (109/556) of blood samples. Seroprevalence varied among the eight areas surveys, ranging from over 32% in Hangzhou to only 2% in Jiangshan (X2 = 28.22, P < 0.001). We detected a significantly higher prevalence of Bartonella antibodies in people who had been bitten by dogs than in blood donors (X2 = 13.86, P < 0.001). Seroprevalence of Bartonella was similar among males (18.61%, n = 317) and females (20.92%, n = 239). CONCLUSIONS: Bartonella antibodies were encountered in people living across Zhejiang Province and the seropositivity rate among those exposed to dog bites was significantly higher than that among blood donors, indicating that dog bites may be a risk factor for Bartonella infection.
PMCID: PMC2886056 PMID: 20482887 [PubMed - indexed for MEDLINE]
23. Mol Ecol. 2010 Jun;19(11):2241-55. Epub 2010 May 6.
Rapid diversification by recombination in Bartonella grahamii from wild rodents in Asia contrasts with low levels of genomic divergence in Northern Europe and America.
Berglund EC, Ellegaard K, Granberg F, Xie Z, Maruyama S, Kosoy MY, Birtles RJ, Andersson SG.
Department of Molecular Evolution, Uppsala University, Uppsala, Sweden.
Bartonella is a genus of vector-borne bacteria that infect the red blood cells of mammals, and includes several human-specific and zoonotic pathogens. Bartonella grahamii has a wide host range and is one of the most prevalent Bartonella species in wild rodents. We studied the population structure, genome content and genome plasticity of a collection of 26 B. grahamii isolates from 11 species of wild rodents in seven countries. We found strong geographic patterns, high recombination frequencies and large variations in genome size in B. grahamii compared with previously analysed cat- and human-associated Bartonella species. The extent of sequence divergence in B. grahamii populations was markedly lower in Europe and North America than in Asia, and several recombination events were predicted between the Asian strains. We discuss environmental and demographic factors that may underlie the observed differences.
PMID: 20465583 [PubMed - indexed for MEDLINE]
24. Wiad Parazytol. 2010;56(1):1-9.
[Bartonella spp. as a zoonotic pathogens transmitting by blood-feeding arthropods]
[Article in Polish]
Katedra Genetyki, Uniwersytet Szczeci�ski, al. Piast�w 40B, 71-065 Szczecin. firstname.lastname@example.org
Prior to 1993, Bartonella bacilliformis was the only member of the Bartonella genus. Now, the genus Bartonella currently contains over 30 species of Gram-negative bacteria that parasitize mammalian erythrocytes and endothelial cells. Bartonella spp. have been isolated from a variety of mammal species, most often from rodents, ruminants and carnivores, and these animals are implicated as reservoirs for the genus Bartonella. The persistent bacteriemia is more readily documented in the primary reservoir species and may occur less frequently or to a much lower lever in accidental hosts. In the natural host, clinical manifestations of the infection may be minimal or unrecognizable. Several insects have been implicated in Bartonella transmission, including flies and ticks. The reservoir host and vector varying depending on the Bartonella species involved, although, neither the reservoir, nor the vector has been identified definitively for many recently described Bartonella species. Humans are natural reservoir hosts for two species: Bartonella bacilliformis and Bartonella quintana, but many animal-associated Bartonella can also cause disease in humans. Members of the genus Bartonella are involved in a variety of human diseases, such as Carrion's disease, cat scratch disease, trench fever, bacillary angiomatosis, endocarditis, pericarditis and neuroretinitis. Most cases of bartonellosis are now diagnosed by tests based on PCR or through serological tests using specific antigens.
PMID: 20450002 [PubMed - indexed for MEDLINE]
25. J Bacteriol. 2010 Jul;192(13):3352-67. Epub 2010 Apr 23.
The BatR/BatS two-component regulatory system controls the adaptive response of Bartonella henselae during human endothelial cell infection.
Quebatte M, Dehio M, Tropel D, Basler A, Toller I, Raddatz G, Engel P, Huser S, Schein H, Lindroos HL, Andersson SG, Dehio C.
Focal Area Infection Biology, Biozentrum, University of Basel, Klingelbergstrasse 70, CH-4056 Basel, Switzerland.
Here, we report the first comprehensive study of Bartonella henselae gene expression during infection of human endothelial cells. Expression of the main cluster of upregulated genes, comprising the VirB type IV secretion system and its secreted protein substrates, is shown to be under the positive control of the transcriptional regulator BatR. We demonstrate binding of BatR to the promoters of the virB operon and a substrate-encoding gene and provide biochemical evidence that BatR and BatS constitute a functional two-component regulatory system. Moreover, in contrast to the acid-inducible (pH 5.5) homologs ChvG/ChvI of Agrobacterium tumefaciens, BatR/BatS are optimally activated at the physiological pH of blood (pH 7.4). By conservation analysis of the BatR regulon, we show that BatR/BatS are uniquely adapted to upregulate a genus-specific virulence regulon during hemotropic infection in mammals. Thus, we propose that BatR/BatS two-component system homologs represent vertically inherited pH sensors that control the expression of horizontally transmitted gene sets critical for the diverse host-associated life styles of the alphaproteobacteria.
PMCID: PMC2897681 [Available on 2011/1/1] PMID: 20418395 [PubMed - indexed for MEDLINE]
26. Hawaii Med J. 2010 Mar;69(3):68-9.
A "silent culture-negative" abdominal aortic mycotic aneurysm: Rapid detection of Bartonella species using PCR and high-throughput mass spectrometry.
Koo M, Manalili S, Bankowski MJ, Sampath R, Hofstadler SA, Koo J.
University of Hawai'i John A Burns School of Medicine, Honolulu, HI 96813, USA.
A gram-negative, rod-shaped microorganism was detected in a 69-year-old man suffering from chronic back pain but otherwise exhibiting no signs of infection. The bacterium could not be identified using any routine diagnostic modality. A research use only application utilizing PCR and Mass Spectrometry was performed on nucleic acid extracted from the tissue sample. These studies resulted in the implication of Bartonella quintana as the underlying cause of the infection. B. quintana is not a well-known cause of an abdominal aortic mycotic aneurysm. This article will discuss the B. quintana infection, its diagnosis and treatment, and reinforce the potential of B. quintana as a possible etiology in mycotic aneurysms that show no apparent indications of infection. It will also explore the potential use of polymerase chain reaction detected by electrospray ionization mass spectrometry (PCR/ESI-MS) to help identify B. quintana in a situation where other conventional methods prove non-informative.
PMID: 20397506 [PubMed - indexed for MEDLINE]
27. Am J Pathol. 2010 Jun;176(6):2753-63. Epub 2010 Apr 15.
An immunocompromised murine model of chronic Bartonella infection.
Chiaraviglio L, Duong S, Brown DA, Birtles RJ, Kirby JE.
Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
Bartonella are ubiquitous gram-negative pathogens that cause chronic blood stream infections in mammals. Two species most often responsible for human infection, B. henselae and B. quintana, cause prolonged febrile illness in immunocompetent hosts, known as cat scratch disease and trench fever, respectively. Fascinatingly, in immunocompromised hosts, these organisms also induce new blood vessel formation leading to the formation of angioproliferative tumors, a disease process named bacillary angiomatosis. In addition, they cause an endothelial-lined cystic disease in the liver known as bacillary peliosis. Unfortunately, there are as yet no completely satisfying small animal models for exploring these unique human pathologies, as neither species appears able to sustain infection in small animal models. Therefore, we investigated the potential use of other Bartonella species for their ability to recapitulate human pathologies in an immunodeficient murine host. Here, we demonstrate the ability of Bartonella taylorii to cause chronic infection in SCID/BEIGE mice. In this model, Bartonella grows in extracellular aggregates, embedded within collagen matrix, similar to previous observations in cat scratch disease, bacillary peliosis, and bacillary angiomatosis. Interestingly, despite overwhelming infection later in disease, evidence for significant intracellular replication in endothelial or other cell types was not evident. We believe that this new model will provide an important new tool for investigation of Bartonella-host interaction.
PMCID: PMC2877837 [Available on 2011/6/1] PMID: 20395436 [PubMed - in process]
28. J Clin Microbiol. 2010 Jun;48(6):2289-93. Epub 2010 Apr 14.
Molecular evidence of perinatal transmission of Bartonella vinsonii subsp. berkhoffii and Bartonella henselae to a child.
Breitschwerdt EB, Maggi RG, Farmer P, Mascarelli PE.
College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough Street, Raleigh, NC 27606-1428, USA. email@example.com
Bartonella vinsonii subsp. berkhoffii, Bartonella henselae, or DNA of both organisms was amplified and sequenced from blood, enrichment blood cultures, or autopsy tissues from four family members. Historical and microbiological results support perinatal transmission of Bartonella species in this family. It is of clinical relevance that Bartonella spp. may adversely influence human reproductive performance.
PMCID: PMC2884525 [Available on 2010/12/1] PMID: 20392912 [PubMed - indexed for MEDLINE]
29. J Am Vet Med Assoc. 2010 Apr 15;236(8):869-73.
Evaluation of topical application of 10% imidacloprid-1% moxidectin to prevent Bartonella henselae transmission from cat fleas.
Bradbury CA, Lappin MR.
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA. firstname.lastname@example.org
OBJECTIVE: To determine whether monthly topical administration of a combination of 10% imidacloprid and 1% moxidectin would lessen flea (Ctenocephalides felis) transmission of Bartonella henselae among cats. DESIGN: Controlled trial. ANIMALS: 18 specific pathogen-free cats housed in 3 groups of 6. PROCEDURES: 3 enclosures were separated by mesh to allow fleas to pass among groups yet prevent cats from contacting one another. One group was inoculated IV with B henselae, and after infection was confirmed, the cats were housed in the middle enclosure. This infected group was flanked by a group that was treated topically with 10% imidacloprid-1% moxidectin monthly for 3 months and by an untreated group. On days 0, 15, 28, and 42, 100 fleas/cat were placed on each of the 6 cats in the B henselae-infected group. Blood samples were collected from all cats weekly for detection of Bartonella spp via PCR assay, bacterial culture, and serologic assay. RESULTS: B henselae infection was confirmed in the cats infected IV and in all untreated cats after flea exposure; none of the cats treated with the imidacloprid-moxidectin combination became infected. CONCLUSIONS AND CLINICAL RELEVANCE: In this setting, monthly topical administration of 10% imidacloprid-1% moxidectin reduced flea infestation, compared with infestation in untreated cats, and thus prevented flea transmission of B henselae to treated cats. Regular monthly use of this flea control product in cats may lessen the likelihood of humans acquiring B henselae infection.
PMID: 20392182 [PubMed - indexed for MEDLINE]
30. Parasit Vectors. 2010 Apr 8;3(1):29.
Bartonella vinsonii subsp. berkhoffii and Bartonella henselae bacteremia in a father and daughter with neurological disease.
Breitschwerdt EB, Maggi RG, Lantos PM, Woods CW, Hegarty BC, Bradley JM.
Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough St,, Raleigh, NC, USA. email@example.com.
ABSTRACT: BACKGROUND: Bartonella vinsonii subsp. berkhoffii is an important, emerging, intravascular bacterial pathogen that has been recently isolated from immunocompetent patients with endocarditis, arthritis, neurological disease and vasoproliferative neoplasia. Vector transmission is suspected among dogs and wild canines, which are the primary reservoir hosts. This investigation was initiated to determine if pets and family members were infected with one or more Bartonella species. METHODS: PCR and enrichment blood culture in Bartonella alpha Proteobacteria growth medium (BAPGM) was used to determine infection status. Antibody titers to B. vinsonii subsp. berkhoffii genotypes I-III and B. henselae were determined using a previously described indirect fluorescent antibody test. Two patients were tested sequentially for over a year to assess the response to antibiotic treatment. RESULTS: Intravascular infection with B. vinsonii subsp. berkhoffii genotype II and Bartonella henselae (Houston 1 strain) were confirmed in a veterinarian and his daughter by enrichment blood culture, followed by PCR and DNA sequencing. Symptoms included progressive weight loss, muscle weakness, lack of coordination (the father) and headaches, muscle pain and insomnia (the daughter). B. vinsonii subsp. berkhoffii genotype II was also sequenced from a cerebrospinal fluid BAPGM enrichment culture and from a periodontal swab sample. After repeated courses of antibiotics, post-treatment blood cultures were negative, there was a decremental decrease in antibody titers to non-detectable levels and symptoms resolved in both patients. CONCLUSIONS: B. vinsonii subsp. berkhoffii and B. henselae are zoonotic pathogens that can be isolated from the blood of immunocompetent family members with arthralgias, fatigue and neurological symptoms. Therapeutic elimination of Bartonella spp. infections can be challenging, and follow-up testing is recommended. An increasing number of arthropod vectors, including biting flies, fleas, keds, lice, sandflies and ticks have been confirmed or are suspected as the primary mode of transmission of Bartonella species among animal populations and may also pose a risk to human beings.
PMCID: PMC2859367 PMID: 20377863 [PubMed - in process]
31. Vet Dermatol. 2010 Mar 31. [Epub ahead of print]
Bacillary angiomatosis in an immunosuppressed dog.
Yager JA, Best SJ, Maggi RG, Varanat M, Znajda N, Breitschwerdt EB.
Yager-Best Veterinary Surgical Pathology, Guelph, ON, Canada N1E 6V1.
Abstract A dog being treated with immunosuppressive doses of prednisone and azathioprine for pancytopenia of unknown origin, developed, over a 2-week period, multiple erythematous nodular lesions in the skin including footpads. Skin samples revealed lesions identical to those of human bacillary angiomatosis (BA). The nodules were composed of multifocal proliferations of capillaries, each lined by protuberant endothelial cells. The capillary clusters were separated by an oedematous connective tissue, lightly infiltrated with degenerate inflammatory cells, including neutrophils and macrophages. Tissue sections stained with Warthin-Starry silver stain revealed large numbers of positively stained bacilli in the stromal tissue, most heavily concentrated around the proliferating capillaries. Lesions of vascular degeneration and inflammation were evident. Bartonella vinsonii subsp. berkhoffii genotype 1 was independently amplified and sequenced from the blood and the skin tissue. The pathognomonic nature of the histological lesions, demonstration of compatible silver-stained bacilli in the tissue, and identification of B. vinsonii subsp. berkhoffii in the blood and tissue indicates that this is most likely the aetiologic agent responsible for the lesions. Antibiotic therapy was successful in resolving the nodules. It would appear that B. vinsonii subsp berkhoffii, like Bartonella henselae and Bartonella quintana, has the rare ability to induce angioproliferative lesions, most likely in association with immunosuppression. The demonstration of lesions identical to those of human BA in this dog is further evidence that the full range of clinical manifestations of human Bartonella infection occurs also in canines.
PMID: 20374571 [PubMed - as supplied by publisher]
32. Emerg Infect Dis. 2010 Apr;16(4):743-5.
Bartonella spp. infections, Thailand.
Bhengsri S, Baggett HC, Peruski LF Jr, Morway C, Bai Y, Fisk TL, Sitdhirasdr A, Maloney SA, Dowell SF, Kosoy M.
PMID: 20350414 [PubMed - indexed for MEDLINE]
33. Rev Med Liege. 2010 Feb;65(2):78-80.
[A clinical case of spontaneous involution of systemic cat scratch disease]
[Article in French]
Loeckx I, Tuerlinckx D, Jespers S, Marchant AS, Bodart E.
Service de P�diatrie, Universit� Catholique de Louvain, Cliniques Universitaires de Mont-Godinne, 5530 Yvoir, Belgique.
Typical Cat-scratch disease (CSD) manifests as regional lymphadenopathy following cat scratch and sometimes associated with mild fever. There is a lot of atypical manifestations and some of those have systemic involvement. Hepatosplenic CSD is a systemic presentation associating fever of unknown origin with nodules in the liver and/or the spleen. Ultrasound abdominal examination shows nodules (3-30 mm) in the spleen and/or in the liver. Diagnostic is based on serology for B henselae (always IgG + and sometimes IgM +), or polymerase chain reaction (PCR) on the liver to test for the presence of B henselae. Hepatosplenic CSD is rare and therefore underdiagnosed. There is no consensus about the treatment but most of the authors suggest to treat with rifampicine. We report a case of a 4-years-old girl presenting with fever of unknown origin (FUO), high inflammatory markers with normal leukocytosis and hepatosplenic nodules. The diagnosis of CSD was made retrospectively. Evolution was favourable even though no specific antibiotic treatment for Bartonella henselae was administrated.
PMID: 20344917 [PubMed - indexed for MEDLINE]
34. PLoS One. 2010 Mar 19;5(3):e9765.
Multi-locus sequence typing of a geographically and temporally diverse sample of the highly clonal human pathogen Bartonella quintana.
Arvand M, Raoult D, Feil EJ.
Hesse State Health Office, Centre for Health Protection, Dillenburg, Germany. firstname.lastname@example.org
Bartonella quintana is a re-emerging pathogen and the causative agent of a variety of disease manifestations in humans including trench fever. Various typing methods have been developed for B. quintana, but these tend to be limited by poor resolution and, in the case of gel-based methods, a lack of portability. Multilocus sequence typing (MLST) has been used to study the molecular epidemiology of a large number of pathogens, including B. henselae, a close relative of B. quintana. We developed a MLST scheme for B. quintana based on the 7 MLST loci employed for B. henselae with two additional loci to cover underrepresented regions of the B. quintana chromosome. A total of 16 B. quintana isolates spanning over 60 years and three continents were characterized. Allelic variation was detected in five of the nine loci. Although only 8/4270 (0.002%) of the nucleotide sites examined were variable over all loci, these polymorphisms resolved the 16 isolates into seven sequence types (STs). We also demonstrate that MLST can be applied on uncultured isolates by direct PCR from cardiac valve tissue, and suggest this method presents a promising approach for epidemiological studies in this highly clonal organism. Phylogenetic and clustering analyses suggest that two of the seven STs form a distinct lineage within the population.
PMCID: PMC2841634 PMID: 20333257 [PubMed - in process]
35. J Vet Emerg Crit Care (San Antonio). 2010 Feb;20(1):62-9.
Feline hemotropic mycoplasmas.
Department of Medicine & Epidemiology, University of California - Davis, Davis, CA 95618, USA. email@example.com
OBJECTIVE: To describe the current understanding of the etiology, pathogenesis, diagnosis, and treatment of feline hemotropic mycoplasmosis (feline infectious anemia). DATA SOURCES: Manuscripts published on hemotropic mycoplasmosis in cats and other animal species, based on a search of PubMed using the search terms 'hemoplasmas,''haemoplasmas,''hemotropic,''haemotropic,' and 'Haemobartonella,' as well as references published within manuscripts accessed. HUMAN DATA SYNTHESIS: Although hemotropic bacteria such as Bartonella bacilliformis have been recognized in humans for over 100 years, it has only been in recent years that some of these have been identified as hemotropic mycoplasmas. VETERINARY DATA SYNTHESIS: Three species of hemotropic mycoplasmas have been documented in cats worldwide, Mycoplasma haemofelis, 'Candidatus Mycoplasma turicensis,' and 'Candidatus Mycoplasma haemominutum.' These organisms were previously known as Haemobartonella felis, but are now known to be mycoplasmas. M. haemofelis is the most pathogenic species, and causes anemia in immunocompetent cats. Although 'Candidatus Mycoplasma turicensis' and 'Candidatus Mycoplasma haemominutum' may be more capable of causing anemia in immunosuppressed cats, their pathogenicity remains controversial. Assays based on polymerase chain reaction technology are the most sensitive and specific diagnostic tests available for these organisms, because they remain uncultivable in the laboratory setting. Blood smears are unreliable for diagnosis of hemoplasmosis because of their lack of sensitivity and specificity. CONCLUSIONS: Cats presenting to emergency/critical care specialists with hemolytic anemia should be tested using polymerase chain reaction assays for hemotropic mycoplasmas before instituting antimicrobial therapy. Positive test results for M. haemofelis suggest involvement of this organism in hemolytic anemia. Other differential diagnoses for hemolytic anemia should be considered in cats testing positive for 'Candidatus Mycoplasma turicensis' and 'Candidatus Mycoplasma haemominutum,' because the presence of these organisms is not always associated with anemia. Blood from infected cats should be handled with care because of the potential zoonotic nature of this infection.
PMID: 20230435 [PubMed - indexed for MEDLINE]
36. J Vet Emerg Crit Care (San Antonio). 2010 Feb;20(1):46-61.
Conventional and molecular diagnostic testing for the acute neurologic patient.
Nghiem PP, Schatzberg SJ.
Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30606, USA.
OBJECTIVE: The aim of this review is to describe and evaluate both conventional and molecular diagnostic testing utilized in dogs and cats with acute neurologic diseases. Various types of polymerase chain reaction (PCR) are explored along with novel molecular diagnostic testing that ultimately may prove useful in the critical care setting. DATA SOURCES: PUBMED was searched to obtain relevant references material using keywords: 'canine OR feline meningitis AND meningoencephalitis,''feline infectious peritonitis,''canine distemper,''canine OR feline AND toxoplasma,''canine neospora,''canine OR feline AND rickettsia,''granulomatous meningoencephalitis,''steroid responsive meningitis arteritis,''necrotizing encephalitis,''novel neurodiagnostics,''canine OR feline AND CNS borrelia,''canine OR feline AND CNS bartonella,''canine OR feline AND CNS fungal,''nested OR multiplex OR degenerate OR consensus OR CODEHOP AND PCR.' Research findings from the authors' laboratory and current veterinary textbooks also were utilized. HUMAN DATA SYNTHESIS: Molecular diagnostic testing including conventional, real-time, and consensus and degenerate PCR and microarray analysis are utilized routinely for the antemortem diagnosis of infectious meningoencephalitis (ME) in humans. Recently, PCR using consensus degenerate hybrid primers (CODEHOP) has been used to identify and characterize a number of novel human viruses. VETERINARY DATA SYNTHESIS: Molecular diagnostic testing such as conventional and real-time PCR aid in the diagnosis of several important central nervous system infectious agents including canine distemper virus, Toxoplasma gondii, Neospora caninum, rickettsial species, and others. Recently, broadly reactive consensus and degenerate PCR reactions have been applied to canine ME including assays for rickettsial organisms, Borrelia spp. and Bartonella spp., and various viral families. CONCLUSIONS: In the acute neurologic patient, there are several key infectious diseases that can be pursued by a combination of conventional and molecular diagnostic testing. It is important that the clinician understands the utility, as well as the limitations, of the various neurodiagnostic tests that are available.
PMID: 20230434 [PubMed - indexed for MEDLINE]
37. J Vet Emerg Crit Care (San Antonio). 2010 Feb;20(1):8-30.
Bartonellosis: an emerging infectious disease of zoonotic importance to animals and human beings.
Breitschwerdt EB, Maggi RG, Chomel BB, Lappin MR.
Department of Clinical Sciences, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA. firstname.lastname@example.org
OBJECTIVE: To provide a review of clinically relevant observations related to Bartonella species as emerging pathogens in veterinary and human medicine. DATA SOURCES: Literature as cited in PubMed and as generated by each of the authors who have contributed to various aspects of the clinical understanding of bartonellosis. HUMAN DATA SYNTHESIS: Important historical and recent publications illustrating the evolving role of animal reservoirs as a source of human infection. VETERINARY DATA SYNTHESIS: Comprehensive review of the veterinary literature. CONCLUSIONS: In addition to inducing life-threatening illnesses, such as endocarditis, myocarditis, and meningoencephalitis and contributing to chronic debilitating disease, such as arthritis, osteomyelitis, and granulomatous inflammation in cats, dogs, and potentially other animal species; pets and wildlife species can serve as persistently infected reservoir hosts for the transmission of Bartonella spp. infection to veterinary professionals and others with direct animal contact.
PMID: 20230432 [PubMed - indexed for MEDLINE]
38. Appl Environ Microbiol. 2010 May;76(9):2923-31. Epub 2010 Mar 12.
Prevalence and seasonality of tick-borne pathogens in questing Ixodes ricinus ticks from Luxembourg.
Reye AL, H�bschen JM, Sausy A, Muller CP.
Institute of Immunology, National Public Health Laboratory/CRP Sant�, Luxembourg, Luxembourg.
In Europe, ixodid ticks are important arthropod vectors of human and animal pathogens, but comprehensive studies of the prevalence of all relevant pathogens in Central Europe are scarce. As a result of ecological changes, the incidences of tick-borne infections are expected to increase. In this study, 1,394 nymphal and adult Ixodes ricinus ticks sampled monthly during the active season from 33 ecologically distinct collection sites throughout Luxembourg were screened for all human tick-borne pathogens relevant in Central Europe. Species were identified by sequence analysis of detection PCR amplicons. Mean infection rates of ticks were 11.3% for Borrelia burgdorferi sensu lato, 5.1% for Rickettsia sp., 2.7% for Babesia sp., and 1.9% for Anaplasma phagocytophilum. No tick was found to be infected with Coxiella sp., Francisella tularensis subsp., or Tick-borne encephalitis virus (TBEV). A total of 3.2% of ticks were infected with more than one pathogen species, including mixed Borrelia infections (1.5%). Seasonal variations of tick infection rates were observed for Borrelia, Babesia, and Anaplasma, possibly reflecting a behavioral adaptation strategy of questing ticks. A positive correlation between the grade of urbanization and Borrelia infection rate of ticks was observed, suggesting an established urban zoonotic cycle. We also found Hepatozoon canis (0.1%) and Bartonella henselae (0.3%), which so far have not been found in questing Ixodes ricinus ticks in Central Europe.
PMCID: PMC2863427 [Available on 2010/11/1] PMID: 20228110 [PubMed - indexed for MEDLINE]
39. J Med Microbiol. 2010 Jun;59(Pt 6):743-5. Epub 2010 Mar 11.
Evaluation of sensitivity, specificity and cross-reactivity in Bartonella henselae serology.
Vermeulen MJ, Verbakel H, Notermans DW, Reimerink JH, Peeters MF.
PMID: 20223899 [PubMed - indexed for MEDLINE]
40. Acta Trop. 2010 Jul-Aug;115(1-2):137-41. Epub 2010 Mar 3.
Bartonella spp. infection in HIV positive individuals, their pets and ectoparasites in Rio de Janeiro, Brazil: serological and molecular study.
Lamas CC, Mares-Guia MA, Rozental T, Moreira N, Favacho AR, Barreira J, Guterres A, B�ia MN, de Lemos ER.
Laborat�rio de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil. email@example.com
BACKGROUND: Bartonella is the agent of cat-scratch disease, but is also responsible for more severe conditions such as retinitis, meningoencephalitis, endocarditis and bacillary angiomatosis. Its seroprevalence is unknown in Brazil. METHODS: Patients in an AIDS clinic, asymptomatic at the time of the study, were enrolled prospectively. They answered a structured questionnaire and had blood taken for serological and molecular assays. Cat breeder's pets were tested serologically and collected ectoparasites were tested by molecular biology techniques. Blood donors, paired by age and sex, were tested for Bartonella IgG antibodies. RESULTS: 125 HIV positive patients with a median age of 34 were studied; 61 were male and 75% were on HAART. Mean most recent CD4 count was 351-500 cells/mm(3). A high rate of contact with ticks, fleas and lice was observed. Bartonella IgG seroreactivity rate was 38.4% in HIV positive individuals and breeding cats was closely associated with infection (OR 3.6, CI 1.1-11.9, p<0.05). No difference was found between the sexes. Titers were 1:32 in 39 patients, 1:64 in seven, 1:128 in one and 1:256 in one. In the control group, IgG seroreactivity to Bartonella spp. was 34%, and female sex was correlated to seropositivity. Fourteen of 61 (23%) males vs 29/64 (45.3%) females were seroreactive to Bartonella (OR 2.8, CI 1.2-6.5, p<0.01). Titers were 1:32 in 29 patients, 1:64 in ten and 1:128 in four. CONCLUSIONS: Bartonella spp. seroprevalence is high in HIV positive and in blood donors in Rio de Janeiro. This may be of public health relevance.
PMID: 20206113 [PubMed - indexed for MEDLINE]
41. Emerg Infect Dis. 2010 Mar;16(3):500-3.
Candidatus Bartonella mayotimonensis and endocarditis.
Lin EY, Tsigrelis C, Baddour LM, Lepidi H, Rolain JM, Patel R, Raoult D.
Mayo Clinic, Rochester, Minnesota, USA. firstname.lastname@example.org
We describe a new Bartonella species for which we propose the name Candidatus Bartonella mayotimonensis. It was isolated from native aortic valve tissue of a person with infective endocarditis. The new species was identified by using PCR amplification and sequencing of 5 genes (16S rRNA gene, ftsZ, rpoB, gltA, and internal transcribed spacer region).
PMID: 20202430 [PubMed - indexed for MEDLINE]
42. Emerg Infect Dis. 2010 Mar;16(3):385-91.
Potential for tick-borne bartonelloses.
Angelakis E, Billeter SA, Breitschwerdt EB, Chomel BB, Raoult D.
Universit� de la M�diterran�e, Marseille, France.
As worldwide vectors of human infectious diseases, ticks are considered to be second only to mosquitoes. Each tick species has preferred environmental conditions and biotopes that determine its geographic distribution, the pathogens it vectors, and the areas that pose risk for tick-borne diseases. Researchers have identified an increasing number of bacterial pathogens that are transmitted by ticks, including Anaplasma, Borrelia, Ehrlichia, and Rickettsia spp. Recent reports involving humans and canines suggest that ticks should be considered as potential vectors of Bartonella spp. To strengthen this suggestion, numerous molecular surveys to detect Bartonella DNA in ticks have been conducted. However, there is little evidence that Bartonella spp. can replicate within ticks and no definitive evidence of transmission by a tick to a vertebrate host.
PMID: 20202411 [PubMed - indexed for MEDLINE]
43. Emerg Infect Dis. 2010 Mar;16(3):379-84.
Bartonella spp. transmission by ticks not established.
Telford SR 3rd, Wormser GP.
Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachussetts, USA.
Bartonella spp. infect humans and many animal species. Mainly because PCR studies have demonstrated Bartonella DNA in ticks, some healthcare providers believe that these microorganisms are transmitted by ticks. B. henselae, in particular, is regarded as being present in and transmissible by the Ixodes scapularis tick. The presence of a microbial agent within a tick, however, does not imply that the tick might transmit it during the course of blood feeding and does not confer epidemiologic importance. After a critical review of the evidence for and against tick transmission, we conclude that transmission of any Bartonella spp. by ticks, to animals or humans, has not been established. We are unaware of any well-documented case of B. henselae transmission by I. scapularis ticks.
PMID: 20202410 [PubMed - indexed for MEDLINE]
44. BMC Genomics. 2010 Mar 4;11:152.
Genome dynamics of Bartonella grahamii in micro-populations of woodland rodents.
Berglund EC, Ehrenborg C, Vinnere Pettersson O, Granberg F, N�slund K, Holmberg M, Andersson SG.
Department of Moleculcar Evolution, Norbyv�gen 18C, S-75236 Uppsala, Sweden.
BACKGROUND: Rodents represent a high-risk reservoir for the emergence of new human pathogens. The recent completion of the 2.3 Mb genome of Bartonella grahamii, one of the most prevalent blood-borne bacteria in wild rodents, revealed a higher abundance of genes for host-cell interaction systems than in the genomes of closely related human pathogens. The sequence variability within the global B. grahamii population was recently investigated by multi locus sequence typing, but no study on the variability of putative host-cell interaction systems has been performed. RESULTS: To study the population dynamics of B. grahamii, we analyzed the genomic diversity on a whole-genome scale of 27 B. grahamii strains isolated from four different species of wild rodents in three geographic locations separated by less than 30 km. Even using highly variable spacer regions, only 3 sequence types were identified. This low sequence diversity contrasted with a high variability in genome content. Microarray comparative genome hybridizations identified genes for outer surface proteins, including a repeated region containing the fha gene for filamentous hemaggluttinin and a plasmid that encodes a type IV secretion system, as the most variable. The estimated generation times in liquid culture medium for a subset of strains ranged from 5 to 22 hours, but did not correlate with sequence type or presence/absence patterns of the fha gene or the plasmid. CONCLUSION: Our study has revealed a geographic microstructure of B. grahamii in wild rodents. Despite near-identity in nucleotide sequence, major differences were observed in gene presence/absence patterns that did not segregate with host species. This suggests that genetically similar strains can infect a range of different hosts.
PMCID: PMC2847970 PMID: 20202191 [PubMed - indexed for MEDLINE]
45. Ann Emerg Med. 2010 Mar;55(3):280-2; discussion 282-3.
Update on emerging infections: news from the Centers for Disease Control and Prevention. Bartonella quintana in body lice and head lice from homeless persons, San Francisco, California, USA.
Department of Emergency Medicine, Tufts Medical Center, Boston, MA, USA.
Comment on: Emerg Infect Dis. 2009 Jun;15(6):912-5.
PMID: 20201124 [PubMed - indexed for MEDLINE]
46. An Pediatr (Barc). 2010 Apr;72(4):290-1. Epub 2010 Mar 2.
[Neuroretinitis in cat-scratch disease]
[Article in Spanish]
Dur� Trav� T, Yoldi Petri ME, Lavilla Oiz A, Molins Castiella T.
PMID: 20199895 [PubMed - indexed for MEDLINE]
47. Trends Parasitol. 2010 Apr;26(4):197-204. Epub 2010 Feb 23.
Flea-associated zoonotic diseases of cats in the USA: bartonellosis, flea-borne rickettsioses, and plague.
McElroy KM, Blagburn BL, Breitschwerdt EB, Mead PS, McQuiston JH.
Centers for Disease Control and Prevention, Division of Viral and Rickettsial Diseases, 1600 Clifton Road, Atlanta, GA 30333, USA.
Cat-scratch disease, flea-borne typhus, and plague are three flea-associated zoonoses of cats of concern in the USA. Although flea concentrations may be heaviest in coastal and temperate climates, fleas and flea-borne disease agents can occur almost anywhere in the USA. Understanding flea-borne pathogens, and the associated risks for owners and veterinarians, is important to reduce the likelihood of zoonotic infection.
PMID: 20185369 [PubMed - indexed for MEDLINE]
48. Cutis. 2010 Jan;85(1):37-42.
Inoculation bartonellosis in an adult: a case report.
Bolton JG, Galeckas KJ, Satter EK.
Branch Medical Clinic, Marine Corps Air Station, PO Box 452002, San Diego, CA 92145, USA. email@example.com
Cat-scratch disease (CSD) and bacillary angiomatosis (BA) are caused by a gram-negative bacilli classified under the genus Bartonella (formerly Rochalimaea). Patient history, symptoms, and histopathology often fall along a continuum; therefore, both conditions should be considered in the differential diagnosis. We report a case of an 83-year-old immunocompetent woman who presented with a pyogenic granuloma-like lesion on her dorsal left wrist. The histologic differential diagnosis included an inoculation site from a cat scratch infected with Bartonella and BA. Because the patient had only 1 lesion at the site of a prior cat scratch, the lesion was diagnosed as inoculation bartonellosis. We also review the epidemiologic, clinical, and histopathologic features of CSD and BA.
PMID: 20184210 [PubMed - indexed for MEDLINE]
49. J Appl Microbiol. 2010 Jan 22. [Epub ahead of print]
Bartonellosis, an increasingly recognized zoonosis.
Chomel BB, Kasten RW.
Department of population Health and reproduction, School of Veterinary Medicine, University of California, Davis CA, USA.
Summary Cat scratch disease is the most common zoonotic infection caused by Bartonella bacteria. Among the many mammals infected with Bartonella spp., cats represent a large reservoir for human infection, as they are the main reservoir for Bartonella henselae, Bartonella clarridgeiae and Bartonella koehlerae. Bartonella spp. are vector-borne bacteria, and transmission of B. henselae by cat fleas occurs mainly through infected flea faeces, although new potential vectors (ticks and biting flies) have been identified. Dogs are also infected with various Bartonella species and share with humans many of the clinical signs induced by these infections. Although the role of dogs as source of human infection is not yet clearly established, they represent epidemiological sentinels for human exposure. Present knowledge on the aetiology, clinical features and epidemiological characteristics of bartonellosis is presented.
PMID: 20148999 [PubMed - as supplied by publisher]
50. Dermatol Online J. 2010 Jan 15;16(1):9.
A toddler with facial nodules: a case of idiopathic facial aseptic granuloma.
Martinez-Diaz GJ, Kim J, Bruckner AL.
Stanford University School of Medicine, USA.
We describe the case of a 3-year-old boy who presented with several asymptomatic facial nodules present for six months. A skin biopsy obtained from the nodules showed a moderately well-defined granuloma in the superficial and deep dermis. A squamous epithelial lined cyst, extravasated keratin, or shadow cells were not identified. Bartonella henselae titers and the Coccidioidomycosis immitis immunodiffusion test were negative; a Tuberculin Skin Test was non-reactive. Fite, Periodic acid-Schiff (PAS) and Gomori-Grocott methenamine silver (GMS) stains failed to identify microorganisms. In addition, tissue cultures for bacteria, fungus, and acid fast bacilli were negative. In light of the clinical findings, histology, and negative cultures, a diagnosis of idiopathic facial aseptic granuloma (IFAG) was made. After the biopsy, the child was treated with erythromycin and clarithromycin, each for one month, and the lesions slowly improved.
PMID: 20137751 [PubMed - indexed for MEDLINE]