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Bartonella Treatment, Testing and Diagnosis: New Research Shows Certainty is Naive


Years ago, before I spent years reading full-time on Bartonella, Babesia and Lyme disease, it is clear I had many false beliefs. The tick infections carried on over 200 animals in America I thought were easy to treat and diagnose. Perhaps they are easy to treat when caught soon after a bite. But newer research and pending research shows deer ticks rarely have one infection in their stomachs. Each season calls into question many things about Bartonella and Babesia and other tick and flea borne infections.

Below is a very tiny sample of Bartonella treatment information. I discuss in my 500 page 2 volume textbook skin diagnosis tools and treatments that routinely fail. The goal then and now is to prevent the damage Bartonella can cause to every human organ.

Pearls exist in some of these abstracts, and if a healer is going to treat Bartonella, perhaps at least they might take a look at these tiny sample abstracts on treatment. This would be a very basic start.

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.

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]

Klin Oczna. 2010;112(4-6):131-4.

[Neuroretinitis in cat scratch disease]

[Article in Polish]

Karolak J, Gotz-Wipckowska A.

Z Katedry i Kliniki Okulistyki Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu.

PURPOSE: To present two cases of neuroretinitis in cat scratch disease We present two girls treated in Department of Ophthalmology of Poznai University of Medical Sciences because of unilateral, painless decrease of vision. Both patients presented following cat exposure fever and lymph nodes swelling. Ophthalmoscopic findings was neuroretinitis (optic disc edema with the macular star). Bartonella henselae antibody titers (IgG) were elevated. CSD is usually self-limited infection in immunocompetent patients and there is no clear treatment recommendations. One of our patients received treatment which included oral antibiotic (macrolides) and steroid. The second patient was left without treatment. In our case--the duration of visual loss was longer in patient who was not treated.

PMID: 20825068 [PubMed - in process]

Int Ophthalmol. 2010 Jul 30. [Epub ahead of print]

Cat-scratch disease: ocular manifestations and visual outcome.

Curi AL, Machado D, Heringer G, Campos WR, Lamas C, Rozental T, Gutierres A, Orefice F, Lemos E.

Department of Ophthalmology, Instituto de Pesquisa Clinica Evandro Chagas, IPEC-FIOCRUZ, R. Francisco Dutra 150/801, Cep: 24220-150, Icara�, Niter�i, Rio de Janeiro, Brazil,

To describe the intra-ocular manifestations of cat-scratch disease (CSD) found at two uveitis reference centers in Brazil. Retrospective case series study. Review of clinical records of patients diagnosed with CSD in the Uveitis Department of S�o Geraldo Hospital and the Ophthalmology Department of the Instituto de Pesquisa Cl�nica Evandro Chagas-FIOCRUZ, from 2001 to 2008. In the 8-year period, 24 patients with the diagnosis of CSD were identified. Twelve patients were male and 12 female. The mean age was 27.04 years (range 7-56). Sixteen patients (66.6%) presented with a history of a cat scratch and all patients reported cat exposure. Visual acuity ranged from counting fingers to 1.0 in the affected eye. Thirteen patients presented with bilateral disease. Sixteen (66.6%) patients complained of systemic symptoms, including fever, lymphadenopathy, liver and spleen enlargement and rash. All patients presented with serum antibodies (IgG) to Bartonella henselae. Thirty-seven eyes were affected. The most common findings were small areas of retinal infiltrates which occurred in 11 eyes (29.7%) and angiomatous lesions which occurred in nine eyes (24.3%). Neuroretinitis occurred in only six eyes (16.2%). The most common findings of CSD in our study were retinal infiltrates and angiomatous lesions. CSD patients may present with significant visual loss. Patients may benefit from systemic treatment with antibiotics.

PMID: 20668914 [PubMed - as supplied by publisher]

Rev Med Interne. 2010 Jun 18. [Epub ahead of print]

[Unilateral neuroretinitis revealing cat-scratch disease.]

[Article in French]

Zekraoui Y, Megzari A, El Alloussi T, Berraho A.

Service d'ophtalmologie B, CHU Ibn Sina, Rabat, Maroc.

We report a case of cat-scratch disease neuroretinitis. A 26-year-old man was referred for severe right visual loss. Posterior segment examination showed a papilledema with macular edema. Bartonella henselae immunoglobulin G testing was positive. Four weeks of antibiotic therapy combining oral ciprofloxacin and doxycycline led to progressive resolution of the neuroretinitis and improvement in visual acuity. This report reminds that B. henselae infection can be the cause of neuroretinitis. Its prognosis can be improved by early treatment.

PMID: 20646795 [PubMed - as supplied by publisher]

Int J Pediatr. 2010;2010:763105. Epub 2010 Jun 15.

Neuroretinitis Caused by Bartonella henselae (Cat-Scratch Disease) in a 13-Year-Old Girl.

Dur�-Trav� T, Yoldi-Petri ME, Gallinas-Victoriano F, Lavilla-Oiz A, Bove-Guri M.

Pediatric Neurology Unit, Children's Hospital "Virgen del Camino", 31008 Pamplona, Spain.

Cat-scratch disease-related neuroretinitis is a relatively unusual pathology, with suspicious clinical epidemiological and serological diagnosis. We present a case of an adolescent suffering from unilateral neuroretinitis associated with Bartonella henselae infection characterized by abrupt loss of vision, optic disc swelling, and macular star exudates with optimal response to antibiotic treatment.

PMCID: PMC2902060 PMID: 20628521 [PubMed - in process]

Vet Clin North Am Small Anim Pract. 2010 Jul;40(4):665-84.

Infective endocarditis in dogs: diagnosis and therapy.

Macdonald K.

The Animal Care Center of Sonoma, Rohnert Park, CA 94928, USA.

Infective endocarditis (IE) is a bacterial disease that commonly occurs in dogs. Difficulty in diagnosis and underreporting of IE in dogs contribute to the reported low prevalence rate of the disease. The mitral and aortic valves are the worst affected by IE. Common causative microbial agents include Staphylococcus spp, Streptococcus spp, Escherichia coli, and Bartonella spp. Congestive heart failure, immune-mediated disease, and thromboembolism are the major complications of IE. Diagnosis of IE by echocardiography and long-term treatment with broad-spectrum antibiotics may contribute to the timely detection and treatment of the disease.

PMID: 20610018 [PubMed - in process]

Vet Parasitol. 2010 Sep 20;172(3-4):323-32. Epub 2010 May 25.

Prevention of endemic canine vector-borne diseases using imidacloprid 10% and permethrin 50% in young dogs: a longitudinal field study.

Otranto D, de Caprariis D, Lia RP, Tarallo V, Lorusso V, Testini G, Dantas-Torres F, Latrofa S, Diniz PP, Mencke N, Maggi RG, Breitschwerdt E, Capelli G, Stanneck D.

Dipartimento di Sanit� Pubblica e Zootecnia, Universit� degli Studi di Bari, Valenzano, BA, Italy.

Canine vector-borne diseases (CVBDs) are highly prevalent and increasing in distribution worldwide. A longitudinal study was conducted in southern Italy to determine the incidence of and protection against CVBD-causing pathogens in dogs treated with a combination of imidacloprid 10% and permethrin 50% (ImPer). One hundred eleven autochthonous young dogs were divided into group A (n=63) and group B (n=48), both groups containing dogs positive and negative for one or more CVBD-causing pathogens. Additionally, 10 na�ve male beagles were introduced in each group in May 2008. Group A was treated with ImPer on day 0 and every 21+/-2 days whereas group B was left untreated. Blood and skin samples were collected at baseline (March-April 2008) and at the first, second and third follow-up times (July and October 2008 and April 2009). Bone marrow was sampled at baseline and at the third follow-up. Serological, cytological and molecular tests were performed to detect Anaplasma platys, Babesia spp., Bartonella spp., Dirofilaria immitis, Ehrlichia canis, Hepatozoon canis and Leishmania infantum. Ectoparasites (fleas, ticks, and sand flies) were monitored throughout the study. The baseline prevalence of CVBDs was 39.6% with 44 dogs positive for at least one pathogen. A. platys (27.5%) and Babesia spp. (15.6%) were the most prevalent species and co-infections with up to two pathogens were detected in 16 (14.7%) individuals. At the end of the evaluation period, there was a 90.7% reduction in overall CVBD incidence density rate (IDR) in group A, as following: 100% reduction in L. infantum; 94.6% in E. canis; 94.4% in Babesia spp.; and 81.8% in A. platys. Initially positive treated dogs showed significantly lower pathogen prevalence at the third follow-up than untreated ones. At the end of the evaluation period, 8 of the 10 untreated beagles were infected with at least one pathogen whereas one of the treated beagles was A. platys positive at a single time point (second follow-up). Overall efficacy against ticks was 97.9%. In October 2009, samples were collected from the remaining 83 dogs (44 from group A and 39 from group B) to investigate the annual incidence of CVBDs in the same, at this time untreated, dog population. A high year incidence for tick-borne diseases (78.1%) and for L. infantum (13.6%) was detected in dogs from group A, seven months after the treatment had been withdrawn. The results demonstrate that ImPer preventive treatment against arthropods protects autochthonous and na�ve beagle dogs against CVBD-causing pathogens.

PMID: 20591573 [PubMed - in process]

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,

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

PMID: 20567991 [PubMed - as supplied by publisher]

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]

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.

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]

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.

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]

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]

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]

J Vet Emerg Crit Care (San Antonio). 2010 Feb;20(1):62-9.

Feline hemotropic mycoplasmas.

Sykes JE.

Department of Medicine & Epidemiology, University of California - Davis, Davis, CA 95618, USA.

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]

Pediatr Infect Dis J. 2010 Jul;29(7):675-7.

Disseminated bartonellosis presenting as neuroretinitis in a young adult with human immunodeficiency virus infection.

Dutta A, Schwarzwald HL, Edwards MS.

Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.

Rapidly declining visual acuity from neuroretinitis should prompt aggressive diagnostic intervention to preserve eyesight. We present a young adult with human immunodeficiency virus (HIV) infection in whom neuroretinitis was the presenting feature of disseminated bartonellosis. Tissue biopsy was required to establish the diagnosis and directed therapy was associated with restored vision.

PMID: 20216243 [PubMed - indexed for MEDLINE]

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.

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]

J Feline Med Surg. 2010 Jun;12(6):483-6. Epub 2010 Feb 6.

Successful treatment of Bartonella henselae endocarditis in a cat.

Perez C, Hummel JB, Keene BW, Maggi RG, Diniz PP, Breitschwerdt EB.

Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC, United States.

This report describes the clinical presentation, diagnosis and treatment of a cat with vegetative valvular endocarditis temporally associated with natural infection with Bartonella henselae. Lethargy, abnormal gait and weakness were the main clinical signs that resulted in referral for diagnostic evaluation. Using a novel and sensitive culture approach, B henselae was isolated from the blood. Following antibiotic therapy there was total resolution of clinical signs, the heart murmur, the valvular lesion by echocardiography, and no Bartonella species was isolated or amplified from a post-treatment blood culture. In conjunction with previous case reports, infective endocarditis can be associated with natural B henselae infection in cats; however, early diagnosis and treatment may result in a better prognosis than previously reported.

PMID: 20138559 [PubMed - in process]

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]

Comp Immunol Microbiol Infect Dis. 2010 Mar;33(2):95-107. Epub 2010 Jan 25.

Murine model for Bartonella birtlesii infection: New aspects.

Marignac G, Barrat F, Chomel B, Vayssier-Taussat M, Gandoin C, Bouillin C, Boulouis HJ.

UMR BIPAR INRA-AFSSA-ENVA, Maisons-Alfort, France.

As a model of persistent infection, various aspects of Bartonella birtlesii infection in laboratory mice, including some immunodeficient mice, are presented, particularly focusing on conditions mimicking natural infection. Bacteraemia was explored using different mice strains routes and inoculum doses (3.4-5x10(7)CFU/mouse). Mice became bacteraemic for 5 (C57Bl6/6) to 10 weeks (Balb/c, Swiss) with peaks ranging from 2x10(3) to 10(5)CFU/mL of blood. The ID route induced the most precocious bacteraemia (day 3) while the higher and longer bacteraemia in immunocompetent mice was obtained with SC when infecting Balb/c with approximately 10(3) CFU/mouse. As opposed to ID, SC and IV routes, bacteraemia was obtained with the oral and ocular routes only for high doses (10(7)) and in 33-66% mice. It was significantly higher and longer in CD4-/- mice compared to CD8-/- and double KO mice at most time points. CD8-/- mice and the control group had near to superimposed kinetics. These results confirm the relevance of the present model.

PMID: 20097421 [PubMed - indexed for MEDLINE]

Pediatr Infect Dis J. 2010 May;29(5):472-3.

Renal microabscesses due to Bartonella infection.

Salehi N, Custodio H, Rathore MH.

General Academic and Hospital Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA.

We report a case of cat scratch disease with bilateral renal microabscesses. This case is unique in that there were no other abscesses found intrabdominally. A previously healthy child was admitted with a 12-day history of fever and headaches. Bartonella henselae titers were initially IgG 1:640 and IgM 1:100, and later IgG >1:2560 and IgM >1:800. An abdominal ultrasound examination was normal but CT scan revealed microabscesses in both kidneys.

PMID: 20072078 [PubMed - indexed for MEDLINE]

Med Mal Infect. 2010 Jun;40(6):319-30. Epub 2009 Dec 29.

[Bartonella henselae, an ubiquitous agent of proteiform zoonotic disease]

[Article in French]

Edouard S, Raoult D.

CNRS, UMR6236, IRD 198, unit� de recherche sur les maladies infectieuses tropicales et emergentes, Centre national de r�f�rence des Rickettsies, Bartonella et Coxiella, facult� de m�decine, universit� de la M�diterran�e, boulevard Jean-Moulin, Marseille cedex 5, France.

Bartonella henselae is the causative agent of cat scratch disease, a human infection usually characterized by persistent regional lymphadenopathy. It is transmitted to humans by cat scratches or bites. Cats are the major reservoir for this bacterium thus B. henselae has a worldwide distribution. The bacterial pathogenicity may bay emphasized by the immune status of the infected host. Angiomatosis or hepatic peliosis are the most frequent clinical manifestations in immunocompromised patients. B. henselae is also responsible for endocarditis in patients with valvular diseases, and may induce various clinical presentations such as: bacteriemia, retinitis, musculoskeletal disorders, hepatic or splenic diseases, encephalitis, or myocarditis. Several diagnostic tools are available; they may be combined and adapted to every clinical setting. B. henselae is a fastidious bacterium; its diagnosis is mainly made by PCR and blood tests. No treatment is required for the benign form of cat scratch disease. For more severe clinical presentations, the treatment must be adapted to every clinical presentation.

PMID: 20042306 [PubMed - in process]

J Infect Chemother. 2009 Dec;15(6):414-6.

Cat scratch disease presenting with a retroperitoneal abscess in a patient without animal contacts.

Koga T, Taguchi J, Suzuki M, Higa Y, Kamimura T, Nishimura M, Arakawa M.

Asakura Medical Association Hospital, 422-1 Raiha, Asakura, Fukuoka, 838-0069, Japan.

Cat scratch disease (CSD) is usually diagnosed in patients presenting with regional lymphadenopathy and pyrexia that follow contacts with animals. We describe here a young adult male patient who presented with marked pyrexia and a retroperitoneal abscess without relevant medical histories, illustrating that CSD can be a diagnostic challenge on selected occasions.

PMID: 20012734 [PubMed - indexed for MEDLINE]

J Clin Microbiol. 2010 Feb;48(2):617-8. Epub 2009 Dec 9.

Comparative activity of pradofloxacin, enrofloxacin, and azithromycin against Bartonella henselae isolates collected from cats and a human.

Biswas S, Maggi RG, Papich MG, Keil D, Breitschwerdt EB.

Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27606, USA.

Using Bartonella henselae isolates from cats and a human, the activity of pradofloxacin was compared with those of enrofloxacin and azithromycin. By Etest and disc diffusion assay, pradofloxacin showed greater antimicrobial activity than did other antibiotics. We conclude that pradofloxacin may prove useful for the treatment of B. henselae infections.

PMCID: PMC2815609 PMID: 20007401 [PubMed - indexed for MEDLINE]

J AAPOS. 2009 Dec;13(6):602-4.

Bartonella henselae neuroretinitis in a 15-year-old girl with chronic myelogenous leukemia.

Irshad FA, Gordon RA.

Tulane University School of Medicine, Department of Ophthalmology, 1413 Tulane Avenue, New Orleans, LA 70112, USA.

A 15-year-old girl being treated with imatinib for chronic myelogenous leukemia (CML) presented with acute vision loss in her right eye accompanied by swelling of the right side of her neck. On examination, she was found to have disk and macular edema of the right eye. Fine-needle aspiration and excisional biopsies of an enlarged submandibular lymph node were negative for malignancy. Although initial serologies were equivocal for Bartonella henselae, repeat serologies performed 1 week later upon the appearance of a macular star were positive. This is the first reported case of B. henselae in a patient with CML.

PMID: 20006827 [PubMed - indexed for MEDLINE]

Otolaryngol Pol. 2009 May-Jun;63(3):271-3.

[Cat scratch disease--an underestimated diagnosis]

[Article in Polish]

Szaleniec J, Ole� K, Sk�adzie� J, Strek P.

Katedra Klinika Otolaryngologii UJCM w Krakowie.

INTRODUCTION: Cat scratch disease is a rare and frequently underestimated cause of lymphadenopathy, which may occur also in the head and neck. The infection is most commonly caused by intracellular bacilli Bartonella, transmitted by domestic animals. AIM: We present a case report of a patient treated in the Department of Otolaryngology UJCM in Krakow. The patient presented with a neck tumor. Due to unclear clinical manifestation he underwent surgical treatment. The postoperative histopathological examination suggested cat scratch disease. In detailed anamnesis the patient admitted contact with cats and dogs in his household. No posoperative complications were observed. CONCLUSIONS: In every case of neck tumor it is advisable to consider cat scratch disease, remembering that exclusion of a neoplastic process remains a priority.

PMID: 19886535 [PubMed - indexed for MEDLINE]

Vector Borne Zoonotic Dis. 2010 May;10(4):415-9.

Cervical lymphadenitis in a patient coinfected with Toxoplasma gondii and Bartonella henselae.

Yoon HJ, Lee WC, Choi YS, Cho S, Song YG, Choi JY, Kim CO, Kim EJ, Kim JM.

Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea.

Cat scratch disease, caused by Bartonella henselae, is a worldwide zoonosis that is most frequently associated with the bite or scratch of a kitten under 6 months of age, as well as from a fleabite. Toxoplsma gondii is also another important zoonotic agent in cats and humans, which is mainly acquired by ingestion of food or water that is contaminated with oocytes shed by cats or by eating undercooked or raw meat containing tissue cysts. Here, we report a first case of young patient with cervical lymphadenitis, which shows serological and histological evidence of B. henselae and T. gondii coinfection in Korea with literature review.

PMID: 19874186 [PubMed - indexed for MEDLINE]

Vet Parasitol. 2009 Dec 23;166(3-4):191-8. Epub 2009 Sep 26.

Babesia canis and other tick-borne infections in dogs in Central Poland.

Welc-Faleciak R, Rodo A, Si�ski E, Bajer A.

Department of Parasitology, Institute of Zoology, Faculty of Biology, University of Warsaw, Warsaw, Poland.

Vector-borne infections constitute increasing health problem in dogs worldwide, including sled dogs, dramatically decreasing the fitness of working dogs and even leading to death. In the period 2006-2008 eighty-two blood samples were collected from eight sled dog kennels in Central Poland. The prevalence of four vector-borne infections (Babesia canis, Bartonella sp., Anaplasma/Ehrlichia and Borrelia burgdorferi) was estimated in 82 sled dogs using PCR and nested PCR for diagnosis and the same methods were used to identify the vector-borne pathogens in 26 dogs presenting at veterinary clinics with symptoms of vector-borne diseases. None of four studied vector-borne pathogens was detected in samples originating from veterinary clinics. Among the remaining 82 dogs B. canis infections were confirmed in three dogs undergoing treatment for babesiosis. The DNA of tick-borne pathogens was also found among 22 (27.8%) of the 79 apparently healthy dogs, including 20 cases of B. canis infection (25.3%), one case of B. burgdorferi s.l. infection and one case of Anaplasma phagocytophilum infection. No evidence of Bartonella spp. and Ehrlichia canis infections were found in this set of samples. Sequencing of a Babesia fragment of 18S rDNA amplified from acute (n=5) and asymptomatic (n=5) cases revealed that all isolates were identical to the Babesia canis canis sequence, originally isolated from Dermacentor reticulatus ticks in Poland. A range of factors was shown to affect the distribution of babesiosis in sled dogs. The data are also discussed in respect to the health risk factors generated by asymptomatic B. canis infections and the efficiency of chemoprophylaxis measures taken by sled dog owners.

PMID: 19837515 [PubMed - indexed for MEDLINE]

J Med Case Reports. 2009 Jul 17;3:7325.

Fatal myocarditis-associated Bartonella quintana endocarditis: a case report.

Montcriol A, Benard F, Fenollar F, Ribeiri A, Bonnet M, Collart F, Guidon C.

INTRODUCTION: Bartonella spp. infection is not rare and must be considered with great care in patients with suspected infective endocarditis, particularly if regular blood cultures remain sterile. Management of these infections requires knowledge of the identification and treatment of these bacteria. CASE PRESENTATION: A 50-year-old Senegalese man was admitted to our Department of Cardiac Surgery with a culture-negative endocarditis. Despite valvular surgery and adequate antibiotic treatment, recurrence of the endocarditis was observed on the prosthetic mitral valve. Heart failure required circulatory support. Weaning off the circulatory support could not be attempted owing to the absence of heart recovery. Bacteriological diagnosis of Bartonella quintana endocarditis was performed by molecular methods retrospectively after the death of the patient. CONCLUSIONS: This case report underlines the severity and difficulty of the diagnosis of Bartonella quintana endocarditis. The clinical picture suggested possible Bartonella quintana associated myocarditis, a feature that should be considered in new cases.

PMCID: PMC2737767 PMID: 19830188 [PubMed - in process]

Rev Med Interne. 2009 Dec;30(12):1049-53. Epub 2009 Oct 7.

[Fever and abdominal pain in a 56-year-old woman]

[Article in French]

Sasseigne G, Herbert A, Larvol L, Damade R, Cartry O.

Service de gastroent�rologie, centre hospitalier de Chartres, BP 30407, 28018 Chartres cedex, France.

PMID: 19815317 [PubMed - indexed for MEDLINE]

Transpl Infect Dis. 2009 Oct;11(5):474.

Blood transfusion as an alternative bartonellosis transmission in a pediatric liver transplant.

Velho PE.

Comment on: Transpl Infect Dis. 2008 Dec;10(6):431-3.

PMID: 19804481 [PubMed - indexed for MEDLINE]

Klin Padiatr. 2010 Mar;222(2):73-8. Epub 2009 Sep 29.

Cat scratch disease--heterogeneous in clinical presentation: five unusual cases of an infection caused by Bartonella henselae.

Weinspach S, Tenenbaum T, Sch�nberger S, Schaper J, Engers R, Rueggeberg J, Mackenzie CR, Wolf A, Mayatepek E, Schroten H.

Department of General Pediatrics, University Children's Hospital, Heinrich Heine University D�sseldorf, Moorenstrasse 5, D�sseldorf, Germany.

BACKGROUND: Cat-scratch disease (CSD) is common in children, however the wide spectrum of the clinical presentation of CSD may lead to delayed diagnosis. An atypical presentation of CSD includes in its differential diagnosis diseases such as tuberculosis, other mycobacterioses, Epstein-Barr-Virus infection (EBV) or malignant disease. Since, in a small number of cases, these diseases may be present concurrently with an active CSD, it is important to consider CSD early in the differential diagnosis and order the appropriate tests. These tests include serology and, where possible, histology including molecular diagnostic methods on tissue specimens. PATIENTS AND METHOD: We performed a case series of five patients treated in our hospital with a clinical diagnosis of cat-scratch disease, confirmed by serology. An analysis of the history and clinical symptoms associated specifically with an atypical presentation of CSD was performed. RESULTS: The clinical presentation of CSD no longer encompasses the original typical description from 1950, but rather presents with a wide spectrum of signs and symptoms, including the absence of a documented cat scratch, fever, primary lesions or peripheral lymphadenopathy. Low density lesions in spleen, liver and lymph nodes are typical findings in ultrasound, MRI, or CT. Ignoring CSD as a possibility in investigating possible malignancy or tuberculosis could lead to unnecessary hospitalisation and delay in the proper treatment. CONCLUSION: CSD should also be considered in differential diagnosis of any patient with intraabdominal lymphadenopathy, abdominal pain and fever of unknown origin. A careful history is important, however, often patients with CSD have no history of contact with cats. Therefore in atypical cases of CSD the finding of other clinical symptoms and performance of specific diagnostic tests is important. Our experience suggests that early serological testing for Bartonella henselae should be performed and may avoid invasive diagnostic procedures.

PMID: 19790029 [PubMed - indexed for MEDLINE]

Vet Ther. 2009 Spring-Summer;10(1-2):9-16.

Comparative in vivo adulticidal activity of a topical dinotefuran versus an imidacloprid-based formulation against cat fleas (Ctenocephalides felis) on cats.

Murphy M, Ball CA, Gross S.

Charles River Laboratories Preclinical Services Ireland, Carrentrila, Ballina, Co. Mayo, Ireland.

Fleas cause significant discomfort to pet cats and distress to their owners and are also vectors of disease severe infestations can cause anemia or flea allergy dermatitis and can lead to infections with Dipylidium caninum and Bartonella henselae. Rapid flea kill is an important feature of flea preventives. The efficacy of dinotefuran (Vectra for Cats and Kittens, Summit VetPharm) was compared with that of imidacloprid (Advantage, Bayer Animal Health) against Ctenocephalides felis when applied topically once on day 0. Cats were infested with 100 (+-3) C. felis on study days -1, 8, 15, 22, and 29. Live fleas were counted on study days 0 (2, 6, and 12 hours after treatment), 9, 16, 23, 29 (2, 6, and 12 hours after infestation), and 30. Cats treated with dinotefuran had significantly (P less than .05) fewer fleas than the control cats at all posttreatment examinations except day 29 at 2 hours after infestation and significantly (P less than .05) fewel fleas than cats treated with imidacloprid on days 0 (2 hours after treatment), 9, 16, 23, 29 (6 and 12 hours after infestation), and 30.

PMID: 19742443 [PubMed - indexed for MEDLINE]

Pediatr Infect Dis J. 2009 Oct;28(10):922-5.

Culture negative endocarditis caused by Bartonella henselae in a child with congenital heart disease.

Das BB, Wasser E, Bryant KA, Woods CR, Yang SG, Zahn M.

Division of Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.

A 9-year-old white male with congenital aortic and subaortic stenosis palliated by the Ross-Konno procedure presented with culture-negative endocarditis. Serologic studies and polymerase chain reaction testing of resected homograft valvular tissue provided evidence of Bartonella henselae as the etiology. B. henselae can cause endocarditis in children, particularly those with underlying valvular disease. Serologic testing for B. henselae should be considered in children with culture-negative endocarditis.

PMID: 19738506 [PubMed - indexed for MEDLINE]

MMWR Recomm Rep. 2009 Sep 4;58(RR-11):1-166.

Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics.

Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E, Havens P, Nesheim S, Read JS, Serchuck L, Van Dyke R; Centers for Disease Control and Prevention; National Institutes of Health; HIV Medicine Association of the Infectious Diseases Society of America; Pediatric Infectious Diseases Society; American Academy of Pediatrics.

Collaborators: Brady M, Dominguez KL, Havens P, Handelsman E, Mofenson LM, Nesheim S, Read JS, van Dyke R, Benjamin DK Jr, Bialek SR, Boulware D, Christenson J, Gaur A, Gershon A, Hazra R, Hughes W, Kimberlin D, Ikeda T, Kleiman M, McAuley J, Moscicki AB, Nelson L, Oleske J, Rutstein R, Sanchez PJ, Schuval S, Seward JF, Stauffer W, Ch'ng TW, Yogev R.

National Institutes of Health, Bethesda, Maryland, USA.

This report updates and combines into one document earlier versions of guidelines for preventing and treating opportunistic infections (OIs) among HIV-exposed and HIV-infected children, last published in 2002 and 2004, respectively. These guidelines are intended for use by clinicians and other health-care workers providing medical care for HIV-exposed and HIV-infected children in the United States. The guidelines discuss opportunistic pathogens that occur in the United States and one that might be acquired during international travel (i.e., malaria). Topic areas covered for each OI include a brief description of the epidemiology, clinical presentation, and diagnosis of the OI in children; prevention of exposure; prevention of disease by chemoprophylaxis and/or vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; and discontinuation of secondary prophylaxis after immune reconstitution. A separate document about preventing and treating of OIs among HIV-infected adults and postpubertal adolescents (Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents) was prepared by a working group of adult HIV and infectious disease specialists. The guidelines were developed by a panel of specialists in pediatric HIV infection and infectious diseases (the Pediatric Opportunistic Infections Working Group) from the U.S. government and academic institutions. For each OI, a pediatric specialist with content-matter expertise reviewed the literature for new information since the last guidelines were published; they then proposed revised recommendations at a meeting at the National Institutes of Health (NIH) in June 2007. After these presentations and discussions, the guidelines underwent further revision, with review and approval by the Working Group, and final endorsement by NIH, CDC, the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Disease Society (PIDS), and the American Academy of Pediatrics (AAP). The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of the evidence supporting the recommendation so readers can ascertain how best to apply the recommendations in their practice environments. An important mode of acquisition of OIs, as well as HIV infection among children, is from their infected mother; HIV-infected women coinfected with opportunistic pathogens might be more likely than women without HIV infection to transmit these infections to their infants. In addition, HIV-infected women or HIV-infected family members coinfected with certain opportunistic pathogens might be more likely to transmit these infections horizontally to their children, resulting in increased likelihood of primary acquisition of such infections in the young child. Therefore, infections with opportunistic pathogens might affect not just HIV-infected infants but also HIV-exposed but uninfected infants who become infected by the pathogen because of transmission from HIV-infected mothers or family members with coinfections. These guidelines for treating OIs in children therefore consider treatment of infections among all children, both HIV-infected and uninfected, born to HIV-infected women. Additionally, HIV infection is increasingly seen among adolescents with perinatal infection now surviving into their teens and among youth with behaviorally acquired HIV infection. Although guidelines for postpubertal adolescents can be found in the adult OI guidelines, drug pharmacokinetics and response to treatment may differ for younger prepubertal or pubertal adolescents. Therefore, these guidelines also apply to treatment of HIV-infected youth who have not yet completed pubertal development. Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for preventing and treating OIs, especially those OIs for which no specific therapy exists; 2) information about the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information about managing antiretroviral therapy in children with OIs, including potential drug--drug interactions; 4) new guidance on diagnosing of HIV infection and presumptively excluding HIV infection in infants that affect the need for initiation of prophylaxis to prevent Pneumocystis jirovecii pneumonia (PCP) in neonates; 5) updated immunization recommendations for HIV-exposed and HIV-infected children, including hepatitis A, human papillomavirus, meningococcal, and rotavirus vaccines; 6) addition of sections on aspergillosis; bartonella; human herpes virus-6, -7, and -8; malaria; and progressive multifocal leukodystrophy (PML); and 7) new recommendations on discontinuation of OI prophylaxis after immune reconstitution in children. The report includes six tables pertinent to preventing and treating OIs in children and two figures describing immunization recommendations for children aged 0--6 years and 7--18 years. Because treatment of OIs is an evolving science, and availability of new agents or clinical data on existing agents might change therapeutic options and preferences, these recommendations will be periodically updated and will be available at

PMCID: PMC2821196 PMID: 19730409 [PubMed - indexed for MEDLINE]

Arch Soc Esp Oftalmol. 2009 Aug;84(8):389-94.

[Neuroretinitis. Clinical cases]

[Article in Spanish]

Valverde-Gubianas M, Ramos-L�pez JF, L�pez-Torres JA, Toribio-Garc�a M, Milla-Pe�alver C, G�lvez Torres-Puchol J, Medialdea-Marcos S.

Servicio de Oftalmolog�a, Hospital Universitario Virgen de las Nieves, Granada, Espa�a.

OBJECTIVE: Evaluate the etiology and the most frequent funduscopic alterations of the neuroretinitis. METHODS: We present the case of a woman 24 years old with a bilateral decrease of visual sharpness (AV), painless and progressive, the funduscopic examination of which reveals a bilateral optical disc edema, with no hemorrhages or exudates, retina edema of the posterior pole and phlebitic areas. The systematic study was normal except for the hemogram (18,000/mm(3) leucocytes with 79% neutrophils) and the positive serology next to a Chlamydia. We also present the case of a 64 years old woman with a decrease of AV at the right eye of one week duration. At the back of the eye a macular star can be seen, and papilla edema. A systematic study gave normal results and positive serology at Bartonella henselae. RESULTS: The illness produced by a cat scratch is the most common cause of neuroretinitis. The customary findings are a loss of AV, discromatopsia, afferent papillary defects and abnormality on the visual field. Other frequent findings at the back of the eye are hemorrhagic nerve fibers, cotton-like exudates, papilla edema, macular star and glassy inflammation. The roll of antibiotic therapy is questionable. Oral ciprofloxacine seems to give good results.

PMID: 19728239 [PubMed - indexed for MEDLINE]

Ultrastruct Pathol. 2009 Jul-Aug;33(4):151-4.

Bartonellosis as cause of death after red blood cell unit transfusion.

Magalh�es RF, Urso Pitassi LH, Lania BG, Barjas-Castro ML, Neves Ferreira Velho PE.

Dermatology Division, Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil.

The authors present the case of a young man with aplastic anemia who went into shock and died after several red blood cell unit transfusions. Immunohematological studies did not show any abnormality and blood cultures from patients and blood bags were negative. The ultrastructural findings, allied with current scientific knowledge, permitted the diagnosis of Bartonella sp. infection. In face of this diagnosis, two possibilities should be considered: the first one is that the patient was already infected by the bacteria before the last RBC unit transfusion. The pathogen could be involved in aplastic anemia etiology and in the failure to recover hemoglobin levels, in spite of the transfusions. The second possibility is that the RBC unit was contaminated with a Bartonella sp., which would have led to a state of shock, causing the death of the patient.

PMID: 19728230 [PubMed - indexed for MEDLINE]

J Vet Intern Med. 2009 Nov-Dec;23(6):1273-7. Epub 2009 Aug 26.

Recurrent osteomyelitis in a cat due to infection with Bartonella vinsonii subsp. berkhoffii genotype II.

Varanat M, Travis A, Lee W, Maggi RG, Bissett SA, Linder KE, Breitschwerdt EB.

Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC 27606, USA.

PMID: 19709358 [PubMed - indexed for MEDLINE]

Otolaryngol Pol. 2009 Mar-Apr;63(2):154-7.

[Cat scratch disease--a diagnostic problem, case report]

[Article in Polish]

Dabrowska-Bie� J, Pietniczka-Za�eska M, Rowicki T.

Oddzia� Otolaryngologii Miedzyleskiego Szpitala Specjalistycznego w Warszawie.

AIM OF THE STUDY: Cat scratch disease as a possible cause of neck limphadenopathy. MATERIAL AND METHODS: We present a case of 40-years old men operated in our department on regional unilateral lymphadenopathy. The diagnosis of cat scratch disease was confirmed by the histopathologic examination. CONCLUSIONS: Regional lymphadenopathy with history of contact with cats or other animals suggests the diagnosis of cat scratch disease. If we considered this disease in differential diagnosis it would mean less traumatic treatment for the patient. Cat scratch disease is diagnosed in Poland very rarely; we need to spread the knowledge about this infectious disease.

PMID: 19681487 [PubMed - indexed for MEDLINE]

Med Hypotheses. 2010 Jan;74(1):45-9. Epub 2009 Aug 7.

The pathophysiology of the acute phase of human bartonellosis resembles AIDS.

Ticona E, Huaroto L, Garcia Y, Vargas L, Madariaga MG.

Servicio de Enfermedades Infecciosas, Hospital Nacional Dos de Mayo, Parque Historia de la Medicina Peruana s/n, Lima 01, Peru.

Human bartonellosis is a South American anthroponosis caused by Bartonella bacilliformis. The disease has an acute phase characterized by invasion of red blood cells by parasites, and consequent severe anemia; and a chronic phase presenting with benign vascular tumors. During the acute phase, affected individuals are prone to developing opportunistic infections with a variety of organisms similar to the ones seen in AIDS. After antibiotic treatment is instituted, a subgroup of patients may develop atypical symptoms which potentially represent clinical manifestations of the restoration of macrophage function. We speculate that the pathophysiology of the acute phase of human bartonellosis resembles AIDS, with a period of immunosuppression following the infection and later, clinical manifestations of immune reconstitution subsequent to treatment.

PMID: 19665314 [PubMed - indexed for MEDLINE]

Pediatr Hematol Oncol. 2009 Sep;26(6):454-60.

Cervical lymphadenopathy in childhood epidemiology and management.

Papadopouli E, Michailidi E, Papadopoulou E, Paspalaki P, Vlahakis I, Kalmanti M.

Department of Pediatrics, University Hospital of Heraklion, Heraklion, Greece.

Cervical lymphadenopathy (CL) is common in childhood. The aim of this study is to evaluate the etiology, follow-up, and treatment of persistent CL. The authors studied retrospectively 50 children with CL, hospitalized at the Department of Pediatrics and Pediatrics Surgery. Patients underwent ultrasonography. Thirty-six percent presented abnormal ultrasonographic image and underwent excisional biopsy. Biopsies revealed 4 thyroglossal cysts, 3 branchial cysts, 1 hemangioma, 2 sebaceous cysts, 1 dermoid cyst, 5 occurrences of tuberculosis lymphadenitis, 1 occurrence of Bartonella henselae lymphadenopathy, and 1 case of non-Hodgkin lymphoma. In conclusion, CL is usually a benign finding; bacterial and viral infections are the most common causes. Ultrasonography help in etiology and follow-up of CL.

PMID: 19657996 [PubMed - indexed for MEDLINE]

Int J STD AIDS. 2009 Aug;20(8):585-6.

Cat scratch disease: a diagnostic conundrum.

Scott C, Azwa A, Cohen C, McIntyre M, Desmond N.

Department of Sexual Health & HIV Medicine, St Stephens Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London, UK.

We report the case of a patient who presented to a clinic for evaluation of inguinal lymphadenopathy. Histology of the lymph nodes revealed micoabscess formation suggesting infection with Lymphogranuloma venereum (LGV) or Bartonella henselae--the causative agent in cat scratch disease (CSD). The patient recalled no preceding animal exposure. Clinical and serological findings initially suggested early LGV but convalescent serology supported CSD. This serves as an important reminder that B. henselae infection should be considered a cause of regional lymphadenopathy in individuals suspected of having LGV.

PMID: 19625597 [PubMed - indexed for MEDLINE]

Oral Maxillofac Surg Clin North Am. 2009 Aug;21(3):269-74.

The bacteriology of salivary gland infections.

Brook I.

Georgetown University School of Medicine, 4431 Albemarle Street NW, Washington, DC 20016, USA.

The parotid gland is the salivary gland most commonly affected by inflammation. However, infection of the salivary glands can occur in any of the glands. The most common pathogens associated with acute bacterial infection are Staphylococcus aureus and anaerobic bacteria. The predominant anaerobes include: anaerobic Gram negative bacilli (eg, pigmented Prevotella and Porphyromonas); Fusobacterium spp; and Peptostreptococcus spp. In addition, Streptococcus spp (including Streptococcus pneumoniae) and aerobic and facultative Gram-negative bacilli (including Escherichia coli) have been reported. Aerobic and facultative Gram-negative bacilli are often seen in hospitalized patients. Organisms less frequently found are Haemophilus influenzae, Treponema pallidum, Bartonella henselae, and Eikenella corrodens. Mycobacterium tuberculosis and atypical mycobacteria are rare causes of infection. The choice of antibiotics should be guided by identification of the etiologic agent.

PMID: 19608044 [PubMed - indexed for MEDLINE]

Cardiology. 2009;114(3):208-11. Epub 2009 Jul 15.

Infective endocarditis by Bartonella quintana masquerading as antineutrophil cytoplasmic antibody-associated small vessel vasculitis.

Sugiyama H, Sahara M, Imai Y, Ono M, Okamoto K, Kikuchi K, Nagai R.

Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan.

The Bartonella species have been recently recognized as important causative agents of culture-negative bacterial endocarditis. Antineutrophil cytoplasmic antibodies (ANCAs) have been associated with the spectrum of idiopathic small vessel vasculitis. However, a variety of infections can result in a false-positive ANCA test, and especially subacute bacterial endocarditis (SBE) with the presence of ANCAs occasionally mimics the clinical manifestations of an ANCA-associated vasculitis such as skin purpura and glomerulonephritis. In contrast, noninfectious endocardial involvement is known to be part of the spectrum of the manifestations of the ANCA-associated vasculitis. Therefore, it is crucial to distinguish an ANCA-positive SBE from an ANCA-associated vasculitis with endocardial compromise, because the misdiagnosis of an SBE as an ANCA-associated vasculitis can lead to an inappropriate immunosuppressive therapy with catastrophic consequences. The differential diagnosis is sometimes difficult, especially in the case of culture-negative infective endocarditis with a positive ANCA test. We describe here a case of a culture-negative SBE caused by Bartonellaquintana, accompanied with a positive cytoplasmic ANCA test and clinical findings masquerading as ANCA-associated vasculitis. Both a serological test for Bartonella and polymerase chain reaction restriction fragment length polymorphism analysis were helpful for a correct diagnosis and appropriate treatment.

PMID: 19602882 [PubMed - indexed for MEDLINE]

Tidsskr Nor Laegeforen. 2009 Jun 25;129(13):1326-8.

[Risk of infections among orienteers]

[Article in Norwegian]

Hagen K.

Nasjonalt kompetansesenter for hodepine, Avdeling for nevrologi og klinisk nevrofysiologi, St. Olavs hospital, 7006 Trondheim.

BACKGROUND: Research on orienteers is useful for assessing the risk of infections associated with physical activity in the forest. In this paper four types of infections are reviewed, and the efficacy of preventive initiatives is discussed. MATERIAL AND METHODS: The paper is based on literature retrieved from a non-systemic search in PubMed. RESULTS: Hepatitis B infection was more prevalent among orienteers before they were obliged to use protective clothing. In the 1980s, there was an increase of sudden unexpected death among young Swedish orienteers. Bartonella infection was later suggested as an underlying cause. No unexpected deaths have occurred among young orienteers after 1992 when specific advice was given regarding training and competitions. Orienteers do not seem to be affected by lyme borreliosis or tick-borne encephalitis (TBE) more often than others, but only two old studies have been performed. INTERPRETATION: Orienteers may be at risk of acquiring infection from lyme borreliosis and TBE in Norway in the future, as the incidence of these contagions is increasing. Norwegian medical personnel should consider TBE vaccination of orienteers and others who wander in areas with a high prevalence of infected ticks.

PMID: 19561657 [PubMed - indexed for MEDLINE]

J Heart Lung Transplant. 2009 Jul;28(7):736-9.

Disseminated infection with Bartonella henselae in a lung transplant recipient.

Lienhardt B, Irani S, Gaspert A, Weishaupt D, Boehler A.

Clinic of Pulmonary Medicine, University Hospital, Zurich, Switzerland.

We present the case of a lung transplant recipient with disseminated infection with Bartonella henselae. In non-immunosuppressed humans, the organism typically causes a local infection that manifests itself as regional lymphadenopathy. The role of the host immune response to B henselae is critical in preventing progression to systemic disease. Only rare cases of bartonellosis in transplant recipients have been reported. We discuss aspects and difficulties of diagnosis and treatment of bartonellosis in a lung transplant recipient who suffered from a severe multisystem involvement of this disease. In our case, the initial response to therapy was unsatisfying and necessitated an extended anti-infective combination therapy, which eventually was successful.

PMID: 19560704 [PubMed - indexed for MEDLINE]

Vet Microbiol. 2009 Sep 18;138(3-4):368-72. Epub 2009 Feb 4.

Co-isolation of Bartonella henselae and Bartonella vinsonii subsp. berkhoffii from blood, joint and subcutaneous seroma fluids from two naturally infected dogs.

Diniz PP, Wood M, Maggi RG, Sontakke S, Stepnik M, Breitschwerdt EB.

Center for Comparative Medicine and Translational Research, North Carolina State University, Raleigh, 27606, USA.

This report describes the clinical presentation, isolation and treatment of two dogs naturally infected with Bartonella henselae and Bartonella vinsonii subsp. berkhoffii. Chronic and progressive polyarthritis was the primary complaint for dog #1, from which B. henselae and B. vinsonii subsp. berkhoffii were cultured on three independent occasions from blood and joint fluid samples, despite administration of nearly 4 months of non-consecutive antibiotic therapy. A clinically atypical and progressively severe trauma-associated seroma was the primary complaint for dog #2, from which B. henselae and B. vinsonii subsp. berkhoffii were isolated from serum, blood and seroma fluid. Dogs can be co-infected with two Bartonella spp. and infection with these organisms should not be ruled out if specific antibodies are not detected. Specialized culture techniques should be used for isolation and to assess antibiotic efficacy.

PMID: 19560291 [PubMed - indexed for MEDLINE]

Emerg Infect Dis. 2009 Jun;15(6):912-5.

Bartonella quintana in body lice and head lice from homeless persons, San Francisco, California, USA.

Bonilla DL, Kabeya H, Henn J, Kramer VL, Kosoy MY.

California Department of Public Health, Vector-Borne Disease Section, Richmond, California 94804, USA.

Comment in: Ann Emerg Med. 2010 Mar;55(3):280-2.

Bartonella quintana is a bacterium that causes trench fever in humans. Past reports have shown Bartonella spp. infections in homeless populations in San Francisco, California, USA. The California Department of Public Health in collaboration with San Francisco Project Homeless Connect initiated a program in 2007 to collect lice from the homeless to test for B. quintana and to educate the homeless and their caregivers on prevention and control of louse-borne disease. During 2007-2008, 33.3% of body lice-infested persons and 25% of head lice-infested persons had lice pools infected with B. quintana strain Fuller. Further work is needed to examine how homeless persons acquire lice and determine the risk for illness to persons infested with B. quintana-infected lice.

PMCID: PMC2727331 PMID: 19523290 [PubMed - indexed for MEDLINE]

Przegl Epidemiol. 2009;63(1):11-7.

[Current state of the knowledge of Bartonella infections]

[Article in Polish]

Welc-Faleciak R.

Zak�ad Parazytologii Wydzia� Biologii Uniwersytet Warszawski.

Bartonella spp. are gram-negative bacteria localized in erythrocytes of vertebrate hosts. Genus Bartonella contains numerous recently described species, many of them are new and emerging arthropod-borne human pathogens. In addition to humans, Bartonella spp. have also been isolated from a variety of domesticated (cats, dogs) and wild animals (carnivores, ruminants, rodents), which play a key role as reservoir hosts for these pathogens. The infectious process and the pathogenesis of bartonellosis are still poorly understood. The present paper reviews the factors influencing Bartonella infections including a range of reservoir hosts and vectors, mechanism of phatogenesis, diagnostic methods for indentification Bartonella infections in humans and animals as well as the coinfection with Bartonella and other arthropod-borne pathogens.

PMID: 19522219 [PubMed - indexed for MEDLINE]

Vet Immunol Immunopathol. 2009 Dec 15;132(2-4):251-6. Epub 2009 May 18.

Immunogenicity of Bartonella henselae P26 in cats.

Feng S, Kasten RW, Werner JA, Hodzic E, Barthold SW, Chomel BB.

Center for Comparative Medicine, Schools of Medicine and Veterinary Medicine, University of California, One Shields Avenue, Davis, CA 95616, United States.

Cat scratch disease (CSD) has an estimated prevalence of approximately 200,000 persons in the USA, and approximately 22,000 new cases occur annually. Cats are the natural carriers of Bartonella henselae, the agent for CSD. Zoonotic transmission of B. henselae can result in CSD in immunocompetent humans and bacillary angiomatosis in immunosuppressed humans. Infection in cats often goes undetected. Development of a vaccine to prevent feline infection is warranted to reduce the prevalence of infection in the feline population and to decrease the potential for zoonotic transmission. One of the immunoreactive proteins identified from our previous study was P26. In this study, we demonstrated that B. henselae recombinant P26 (rP26) was immunogenic in cats. Four cats immunized with rP26 and four control cats were challenged with B. henselae type I and blood samples were collected for culture, PCR, and serology. Immunization with rP26 did not provide protection against B. henselae infection in cats at the doses used in this study. However, p26 PCR proved to be more sensitive for detection of infection in cats compared to gltA PCR. Furthermore, ELISA using rP26 as the substrate was more sensitive than ELISA using B. henselae type I outer membrane proteins.

PMID: 19500857 [PubMed - indexed for MEDLINE]

Clin Microbiol Infect. 2009 Dec;15 Suppl 2:130-1. Epub 2009 May 18.

Description of Bartonella spp. infections in a general hospital of Catalonia, Spain.

Sanfeliu I, Ant�n E, Pineda V, Pons I, Perez J, Font B, Segura F.

Microbiology Laboratory, UDIAT Centre Diagn�stic, Corporaci� Parc Taul�, Sabadell, Barcelona, Spain.

PMID: 19456816 [PubMed - indexed for MEDLINE]

Clin Microbiol Infect. 2009 Dec;15 Suppl 2:110-1. Epub 2009 Apr 30.

Bartonella alsatica endocarditis in a French patient in close contact with rabbits.

Jeanclaude D, Godmer P, Leveiller D, Pouedras P, Fournier PE, Raoult D, Rolain JM.

Facult� de M�decine et de Pharmacie, Universit� de la M�diterran�e, URMITE UMR 6236, CNRS-IRD, Marseille, France.

PMID: 19438633 [PubMed - indexed for MEDLINE]

Enferm Infecc Microbiol Clin. 2010 Jan;28(1):64-5. Epub 2009 May 1.

[Embolic stroke as the first manifestation of Bartonella henselae endocarditis in an immunocompetent patient]

[Article in Spanish]

Sureda A, Garc�a D, Loma-Osorio P.

PMID: 19409676 [PubMed - indexed for MEDLINE]

Pol Merkur Lekarski. 2009 Feb;26(152):131-5.

[Diagnostics of cat scratch disease and present methods of bartonellosis recognition--a case report]

[Article in Polish]

Podsiad�y E, Sapiejka E, Dabrowska-Bie� J, Majkowski J, Tylewska-Wierzbanowska S.

National Institute of Public Health-National Institute of Hygiene, Unit of Rickettsiae, Chlamydiae and Spirochaetes, Warsaw, Poland.

Bartonella infections including cat scratch disease (CSD) is a group of infectious diseases which are diagnosed sporadically. Because of this fact the number of CSD cases in Poland is underestimated and their incidence is markedly lower in comparison to other European countries. The aim of our report is to present various diagnostic methods and possibilities on the basis of two cases with symptoms of CSD. The efficiency of specific Bartonella antibiotic therapy is also discussed.

PMID: 19388519 [PubMed - indexed for MEDLINE]

Klin Monbl Augenheilkd. 2009 Apr;226(4):347. Epub 2009 Apr 21.

[Positive polymerase chain reaction for Bartonella henselae in conjunctival granuloma]

[Article in German]

Bianda JC, Dedes W.

Augenklinik, Luzerner Kantonsspital, Luzern, Schweiz.

PMID: 19384797 [PubMed - indexed for MEDLINE]

Clin Dermatol. 2009 May-Jun;27(3):271-80.


Magui�a C, Guerra H, Ventosilla P.

Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano, Heredia, Apartado Postal 4314, Lima, Per�.

Bartonella spp are fastidious bacteria that occur in the blood of man and mammals; they are usually vector borne but can also be transmitted by animal scratches and bites. The bartonelloses of medical importance comprise Carri�n's disease, trench fever, cat-scratch disease, bacillary angiomatosis, and peliosis hepatis. Carri�n's disease, known as Oroya fever in the acute phase and verruga peruana (Peruvian wart) in its chronic form, has curious manifestations that, until recently, have been restricted in their geographic distribution to dwellers of the high, dry Andean valleys, but new sites of disease are emerging. Trench fever is associated with louse-borne disease and homelessness. Cat-scratch disease, bacillary angiomatosis, and peliosis hepatis are increasingly being recognized as causes of human disease, especially in susceptible population groups such as HIV-infected persons. The Bartonella spp are considered emerging human pathogens. The clinical manifestations, differential diagnosis, laboratory diagnosis, and treatment of these conditions are discussed.

PMID: 19362689 [PubMed - indexed for MEDLINE]

Clin Infect Dis. 2009 May 1;48(9):1332-3.

Bartonella quintana coinfection in Staphylococcus aureus endocarditis: usefulness of screening in high-risk patients?

Barbier F, Fournier PE, Dauge MC, Gallien S, Raoult D, Andremont A, Ruimy R.

PMID: 19344260 [PubMed - indexed for MEDLINE]

Pediatr Dent. 2009 Jan-Feb;31(1):58-62.

Cat scratch disease: clinical considerations for the pediatric dentist.

Da Silva K, Chussid S.

Division of Pediatric Dentistry, College of Dental Medicine, Columbia University, New York, NY, USA.

Cat scratch disease (CSD), caused by Bartonella henselae, is a self-limited chronic lymphadenopathy. It is transmitted commonly by a scratch or bite from cats or kittens. Diagnosis of CSD is often difficult, as it masquerades as other causes of cervical lymphadenopathy or submandibular gland pathology. The purpose of this paper was to report a unique case of a 6-year old male who had close contact with a domestic dog and developed CSD which progressed to suppuration. After treatment with antibiotics was unsuccessful, the patient was taken to the operating room for definitive care. As CSD children may be seen in the pediatric dental office, on awareness of its symptomatology can prevent unnecessary dental intervention and facilitate early treatment.

PMID: 19320261 [PubMed - indexed for MEDLINE]

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