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

JAMES SCHALLER, MD

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.

J Clin Microbiol. 2007 Dec;45(12):4081-4. Epub 2007 Oct 17.

Bivalvular Bartonella henselae prosthetic valve endocarditis.

Vikram HR, Bacani AK, DeValeria PA, Cunningham SA, Cockerill FR 3rd.

Division of Infectious Diseases, Mayo Clinic (Phoenix Campus), Phoenix, AZ 85054, USA. vikram.hr@mayo.edu

Prosthetic valve endocarditis is an uncommon manifestation of infection with Bartonella species. Herein, we report a case of Bartonella henselae endocarditis involving prosthetic mitral and aortic valves. The patient had a favorable outcome with combined medical and surgical therapy. Concomitant crescentic glomerulonephritis led to an initial mistaken diagnosis of Wegener's granulomatosis.

PMCID: PMC2168553 PMID: 17942646 [PubMed - indexed for MEDLINE]

Med Parazitol (Mosk). 2007 Jul-Sep;(3):31-5.

[Hematozoon cenoses of small rodents and insectivora in the Orenburg Region]

[Article in Russian]

Bystrov IV, Ni GV.

A total of 2942 specimens of 15 species of ground rodents and insectova in the Orenburg Region were caught and examined during long-term studies. The investigators detected 7 taxonomic groups of hematozoons: rickettsia (Anaplasma sp., Grahamella sp., Haemobartonella sp.), protozoa (Trypanosoma sp., Plasmodium sp., Piroplasma sp.), and nematodes (Filariidae spp., larval stages). The authors give information on the species composition and infection extensiveness of individual systematic groups of small mammals, the most important morphometric and biological signs of blood parasites, and the specificity of parasite-host relations. The Eversmann hamster was found to have parasitic protozoa of the genera Trypanosoma and Piroplasma, which had not been earlier described in the scientific literature.

PMID: 17912832 [PubMed - indexed for MEDLINE]

Int J Antimicrob Agents. 2007 Nov;30 Suppl 1:S32-6. Epub 2007 Sep 24.

Infective endocarditis with negative blood cultures.

Naber CK, Erbel R.

Klinik f�r Kardiologie, Westdeutsches Herzzentrum Essen, Universit�tsklinikum Essen, Hufelandstrasse 5545122 Essen, Germany. christoph.naper@uk-essen.de

Culture-negative endocarditis is important as it has a relatively poor prognosis. The principal reason for negative cultures is prior antibiotic therapy although fastidious organisms such as Bartonella spp. and Coxiella burnetii are also important. PCR may offer significant advantages in diagnosis but tests require standardisation. Modification of current diagnostic criteria is required. Empirical cover of MRSA needs to be considered.

PMID: 17890062 [PubMed - indexed for MEDLINE]

Can Vet J. 2007 Aug;48(8):839-44.

Bartonella vinsonii subsp. berkhoffii endocarditis in a dog from Saskatchewan.

Cockwill KR, Taylor SM, Philibert HM, Breitschwerdt EB, Maggi RG.

Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4.

A dog referred for lameness was diagnosed with culture-negative endocarditis. Antibodies to Bartonella spp. were detected. Antibiotic treatment resulted in transient clinical improvement, but the dog developed cardiac failure and was euthanized. Bartonella vinsonii subsp. berkhoffii genotype IV was identified within the aortic heart valve lesions by PCR amplification and DNA sequencing.

PMCID: PMC1914319 PMID: 17824328 [PubMed - indexed for MEDLINE]

Arthritis Rheum. 2007 Sep;56(9):2957-67.

Inhibition of Toll-like receptor 4 breaks the inflammatory loop in autoimmune destructive arthritis.

Abdollahi-Roodsaz S, Joosten LA, Roelofs MF, Radstake TR, Matera G, Popa C, van der Meer JW, Netea MG, van den Berg WB.

Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. s.abdollahi-roodsaz@reuma.umcn.nl

OBJECTIVE: Degeneration of extracellular matrix of cartilage leads to the production of molecules capable of activating the immune system via Toll-like receptor 4 (TLR-4). The objective of this study was to investigate the involvement of TLR-4 activation in the development and progression of autoimmune destructive arthritis. METHODS: A naturally occurring TLR-4 antagonist, highly purified lipopolysaccharide (LPS) from Bartonella quintana, was first characterized using mouse macrophages and human dendritic cells (DCs). Mice with collagen-induced arthritis (CIA) and mice with spontaneous arthritis caused by interleukin-1 receptor antagonist (IL-1Ra) gene deficiency were treated with TLR-4 antagonist. The clinical score for joint inflammation, histologic characteristics of arthritis, and local expression of IL-1 in joints were evaluated after treatment. RESULTS: The TLR-4 antagonist inhibited DC maturation induced by Escherichia coli LPS and cytokine production induced by both exogenous and endogenous TLR-4 ligands, while having no effect on these parameters by itself. Treatment of CIA using TLR-4 antagonist substantially suppressed both clinical and histologic characteristics of arthritis without influencing the adaptive anti-type II collagen immunity crucial for this model. Treatment with TLR-4 antagonist strongly reduced IL-1beta expression in articular chondrocytes and synovial tissue. Furthermore, such treatment inhibited IL-1-mediated autoimmune arthritis in IL-1Ra(-/-) mice and protected the mice against cartilage and bone pathology. CONCLUSION: In the present study, we demonstrate for the first time that inhibition of TLR-4 suppresses the severity of experimental arthritis and results in lower IL-1 expression in arthritic joints. Our data suggest that TLR-4 might be a novel target in the treatment of rheumatoid arthritis.

PMID: 17763416 [PubMed - indexed for MEDLINE]

Pediatr Infect Dis J. 2007 Sep;26(9):860-2.

Encephalopathy complicated by Guillain-Barre syndrome and hydrocephalus and associated with acute Bartonella quintana infection.

Mantadakis E, Spanaki AM, Psaroulaki A, Fitrolaki D, Minadakis G, Michaeloudi E, Tselentis Y, Briassoulis G.

Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital of Heraklion, Heraklion, Crete, Greece.

We describe a 16-month-old girl who suffered from encephalopathy leading to intensive care unit hospitalization, complicated by Guillain-Barre syndrome and hydrocephalus, and who had serologic and molecular evidence of central nervous system infection by B. quintana. The possible association of B. quintana with Guillain-Barre syndrome and hydrocephalus has not been previously described and demonstrates the growing spectrum of neurologic complications of Bartonella spp. infections.

PMID: 17721391 [PubMed - indexed for MEDLINE]

Scand J Infect Dis. 2007;39(8):728-30.

Familial occurrence of cat-scratch disease, with varying clinical expression.

Song AT, Gory M, Roussi J, Salomon J, Cremieux AC, Perronne C, Bernard L.

Division of Infectious Diseases, Clinicas Hospital of the University of Sao Paulo, Sao Paulo, Brazil.

Cat-scratch disease, primarily caused by Bartonella henselae, typically presents with regional adenopathy, and the role of antibiotics in the treatment is debatable. We present a report of B. henselae infection transmitted by the same kitten to 4 different individuals, each with different clinical characteristics, treatment, and evolution.

PMID: 17654352 [PubMed - indexed for MEDLINE]

J Paediatr Child Health. 2007 Jul-Aug;43(7-8):568-70.

Role of magnetic resonance imaging and scintigraphy in the diagnosis and follow-up of osteomyelitis in cat-scratch disease.

Rozmanic V, Banac S, Miletic D, Manestar K, Kamber S, Paparic S.

Department of Pediatrics, University of Rijeka, Rijeka, Croatia. vojko.rozmanic@medri.hr

Cat-scratch disease (CSD) is a self-limiting infectious disease characterised with lymphadenopathy in a patient with a history of cat contact. Cases of bone involvement in patients with CSD are rare. We reported a case of 11-year-old boy with prolonged intermittent fever, inguinal lymphadenopathy and osteomyelitis. He had a history of exposure to kittens. The physical examination revealed a febrile boy without an apparent site of infection except an enlarged inguinal lymph node. Its histopathology demonstrated granulomatous lesion with no presence of acid-fast bacilli. Serum titers for Bartonella henselae were positive. Multiple bone lesions were detected by skeletal scintigraphy. Magnetic resonance imaging (MRI) confirmed and characterised osteolytic masses. The oral combination of azithromycin and rifampicin were given for 6 weeks with a good clinical response. At follow-up, the boy was without symptoms or signs of the disease. Successive MRI controls showed gradual regression of the bone lesions together with significant decrease of acute-phase reactants. In conclusion, CSD should be considered in the differential diagnosis of osteomyelitis. MRI is more reliable for the characterisation, evaluation of soft-tissue extension and follow-up of the bone lesions than scintigraphy. However, the later method permits an overview of the multiple osseous lesions. Therefore, standard MRI equipment may not exclude bone scintigraphy. Both methods are required until whole-body MRI units become routine.

PMID: 17635689 [PubMed - indexed for MEDLINE]

Rev Sci Tech. 2007 Apr;26(1):203-15.

Vaccines for emerging infections.

Marano N, Rupprecht C, Regnery R.

Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Emerging infectious diseases represent a grave threat to animal and human populations in terms of their impact on global health, agriculture and the economy. Vaccines developed for emerging infections in animals can protect animal health and prevent transmission of zoonotic diseases to humans. Examples in this paper illustrate how industry and public health can collaborate to develop a vaccine to prevent an emerging disease in horses (West Nile virus vaccine), how poultry vaccination can protect animals and prevent transmission to people (avian influenza vaccine), how regulatory changes can pave the way for vaccines that will control the carrier state in animals and thus prevent infection in humans (Bartonella henselae vaccine in cats) and how novel technologies could be applied to vaccinate wildlife reservoir species for rabies. Stemming from the realisation that zoonotic diseases are the predominant source of human emerging infectious diseases, it behoves academic, public health, and animal health agencies to consider creative constructive approaches to combat serious public health challenges. Vaccination of vector/reservoir species, when efficacious vaccines are available, offers significant advantages to combating zoonotic human disease.

PMID: 17633303 [PubMed - indexed for MEDLINE]

Clin Infect Dis. 2007 Jul 15;45(2):149-57. Epub 2007 Jun 5.

Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with lyme disease.

Stricker RB.

International Lyme and Associated Diseases Society, Bethesda, MD, USA. rstricker@usmamed.com

Comment on: Clin Infect Dis. 2007 Jul 15;45(2):143-8.

BACKGROUND: Controversy exists regarding the diagnosis and treatment of Lyme disease. Patients with persistent symptoms after standard (2-4-week) antibiotic therapy for this tickborne illness have been denied further antibiotic treatment as a result of the perception that long-term infection with the Lyme spirochete, Borrelia burgdorferi, and associated tickborne pathogens is rare or nonexistent. METHODS: I review the pathophysiology of B. burgdorferi infection and the peer-reviewed literature on diagnostic Lyme disease testing, standard treatment results, and coinfection with tickborne agents, such as Babesia, Anaplasma, Ehrlichia, and Bartonella species. I also examine uncontrolled and controlled trials of prolonged antibiotic therapy in patients with persistent symptoms of Lyme disease. RESULTS: The complex "stealth" pathology of B. burgdorferi allows the spirochete to invade diverse tissues, elude the immune response, and establish long-term infection. Commercial testing for Lyme disease is highly specific but relatively insensitive, especially during the later stages of disease. Numerous studies have documented the failure of standard antibiotic therapy in patients with Lyme disease. Previous uncontrolled trials and recent placebo-controlled trials suggest that prolonged antibiotic therapy (duration, >4 weeks) may be beneficial for patients with persistent Lyme disease symptoms. Tickborne coinfections may increase the severity and duration of infection with B. burgdorferi. CONCLUSIONS: Prolonged antibiotic therapy may be useful and justifiable in patients with persistent symptoms of Lyme disease and coinfection with tickborne agents.

PMID: 17578772 [PubMed - indexed for MEDLINE]

An Pediatr (Barc). 2007 Apr;66(4):419-20.

[Cat scratch disease]

[Article in Spanish]

Silveira Cancela M.

Comment on: An Pediatr (Barc). 2006 Nov;65(5):506-8.

PMID: 17569180 [PubMed - indexed for MEDLINE]

Br J Dermatol. 2007 Jul;157(1):174-8. Epub 2007 Jun 6.

Bartonella-related pseudomembranous angiomatous papillomatosis of the oral cavity associated with allogeneic bone marrow transplantation and oral graft-versus-host disease.

Vassallo C, Ardig� M, Brazzelli V, Zecca M, Locatelli F, Alessandrino PE, Lazzarino M, Corona S, Lanzerini P, Benazzo M, Fabbi M, Borroni G.

Department of Dermatology, Istituto di Ematologia, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. cvassallo@yahoo.com

Comment in: Br J Dermatol. 2008 Mar;158(3):652-3.

Patients undergoing allogeneic stem cell transplantation are at high risk for infection with a variety of pathogens during different phases of the procedure. Human infections due to Bartonella spp. are viewed as emerging diseases typical in, although not exclusive to, immunosuppressed patients, in particular those with AIDS, organ transplants and haematological malignancies. We describe four patients, three children and one adult, who developed vegetating papillomatous lesions exclusively on the oral mucosae. They shared a history of haematological malignancy and allogeneic bone marrow/stem cell transplantation, and later developed chronic graft-versus-host disease, also involving the oral mucosae. Histopathologically, the vegetating lesions were characterized by a diffuse neoangiogenesis, granulation-like tissue, and a mixed cell infiltrate predominantly composed of neutrophils. Gram-negative bacteria were found in the endothelial cells of the vessels in the deeper portion of the corium by electron microscopy. In three cases, DNA of B. henselae was detected by polymerase chain reaction (PCR), and confirmed by sequencing of the PCR products. All the lesions healed after systemic antibiotic therapy, although some recurred after months, and regressed again after systemic antibiotic treatment associated with conservative surgical excision.

PMID: 17553040 [PubMed - indexed for MEDLINE]

Eur J Pediatr. 2008 Apr;167(4):471-3. Epub 2007 Jun 1.

Prolonged follow up of seven patients affected by hepatosplenic granulomata due to cat-scratch disease.

Scolfaro C, Leunga GG, Bezzio S, Chiapello N, Riva C, Balbo L, Bertaina C, Tovo PA.

Department of Pediatrics, University of Turin, Piazza Polonia, 94, 10126, Turin, Italy. stefaniabezzio@hotmail.com

This study is a retrospective analysis of seven patients with hypoechogenic lesions in the liver and/or spleen due to Bartonella henselae, who were followed from 1998 through to 2005 by the Department of Pediatrics, Turin University. In addition to showing constitutional symptoms, four children had skin lesions suggestive of injuries inflicted by cats, and one child had a history of exposure to cats. The origin of the infection remained undefined in the other two patients. Humoral tests enabled a precise diagnosis in all children. Treatment with macrolides or combinations of two active antibiotics for at least 2-3 weeks led to the definitive clearance of infection, although residual intraparenchymal lesions persisted in five patients for several months or years. Conclusion B. henselae serology allows an easy diagnosis of multiple hepatosplenic granulomata, a clinical picture that appears to be under-recognized. Macrolides or a combination of two active antibiotics for 2-3 weeks leads to a rapid clinical response and a definitive clearance of infection.

PMID: 17541640 [PubMed - indexed for MEDLINE]

Diagn Microbiol Infect Dis. 2007 Sep;59(1):81-4. Epub 2007 May 29.

Unusual concurrent detection by polymerase chain reaction of Bartonella henselae and parvovirus b19 in an immunocompetent child with erythema nodosum and hepatic granulomatous disease.

Casolari C, Pecorari M, Balli F, Fabio G, Gennari W, Sabbatini AM, Nanni N, Migaldi M, Guaraldi N, Tagliazucchi S, Al� M, Bertoli G, Fabio R, Portolani M.

Department of Medical Laboratory and Legal Medicine, University of Modena and Reggio Emilia, Modena 41100, Italy. casolari.chiara@unimore.it

We report an unusual case of documented Bartonella henselae genotype I from hepatic tissue in an Italian immunocompetent girl presenting with erythema nodosum and hepatic granulomata. Polymerase chain reaction (PCR) was performed on biopsied liver sample to confirm the etiologic role of B. henselae and to identify the genetic variant of this organism. A PCR on the same liver biopsy for parvovirus B19 was also positive, but the clinical meaning of this was not clear.

PMID: 17532594 [PubMed - indexed for MEDLINE]

J Formos Med Assoc. 2007 Feb;106(2 Suppl):S65-68.

Cat scratch disease from a domestic dog.

Chen TC, Lin WR, Lu PL, Lin CY, Chen YH.

Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Cat scratch disease (CSD), caused by Bartonella henselae, is a zoonosis and characterized by self-limited lymphadenopathy. It is transmitted commonly by scratch or bite from cats or kitten. We report an unusual case of CSD caused by a domestic dog scratch that we believe is the first report in Taiwan. A 23-year-old healthy woman developed cervical lymphadenopathy, mild fever, headache, and malaise 3 days after dog scratch. Her symptoms improved after azithromycin treatment. Serology proved B. henselae infection. The owners of a domestic dog might be at risk of "cat" scratch disease.

PMID: 17493900 [PubMed - indexed for MEDLINE]

Br J Dermatol. 2007 Apr;156(4):705-8.

Idiopathic facial aseptic granuloma: a multicentre prospective study of 30 cases.

Boralevi F, L�aut�-Labr�ze C, Lepreux S, Barbarot S, Mazereeuw-Hautier J, Eschard C, Ta�eb A; Groupe de Recherche Clinique en Dermatologie P�diatrique.

Laboratory of Pathology, H�pital Pellegrin-Enfant, Place Am�lie Raba-L�on, 33076 Bordeaux cedex, France. franck.boralevi@chu-bordeaux.fr

BACKGROUND: Idiopathic facial aseptic granuloma (IFAG) was recently described in a single-centre retrospective study as a skin condition that occurs specifically in childhood. OBJECTIVES: To improve our epidemiological, clinical and pathological knowledge on IFAG, to search for an infectious aetiology, and to assess therapeutic recommendations. METHODS: Children presenting with one or several acquired nodules on the face, lasting for at least 1 month, with no evidence of any other recognizable clinical entity such as infantile acne, pilomatrixoma, furuncle, tumour or vascular malformation, were enrolled in a prospective multicentre study from June 2001 to June 2004, involving the main French paediatric dermatology outpatient units. We recorded clinical details about the nodule and its duration, ultrasound study pattern, cultures for bacteria and mycobacteria, and Bartonella henselae and Afipia felis antibody testing. RESULTS: Thirty children (17 boys and 13 girls, mean age 3.8 years) were enrolled. Ultrasound studies revealed a solid well-demarcated hypoechoic lesion without calcium deposit. Cultures for bacteria were negative in 70% of cases. Cultures for mycobacteria and cat scratch disease serologies were negative. Antibiotic therapy was ineffective; the lesion healed spontaneously with a mean duration of 11 months. Histological examination, performed in five cases, showed a chronic dermal lymphohistiocytic granuloma with numerous foreign body-type giant cells. CONCLUSIONS: IFAG is characterized by a painless facial nodule, presenting as a single lesion localized on the cheek, with a prolonged course but spontaneous healing. Oral or local antibiotics are usually ineffective. Regarding the pathophysiology, our study rules out a primary infectious disease, and allows considering IFAG either as a granulomatous process appearing around an embryological residue or as a manifestation to include in the spectrum of granulomatous rosacea in childhood.

PMID: 17493068 [PubMed - indexed for MEDLINE]

Klin Monbl Augenheilkd. 2007 Apr;224(4):311-3.

Bartonella henselae infection presenting as a unilateral acute maculopathy.

Wimmersberger Y, Baglivo E.

Clinique d'Ophtalmologie, H�pitaux Universitaires de Gen�ve, Geneva, Switzerland.

BACKGROUND: The purpose of this article is to report an unusual ocular manifestation of cat scratch disease (CSD) presenting as a unilateral acute maculopathy (UAM). We describe and review the clinical, laboratory, fluorescein angiography (FA), indocyanine green angiography (ICG) and optical coherence tomography (OCT) records of a patient with CSD. HISTORY AND SIGNS: A 30-year-old Chinese woman presented with a painless progressive visual loss affecting her left eye. Fundus examination of the left eye disclosed rare vitreous cells and a deep-creamy choroidal macular lesion with satellite foci of choroiditis. THERAPY AND OUTCOME: FA revealed an early hypofluorescence of the lesion, becoming progressively hyperfluorescent with a leakage on the late phase. The ICG disclosed an early hypofluorescence of the macular lesion with a mild staining of its periphery on the late frames. Hypofluorescent satellite lesions were visible both on the early and late frames. The OCT disclosed a serous retinal detachment at the level of the whitish lesion. Serologies for Bartonella henselae (BH) became positive (IgG 1: 512, IgM < 1:20) confirming an active or recent infection. CONCLUSIONS: Ocular manifestations of CSD can appear as a UAM with satellite lesions. CSD should be ruled out in patients manifesting such clinical features.

PMID: 17458800 [PubMed - indexed for MEDLINE]

Rev Chilena Infectol. 2007 Apr;24(2):155-9. Epub 2007 Apr 12.

[Bacillary angiomatosis caused by Bartonella quintana in an human immunodeficiency virus positive patient]

[Article in Spanish]

V�squez T P, Chanqueo C L, Garc�a C P, Poggi M H, Ferr�s G M, Bustos M M, Piottante B A.

Unidad de Infectolog�a, Servicio de Medicina Interna, Hospital San Juan de Dios, and Laboratorio de Microbiolog�a y Biolog�a Molecular, Pontificia Universidad Cat�lica de Chile.

We report the first case of bacillary angiomatosis due to Bartonella quintana affecting a Chilean a HIV positive patient in Chile. He was a 27 years old, heterosexual male, indigent man known to be HIV positive serological status known from September, 2003, under irregular medical control. On April, 2005, he presented a progressive abscess in the frontal region and erythematous papules in the extremities, that extended to face, thorax and mucoses, becoming nodular and violaceous lesions. Bacillary angiomatosis diagnosis was initially sustained on account of the clinical manifestations, and was confirmed by serology and Warthin Starry staining from a skin biopsy. The etiological agent was identified as Bartonella quintana through universal RPC performed from a cutaneous nodule to detect 16S rRNA gen. Azithromycin plus ciprofloxacin was started, besides of anti retroviral therapy antiretroviral, with the lesions being progressively disappearing.

PMID: 17453076 [PubMed - indexed for MEDLINE]

J Antimicrob Chemother. 2007 Jun;59(6):1065-70. Epub 2007 Apr 21.

Molecular mechanisms of resistance to antibiotics in Bartonella bacilliformis.

Biswas S, Raoult D, Rolain JM.

Unit� des Rickettsies, CNRS UMR 6020, IFR 48, Facult� de M�decine et de Pharmacie, Universit� de la M�diterran�e, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France.

OBJECTIVES: Bartonella bacilliformis is the aetiological agent of Carrion's disease. Although ciprofloxacin, rifampicin and erythromycin have been successfully used in the treatment of the disease, failures and relapses have been reported. The objective of our study was to select in vitro mutants resistant to antibiotics in order to determine the frequency of mutations and to characterize the mechanism of resistance at the molecular level. METHODS: Antibiotic-resistant mutants were selected by serial passages of bacteria on blood agar plates containing antibiotics. Candidate genes involved in resistance were amplified and sequenced and compared in order to look at mutations associated with antibiotic resistance. RESULTS: Ciprofloxacin-, rifampicin- and erythromycin-resistant mutants were obtained after five, three and four passages, respectively. Conversely, no mutant was obtained with either gentamicin or doxycycline even after 16 passages. The ciprofloxacin mutant contained an amino acid change at position 87 (Asp --> Asn) in its quinolone resistance-determining region of the DNA gyrase protein, whereas the rifampicin-resistant strain had an amino acid change at position 531 (Ser --> Phe) in the rifampicin resistance-determining region of the rpoB gene. Similarly, the erythromycin-resistant mutant showed an A2058G mutation in the 23S rRNA gene. CONCLUSIONS: According with the current knowledge on the treatment of human bartonellosis, we believe that doxycycline in association with gentamicin may be the preferred regimen for the treatment of the acute and eruptive stages of Carrion's disease, but clinical trials are warranted to support our findings.

PMID: 17449882 [PubMed - indexed for MEDLINE]

Kansenshogaku Zasshi. 2007 Mar;81(2):206-9.

[Pediatric pneumonia, pleural effusion, and pericarditis following cat scratch disease and serological cross-reactions among Bartonella henselae and Rickettsia japonica determined by indirect fluorescence antibodies]

[Article in Japanese]

Takeda N, Ishiwada N, Fukasawa C, Furuya Y, Tsuneoka H, Tsukahara M, Kohno Y.

Department of Pediatrics, Graduate School of Medicine, Chiba University.

Cat scratch disease is associated with a variety of systemic manifestations. We report a pediatric case associated with pneumonia, pleural effusion, and pericarditis. A 3-year-old boy developed prolonged fever unresponsive to antibiotic treatment, including azithromycin and minocycline. Although the fever resolved with corticosteroid treatment, Bartonella henselae IgG titer was positive in indirect fluorescence antibodies, as was Rickettsia japonica IgG titer. Both titers were significantly reduced by serum absorption with B. henselae antigens, and we observed a serological cross-reaction between B. henselae and R. japonica.

PMID: 17447481 [PubMed - indexed for MEDLINE]

Dtsch Med Wochenschr. 2007 Apr 20;132(16):874-7.

[Generalized lymphadenitis associated with Hashimoto's thyroiditis]

[Article in German]

Brecht A, Stiegler T, Lange J, de Groot K.

Medizinische Klinik III, Nephrologie und Rheumatologie. annebrecht@gmx.de

HISTORY AND ADMISSION FINDINGS: A 26-year-old Pakistani woman was admitted to hospital with fever, nausea and vomiting, abdominal pain and general weakness for the previous two weeks, but no diarrhea or constipation. Antibiotic therapy as an out-patient had not provided relief. She also had enlarged cervical lymph nodes. She reported that she had always been in good health before onset of the described symptoms. INVESTIGATIONS: Laboratory tests revealed pancytopenia and a decrease in C3 and C4. The ANA titer was positive. The serum was positive for preceding infections with EBV, CMV, Chlamydia trachomatis, HHV type 6, and toxoplasmosis. There was no evidence of current or previous infections with HIV, Bartonella henselae, Treponema pallidum, Listeria, Hantavirus, Leishmania or dengue fever. The patient's symptoms were found to be associated with Hashimoto's thyroiditis in conjunction with latent hypothyroidism. Abdominal, thoracic and cervical CT scan revealed enlarged lymph nodes, up to 2 cm in size, and enlarged spleen and liver. THERAPY AND CLINICAL COURSE: Histopathology of a cervical lymph node showed features of Kikuchi (Kikuchi-Fujimoto) disease (histiocytic necrotizing lymphadenitis). Prednisone administration (2 mg/kg body weight) led to the patient's rapid recovery. CONCLUSION: Kikuchi disease should be considered in patients with cervical but also general lymphadenopathy, after exclusion of other causes. The specific diagnosis is based on biopsy of affected lymph nodes.

PMID: 17443443 [PubMed - indexed for MEDLINE]

Chirurg. 2008 Mar;79(3):249-51.

[Painful soft-tissue swelling of the upper arm]

[Article in German]

Eichhorn-Sens J, Bund T, Vogt PM.

Plastische Gesichtschirurgie, Marienhospital Stuttgart, B�heimstrabe 37, 70199, Stuttgart. eichhorn-sens@web.de

Cat-scratch disease is an infection by Bartonella henselea and resolves spontaneously. We present a case of untypical Bartonella infection which was misinterpreted by MRI as a soft-tissue sarcoma of the upper arm. The histological findings of an incision biopsy were unspecific, without signs of malignancy. The tumor was excised completely and the final histology, however, showed no evidence of malignant changes. The Bartonella henselae infection could be confirmed by polymerase chain reaction. The untypical presentation of cat-scratch disease should be considered in the differential diagnosis of clinically suspected soft tissue sarcoma.

PMID: 17443304 [PubMed - indexed for MEDLINE]

An Pediatr (Barc). 2007 Apr;66(4):418-9.

[Atypical cat scratch disease in an immunocompetent school-aged child]

[Article in Spanish]

Dorado Moles MJ, L�pez-Ibor B, Figueredo MA, Gonz�lez Laguillo A.

PMID: 17430722 [PubMed - indexed for MEDLINE]

Braz J Infect Dis. 2006 Dec;10(6):411-5.

Bartonellosis: suggestive case reports in adult and pediatric patients and therapeutic issues.

Manfredi R, Sabbatani S.

Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, S Orsola Hospital, Bologna, Italy. Roberto.manfredi@unibo.it

Cat-scratch disease warrants extensive investigation, from an epidemiological, a diagnostic, but especially a therapeutic point of view. Two suggestive episodes of Bartonella henselae-caused cat-scratch disease are reported, and discussed in the light of the most recent literature evidence. The first case occurred in a 60-year-old man, thus suggesting that it is important to maintain an elevated level of suspicion for this disease in adults as well. Both episodes were characterized by a very prolonged and complicated disease course (with the involvement of three lymph node sets in the first case), a need for lymph-node drainage, and apparently negligible activity of many antimicrobial courses, with a very slow local cure. While specific culture and molecular biology techniques proved negative (probably due to late availability of appropriate clinical specimens), indirect immunofluorescence antibody assay was positive since the first weeks of disease, and elevated levels were also fond many months after disease onset. When clinicians face patients with prominent swelling of lymph nodes draining from the upper limbs, cat-scratch disease may be suspected on the grounds of epidemiological and clinical features, with a limited systemic involvement contrasting with a prominent local disease. The significance of specific antibody temporal kinetics in the subacute disease course is still unknown. Although biomolecular assays are now available, the time elapsed from disease onset to clinical diagnosis usually hampers diagnosis, while the roles of surgical debridement and of the unpredictable activity of antimicrobial chemotherapy warrant careful investigation.

PMID: 17420917 [PubMed - indexed for MEDLINE]

Antimicrob Agents Chemother. 2007 Jun;51(6):2011-5. Epub 2007 Apr 2.

Controlled trial of a 5-day course of telithromycin versus doxycycline for treatment of mild to moderate scrub typhus.

Kim DM, Yu KD, Lee JH, Kim HK, Lee SH.

Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, South Korea. drongkim@chosun.ac.kr

New antibiotics are required to have the antibacterial activity against doxycycline-resistant Orientia tsutsugamushi. An in vitro sensitivity study showed that telithromycin was more effective than erythromycin for Rickettsia, Bartonella, and Coxiella burnetii. In this prospective, open-label, randomized trial, we enrolled patients with mild-to-moderate scrub typhus. We compared the efficacy and safety of a 5-day telithromycin therapy with those of a 5-day doxycycline therapy at Chosun University Hospital or one of its two community-based affiliated hospitals (Jangheung Hospital and Cheomdan Hospital), which are all located in southwestern Korea, between September and December 2005. A total of 92 patients were randomly assigned to either the telithromycin group (n = 47) or the doxycycline group (n = 45). After the treatment, fever control time was 20.45 +/- 12.9 h in the telithromycin group and 22.60 +/- 21.44 h in the doxycycline group (P > 0.05). After the treatment, the cure rate was 100% in the telithromycin group and 97.8% in the doxycycline group (P > 0.05). Furthermore, there were no significant differences in time elapsed until such symptoms as headache, myalgia, and rash disappeared. No serious adverse events or death were noted following the treatment in both groups. There were no significant differences in adverse events. In conclusion, the efficacy and safety of a 5-day once-a-day regimen of 800 mg telithromycin were equivalent to those of a 5-day twice-a-day regimen of 100 mg doxycycline in patients with mild-to-moderate scrub typhus. Telithromycin could be considered a promising new antibacterial agent for patients with scrub typhus.

PMCID: PMC1891405 PMID: 17404000 [PubMed - indexed for MEDLINE]

Infection. 2007 Apr;35(2):107-9.

Chronic vasculitis and polyneuropathy due to infection with Bartonella henselae.

Stockmeyer B, Schoerner C, Frangou P, Moriabadi T, Heuss D, Harrer T.

Dept. of Medicine III, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany. Thomas.Harrer@med3.imed.uni-erlangen.de

Bartonella henselae, the causative agent of cat scratch disease and bacillary angiomatosis, is associated with an expanding spectrum of diseases. Here, we report on a 40-year-old patient suffering from chronic recurrent painful ulcers of the toes, distal axonal sensomotor polyneuropathy and Raynaud's phenomenon. Biopsy of the sural nerve demonstrated an axonal neuropathy with a neurogenic muscular atrophy. Treatment with high dose corticosteroids had no beneficial effect. A biopsy taken from a recurring ulcer 7 years after the beginning of the disease revealed superficial ulcerated hyperkeratosis with subepithelial proliferation of small vessels compatible with a diagnosis of verruca peruana, however, without detection of microorganism. Serologic analysis revealed an elevated IFT titer of 1:1,024 against B. henselae. Treatment with erythromycin induced healing of the ulcer, remission of the vasculitis and the polyneuropathy, and a decline of the IFT titer. This case illustrates that B. henselae infection should be considered in patients with vasculitis and polyneuropathic syndromes.

PMID: 17401716 [PubMed - indexed for MEDLINE]

Ocul Immunol Inflamm. 2007 Jan-Feb;15(1):41-3.

Presumed oculoglandular syndrome from Bartonella quintana.

Borboli S, Afshari NA, Watkins L, Foster CS.

The Center for Eye Care, Beloxi, MS , USA.

BACKGROUND: To describe a case of clinically diagnosed oculoglandular syndrome in a 17-year-old patient that was presumed to be due to Bartonella quintana, as suggested by a positive serologic titer. METHODS: The patient presented to the Massachusetts Eye and Ear Infirmary emergency room with signs and symptoms suggestive of oculoglandular syndrome. He had a follicular conjunctivitis with a conjunctival granuloma of the right eye and an ipsilateral large, tender submandibular lymph node. He had recently acquired a kitten and a clinical diagnosis of cat-scratch disease was made. A laboratory workup was initiated to determine the cause of this clinical presentation and empirical treatment with antibiotics was started. RESULTS: All laboratory results were negative or normal except for the IgM titer to Bartonella quintana, which was elevated. The patient responded well to treatment and his symptoms resolved within a few weeks. DISCUSSION: Bartonella quintana infection, a pathogen prevalent in HIV-infected, homeless, or alcoholic patients, is a possible etiologic agent of cat-scratch disease and the associated condition of oculoglandular syndrome.

PMID: 17365807 [PubMed - indexed for MEDLINE]

Int J Clin Pract. 2008 Dec;62(12):1956-7. Epub 2007 Mar 1.

Bartonella henselae lymphadenitis progressing to hepatosplenic disease with slow clinical response despite early diagnosis and treatment.

Pasticci MB, Di Candilo F, Egidi MA, Lapalorcia LM, Marroni M, Tinca E, Sfara C, Stagni G.

PMID: 17343673 [PubMed - indexed for MEDLINE]

Pediatr Neurosurg. 2007;43(2):164-6.

Cat scratch disease with epidural extension while on antimicrobial treatment.

Hussain S, Rathore MH.

Pediatric Infectious Diseases and Immunology, University of Florida, USA.

We report the first case of a child with an epidural abscess caused by Bartonella henselae. This case is unique in that the diagnosis was confirmed by polymerase chain reaction (PCR) of the abscess fluid. A 3-year-old male was admitted with a 1-week history of fever and lower back pain. Magnetic resonance imaging (MRI) of the lumbar spine revealed a paraspinal soft tissue abnormality extending from the T(12) to the L(4) level, and a computed tomography (CT) scan of the lumbar spine showed osteomyelitis at the T(12) level with soft tissue changes. B. henselae serology showed an IgG titer of 1:256 and IgM of <1:16.

PMID: 17337934 [PubMed - indexed for MEDLINE]

Joint Bone Spine. 2007 Mar;74(2):184-6. Epub 2007 Feb 5.

Cat scratch disease during etanercept therapy.

Mathieu S, Vellin JF, Poujol D, Ristori JM, Soubrier M.

Clermont-Ferrand Teaching Hospital, Rheumatology Department, G. Montpied Hospital, Clermont-Ferrand, France. smathieu11@yahoo.fr

Lymphadenopathy in a patient taking TNFalpha antagonist therapy may indicate lymph node tuberculosis or a hematological malignancy. Although histological evidence of granuloma suggests tuberculosis, many other infections responsible for granulomatous reactions have been reported in patients on TNFalpha antagonist therapy. We report a case of granulomatous lymphadenopathy due to Bartonella henselae in a patient taking etanercept to treat ankylosing spondylitis.

PMID: 17337229 [PubMed - indexed for MEDLINE]

Pediatrics. 2007 Mar;119(3):e760-3.

Recurrent expressive aphasia as a presentation of cat-scratch encephalopathy.

Fox JW, Studley JK, Cohen DM.

Children's Hospital of Akron, Division of Emergency Medicine, One Perkins Square, Akron, OH 44308, USA. jfox@chmca.org

Cat-scratch disease is a common disease, occurring in an estimated 24,000 patients annually in the United States, and is one of the most common causes of chronic lymphadenitis in children. A wide array of neurologic complications occurs as a result of cat-scratch disease. However, there have been no reports of acute-onset, self-resolving, recurrent, expressive aphasia, as we report here in an adolescent boy. In our case, establishing the diagnosis of cat-scratch encephalopathy saved time and resources and afforded the family a benign diagnosis. Cat-scratch encephalopathy must be considered in the differential diagnoses when pediatric patients present with unusual neurologic symptoms.

PMID: 17332191 [PubMed - indexed for MEDLINE]

J Am Vet Med Assoc. 2007 Mar 1;230(5):681-5.

Detection of Bartonella henselae DNA in two dogs with pyogranulomatous lymphadenitis.

Morales SC, Breitschwerdt EB, Washabau RJ, Matise I, Maggi RG, Duncan AW.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108, USA.

CASE DESCRIPTION: 1 dog evaluated because of inappetence and lameness of the left hind limb of 1 day's duration and 1 dog evaluated because of inappetence, fever, and lymphadenopathy of 2 weeks' duration. CLINICAL FINDINGS: Histologic examination of excisional biopsy specimens from lymph nodes revealed pyogranulomatous lymphadenitis in both dogs. Quantitative real-time PCR assays detected Bartonella henselae DNA in blood samples and affected lymph node specimens from both dogs. Antibodies against B. henselae were not detected via immunofluorescent antibody testing during active disease in either dog. TREATMENT AND OUTCOME: 1 dog recovered after 6 weeks of treatment with doxycycline (5 mg/kg [2.3 mg/lb], p.o., q 12 h), whereas the other dog recovered after receiving a combination of azithromycin (14.5 mg/kg [6.6 mg/lb], p.o., q 24 h for 21 days), doxycycline (17.3 mg/kg [7.9 mg/lb], p.o., q 24 h for 4 weeks), and immunosuppressive corticosteroid (prednisone [3 mg/kg {1.4 mg/lb}, p.o., q 24 h], tapered by decreasing the daily dose by 25% every 2 weeks) treatment. CLINICAL RELEVANCE: B. henselae is implicated as a possible cause or a cofactor in the development of pyogranulomatous lymphadenitis in dogs. In dogs with pyogranulomatous lymphadenitis, immunofluorescent assays may not detect antibodies against B. henselae. Molecular testing, including PCR assay of affected tissues, may provide an alternative diagnostic method for detection of B. henselae DNA in pyogranulomatous lymph nodes.

PMID: 17331050 [PubMed - indexed for MEDLINE]

Emerg Infect Dis. 2006 Dec;12(12):1869-72.

Bartonella quintana endocarditis in dogs.

Kelly P, Rolain JM, Maggi R, Sontakke S, Keene B, Hunter S, Lepidi H, Breitschwerdt KT, Breitschwerdt EB.

Ross University, Basseterre, Saint Kitts, West Indies. pkelly@rossvet.edu.kn

We provide the first evidence that Bartonella quintana can infect dogs and cause typical signs of endocarditis. Using PCR and sequencing, we identified B. quintana in the blood of a dog from the United States with aortic valve endocarditis and probably also in the mitral valve of a dog from New Zealand with endocarditis.

PMID: 17326937 [PubMed - indexed for MEDLINE]

Vet Microbiol. 2007 Jun 21;122(3-4):290-7. Epub 2007 Jan 31.

Experimental infection of domestic cats with passaged genotype I Bartonella henselae.

Werner JA, Kasten RW, Feng S, Sykes JE, Hodzic E, Salemi MR, Barthold SW, Chomel BB.

Center for Comparative Medicine, Schools of Medicine and Veterinary Medicine, University of California, Davis, CA 95616, USA.

The influence of in vitro passage on Bartonella henselae pathogenesis in cats has not been thoroughly evaluated. Our objective was to examine the bacterial kinetics and humoral immune responses in cats experimentally infected with three different in vitro passages of B. henselae F1, a genotype I strain of feline origin. The F1 strain was in vitro passaged 20 and 40 times, and each was inoculated into a group of 5 cats. The kinetics of bacteremia and the feline humoral immune response to bacterial antigens were compared to a previous study involving a group of six cats inoculated with the original F1 strain. Among the three groups of cats, the kinetics of bacteremia profiles and the humoral immune responses to B. henselae lysates were similar. The influence of passage on bacterial membrane proteins was examined. In vitro passage altered the expression of 4/17 (23.5%) bacterial membrane proteins and 6/15 (40%) bacterial membrane antigens. An association between poor seroreactivity to three lysate antigens (15-, 18- and 45kDa), prolonged bacteremia and decreased serum bactericidal activity was noted. Our data show that in vitro passage of B. henselae did not alter the kinetics of bacteremia, including the occurrence of relapsing bacteremia, in experimentally infected cats. This suggests that highly passaged strains may not be suitable for future vaccination studies. Furthermore, in vitro passage results in phenotypic and antigenic changes in the bacterial membrane protein profile, which warrants caution in the interpretation of studies involving passaged B. henselae strains.

PMID: 17321078 [PubMed - indexed for MEDLINE]

BMC Infect Dis. 2007 Feb 23;7:8.

Adult systemic cat scratch disease associated with therapy for hepatitis C.

Bhatti Z, Berenson CS.

Infectious Disease Division, VA Western New York Healthcare System, State University of New York at Buffalo School of Medicine, Buffalo, New York 14215, USA. zbhatti@hotmail.com

BACKGROUND: We describe the first case of systemic cat scratch disease in a patient receiving peginterferon alpha-2a and ribavirin for treatment of hepatitis C. Cases of adult systemic CSD are extremely infrequent and immunomodulatory treatment for hepatitis C has been associated with aberrant host responses to common pathogens. CASE PRESENTATION: A 52 year old man being treated for hepatitis C presented with diffuse lymphadenopathy, weight loss, fevers and splenic lesions. Symptoms were initially confused with adverse effects of his regimen, delaying recognition of his infection. Diagnostic investigation, including histopathology, microbiology and serologic parameters, confirmed that his illness was due to disseminated cat scratch disease with Bartonella henselae. CONCLUSION: Disseminated CSD is exceptionally rare in adults. We describe the first case of disseminated cat scratch disease associated with peginterferon alpha and ribavirin to alert clinicians of the need to be aware of unusual manifestations of common infections in this population.

PMCID: PMC1810538 PMID: 17319959 [PubMed - indexed for MEDLINE]

Clin Infect Dis. 2007 Mar 15;44(6):849, 884-5.

An HIV-positive patient with cervical lymphadenopathy and skin lesions.

dos Santos RP, Cartell A, Goldani LZ.

Infectious Diseases Section, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. rpsrodrigo@gmail.com

PMID: 17304465 [PubMed - indexed for MEDLINE]

Transplant Proc. 2007 Jan-Feb;39(1):311-3.

High suspicion of bacillary angiomatosis in a kidney transplant recipient: a difficult way to diagnose--case report.

Dardenne S, Coche E, Weynand B, Poncelet A, Zech F, De Meyer M.

Service de Chirurgie et Transplantation Abdominale, Universite Catholique de Louvain, Cliniques Universitaires, Brussels, Belgium. sabrinoduodenne@hotmail.com

Bacillary angiomatosis is an infection caused by Bartonella, which has first been described in human immunodeficiency virus (HIV)-infected patients. We report an unusually located lesion, in a totally asymptomatic kidney transplant recipient. The diagnosis was strongly suggested based on the iconography and our histological analysis, but was not confirmed using polymerase chain reaction (PCR) and immunohistochemical studies. We illustrate our difficult way to the diagnosis as well as the course of the disease and our therapeutic strategy.

PMID: 17275532 [PubMed - indexed for MEDLINE]

J Wildl Dis. 2006 Oct;42(4):750-8.

Effect of experimental ectoparasite control on bartonella infections in wild Richardson's ground squirrels.

Jardine C, Waldner C, Wobeser G, Leighton FA.

Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4, Canada. cjardi01@uoguelph.ca

The purpose of this study was to investigate the role of ectoparasites in transmitting Bartonella infections in wild Richardson's ground squirrels (Spermophilus richardsonii). Richardson's ground squirrels were trapped, examined for fleas, and tested for Bartonella bacteremia once monthly, at six sites, from April to September 2004. After the initial trapping session in April, burrows at three sites were treated with deltamethrin insecticide. Richardson's ground squirrels trapped on treated sites were less likely to have fleas and had fewer fleas than squirrels on control sites in all months following treatment. We found no difference in the prevalence of Bartonella infections on control and treated sites in May, immediately following treatment; however, significantly fewer squirrels were infected with Bartonella on treated sites in June and July. We conclude that ectoparasites are a main route of transmission for Bartonella infections in Richardson's ground squirrels.

PMID: 17255441 [PubMed - indexed for MEDLINE]

Liver Int. 2007 Feb;27(1):145-8.

Cat scratch disease causing hepatic masses after liver transplant.

Thudi KR, Kreikemeier JT, Phillips NJ, Salvalaggio PR, Kennedy DJ, Hayashi PH.

Gastroenterology and Hepatology Division, Department of Internal Medicine, Saint Louis University Hospital, St Louis, MO, USA.

Hepatic cat scratch disease is rarely reported in liver transplant recipients and has never been reported with discrete liver lesions in the graft. A 52-year-old woman was transplanted for hepatitis C cirrhosis and hepatocellular carcinoma. Her posttransplant course was uneventful. She presented 2.7 years after transplantation with fever of unknown origin and went on to develop multiple and diffuse discrete liver lesions. Despite an extensive work-up including percutaneous and laparoscopic biopsies, a subsegmental resection that included one of these masses was required to make the diagnosis of Bartonella henselae infection. Serologic tests were equivocal. Histology was consistent with cat scratch disease of the liver, and polymerase chain reaction (PCR) testing of the resected tissue confirmed the diagnosis. Response to doxycycline was rapid. Fevers resolved within 7 days. Repeat abdominal CT scan showed reduction of the liver masses. Cat scratch disease should be considered in postliver transplant patients presenting with fever and liver lesions, especially if close contact with cats has occurred. Diagnosis by PCR testing of involved tissue is preferred when serologies are equivocal due to immunosuppression.

PMID: 17241393 [PubMed - indexed for MEDLINE]

Pediatr Transplant. 2007 Feb;11(1):105-9.

Cat-scratch disease relapse in a kidney transplant recipient.

Rheault MN, van Burik JA, Mauer M, Ingulli E, Ferrieri P, Jessurun J, Chavers BM.

Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.

Cat-scratch disease, an infectious illness infrequently reported in kidney transplant patients, is caused by the organism Bartonella henselae and is transmitted through contact with cats or kittens. It is a self-limited disorder in the general pediatric population. Here we present a case of unsuspected cat-scratch disease in a pediatric kidney transplant patient who presented with fever and lymphadenopathy. Eight months after treatment with a short course of azithromycin, the patient developed a recurrence of cat-scratch disease. We emphasize that the evaluation of a young immunocompromised kidney transplant patient presenting with fever and lymphadenopathy should include unusual infections such as cat-scratch disease. We review the diagnosis and treatment of this uncommon infection in the organ transplant population.

PMID: 17239132 [PubMed - indexed for MEDLINE]

Acta Med Croatica. 2006 Dec;60(5):483-6.

[Rash and purulent lymphadenitis in cat scratch disease]

[Article in Croatian]

Dzelalija B, Medi� A, Rode OD, Mazzi A.

Op�a bolnica Zadar, Zavod za javno zdravstvo Zadarske zupanije, Zadar, Hrvatska. boris.dzelalija@zd.t-com.hr

We present a case of a cat-scratch disease (CSD) presenting with typical (primary lesion and regional lymphadenitis) and rare (purulent lymphadenitis and maculopapular rash) symptoms and positive epidemiological data. Laboratory blood test showed normal values for routine parameters, except for mild leukocytosis (L 12.4 x 10(9)), elevated erythrocyte sedimentation rate (SE 65/h) and moderately elevated asparta e-aminotransferase and alanine-aminotransferase values (AST/ALT 48/90), fibrinogen (5.3 g/L) and C-reactive protein (CRP 85 mg/L). Cytological analysis of lymph node content revealed granulomatous inflammation in the first sample, and purulent inflammation in the second sample. In paired serum samples, collected on the 15th and 29th day from the onset of disease, antibodies IgG (titre 4096/8192) and IgM (titre 80/40) to Bartonella henselae were detected by using an indirect immunofluorescence assay (IFA). Antibiotic therapy with azithromycin (1 x 500 mg per os/5 days) was administered. Purulent lymphadenitis and rash, although a rare clinical manifestation in CSD, are significant clinical findings in differentiating CSD from other febrile illnesses accompanied with rash and lymphadenitis.

PMID: 17217106 [PubMed - indexed for MEDLINE]

Eur J Pediatr. 2007 Dec;166(12):1289-91. Epub 2006 Dec 22.

Pyogenic splenic abscess in an infant with serological evidence of cat scratch disease.

Kusuhara K, Nakao F, Saito M, Nakamura K, Ieiri S, Taguchi T, Hara T.

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. kkusuhar@pediatr.med.kyushu-u.ac.jp

PMID: 17186270 [PubMed - indexed for MEDLINE]

Rev Med Chil. 2006 Oct;134(10):1243-8. Epub 2006 Dec 13.

[Cat-scratch disease. Review of eight adult patients hospitalized for fever or adenopathy]

[Article in Spanish]

Eymin G, Zapata A, Andrade M, Aizman A, Rojas L, Rabagliati R.

Departamento de Medicina Interna, Hospital Cl�nico, Facultad de Medicina, Pontificia Universidad Cat�lica de Chile, Santiago, Chile. geymin@med.puc.cl

BACKGROUND: Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever. AIM: To report the clinical and laboratory features of eight patients with cat-scratch disease. MATERIAL AND METHODS: Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence). RESULTS: Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials. CONCLUSIONS: Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.

PMID: 17186093 [PubMed - indexed for MEDLINE]

Brain Dev. 2007 Jul;29(6):377-9. Epub 2006 Dec 15.

Effect of high-dose methyl-prednisolone on brainstem encephalopathy and basal ganglia impairment complicating cat scratch disease.

Genizi J, Kasis I, Schif A, Shahar E.

Child Neurology Unit & Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.

Cat scratch disease (CSD) is a zoonotic illness caused by the Gram negative bacillus Bartonella henselae characterized by a small skin lesion at the site of a bite, lick or scratch by a cat, commonly followed by regional lymphadenopathy 1 or 2 weeks later. We report herein on severe neurological complications of CSD combining brainstem encephalopathy and basal ganglia impairment. This 12-year-old female acutely presented to a local hospital with profound coma and a prolonged tonic posturing of extremities. On the neurological examination she was deeply comatose with pin-point pupils and lack of vestibulo-ocular responses, suggestive of brainstem encephalopathy, along with marked rigid hypertonicity suggestive also of basal ganglia impairment. Initially suspecting Herpes simplex encephalitis or acute disseminated encephalomyelitis she was promptly started with high-dose methyl-prednisolone and acyclovir. Her parents apparently reported that she was scratched by a kitten some 4 weeks prior to her present admission and as such, suspecting CSD, she was begun with doxycycline and rifampicin. Her serology had proven positive for IgM antibodies to Bartonella henselae establishing the diagnosis. She regained consciousness after 4 days and the signs of brainstem and extra-pyramidal impairment also gradually abated and disappeared after 10 days. A follow-up exam after a month disclosed mild extra-pyramidal abnormalities which disappeared after 3 months. Although extremely rare, CSD should be also considered in a patient presenting with a severe encephalopathy and associated basal ganglia impairment. The prompt administration of high-dose methyl-prednisolone upon admission may have contributed to the favorable outcome in our patient and therefore should be advocated in any patient presenting with profound encephalopathy regardless the underlying etiology recovered later.

PMID: 17174500 [PubMed - indexed for MEDLINE]

Vojnosanit Pregl. 2006 Nov;63(11):971-4.

[Bartonella henselae as a cause of optical nerve neuritis]

[Article in Serbian]

Veselinovi� D.

Klinicki centar, Klinika za ocne bolesti, Nis, Srbija. veselinovicdr@Yahoo.com

INTRODUCTION: Bartonella henselae is included into the group of gram-negative bacteria that can cause not so rare disease known as cat-scratch disease (CSD). This disease is characterized by the specific general symptoms, and the complications in the eyes can be manifested in the form of neuroretinitis, follicular conjunctivitis and focal chorioretinitis. In this paper clinical and epidemiological characteristics of a patient with ophthalmologic complications caused by Bartonella henselae are described. We indicate diagnostic possibilities and the criteria for making the diagnosis. CASE REPORT: We presented a 42-year-old female patient with CSD symptoms, and with a registered neuritis as an ophthalmologic complication. Two weeks after the occurrence of a scratch on the hand after the contact with a cat, there was a slight lymphadenopathy of the axial area of the left side, accompanied by light febrility and weakness. A week after these symptoms occuring, the patient complained of a reduction of the visual acuity in her left eye. The established visual acuity in the left eye was 0.1 with ophthalmological findings of a light edema of the optical disk and a partial star-like edema in the nasal half of the macula. Central scotoma was present, with the extension of the blind spot and the constriction of central isopter of the left eye visual field. Fluorescein biomicroscopy revealed an intensive leaking of fluoresceins at the level of optical disk and macular region in an early arterial phase, without the appearance of pathological phenomena at the level of retinal blood vessels. With the application of doxycyline 100 mg two times a day, and systemic application of prednisolone (at the initial doses of 120 mg), after a two-week period, there was a full recovery of the visual acuity, out the optical disk edema, and the presence of light edema in the left eye macula receded. The complete disappearance of the edema in the macula was registered four weeks following the application of the therapy. CONCLUSION: Cat-scratch disease can be recognized by means of characteristic general symptoms, and it must be considered in persons with ophthalmologic picture of neuroretinitis. In spite of the good prognosis for the general condition of a patient, it is advised to apply antibiotic therapy in the cases where ophthalmologic complications appear. We recommend the application of doxycyline 100 mg two times a day, for a month. When pronounced edema of the optical disk and edema in the macula are present, a systematic application of corticosteroids is necessary.

PMID: 17144434 [PubMed - indexed for MEDLINE]

J Infect. 2007 May;54(5):417-21. Epub 2006 Nov 29.

Bone infection in cat-scratch disease: a review of the literature.

Hajjaji N, Hocqueloux L, Kerdraon R, Bret L.

Service des Maladies Infectieuses et Tropicales, Centre Hospitalier R�gional-La Source, BP 86709, 45067 Orl�ans Cedex 2, France.

OBJECTIVE: To describe the main features of bone infection associated with Cat-scratch disease (CSD). METHODS: We searched for articles indexed in the international literature databases by using the following key words: "Bartonella", "bone", "cat-scratch", "osteomyelitis" and "osteolytic". RESULTS: Cases of 47 patients were reviewed. The median age was 9 years, with an equal sex distribution. Bone pain and fever were the main symptoms. The presence of fever and increased age were more common in patients with bone infection than classically reported in uncomplicated (i.e. nodal) CSD. The vertebral column and pelvic girdle were the most common sites of infection. Radiological examination typically confirmed bone osteolysis. All patients recovered without complications or chronic infection, although they received a various combination antibiotic regimen and duration therapy. The mechanism by which infection might spread to the bone is via the haematogenous route, accounting for most of the disseminated cases and via the lymphatic route, for those with regional limited extension. CONCLUSIONS: Bone infection is rare but should be considered when bone pain and fever are present in a patient with nodal CSD. The prognosis is good, whatever treatment is given. Thus bone biopsy should be recommended only in a difficult diagnostic setting, when other bacteria or malignant disease are suspected.

PMID: 17140668 [PubMed - indexed for MEDLINE]

Wien Klin Wochenschr. 2006 Oct;118(19-20):615-8.

An unusual outcome in a child with hepatosplenic cat-scratch disease.

Vukeli� D, Beni� B, Bozinovi� D, Vukovi� B, Dakovic Rode O, Culig Z, Vukovi� J, Batinica S, Visnji� S, Puljiz I.

University Hospital for Infectious Diseases Dr. Fran Mihaljevi�, Zagreb, Croatia. bfm@bfm.hr

Typical cat-scratch disease (Bartonella henselae infection) in an immunocompetent child is usually associated with a history of scratch, bite or intimate contact with a cat. Most patients develop a non-tender papule in the scratch line after three to ten days. This may persist for only a few days or as long as two to three weeks. During the next two weeks or more, regional lymph nodes that drain the area gradually enlarge and then slowly resolve in more than 10% of patients. The nodes develop overlying erythema and may suppurate. Atypical forms of cat-scratch disease occur in a minority of cases and are characterized by ocular or neurological manifestations, hepatosplenic involvement, vertebral osteomyelitis, endocarditis etc. Immunocompromised individuals with B. henselae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia. There have been several reports of hepatosplenic granulomas caused by B. henselae in immunocompetent children. We report a case of a 6-year-old boy with the hepatosplenic form of cat-scratch disease. Despite early diagnosis and long-term antimicrobial treatment, splenectomy could not be avoided.

PMID: 17136337 [PubMed - indexed for MEDLINE]

Pediatr Infect Dis J. 2006 Dec;25(12):1177-81.

Transient paresis associated with cat-scratch disease: case report and literature review of vertebral osteomyelitis caused by Bartonella henselae.

Vermeulen MJ, Rutten GJ, Verhagen I, Peeters MF, van Dijken PJ.

Department of Pediatrics, St. Elisabeth Hospital, Tilburg, The Netherlands. m.vermeulen@vumc.nl

Cat-scratch disease (CSD) rarely presents as vertebral osteomyelitis. We describe a case with paresis of the arm with total recovery after antibiotic and neurosurgical therapy. We reviewed 20 other cases of CSD vertebral osteomyelitis in the literature. This diagnosis should be considered in patients with systemic symptoms, back pain, and cat contact. The prognosis is generally good.

PMID: 17133166 [PubMed - indexed for MEDLINE]

Ann N Y Acad Sci. 2006 Oct;1078:223-35.

Arthropod-borne diseases in homeless.

Brouqui P, Raoult D.

Unit� des rickettsies, CNRS UMR 6020, IFR 48, Facult� de m�decine, 27 bd, J Moulin, 13385 Marseille, cedex 5, France. philippe.brouqui@medecine.univ-mrs.fr

Homeless people are particularly exposed to ectoparasite. The living conditions and the crowded shelters provide ideal conditions for the spread of lice, fleas, ticks, and mites. Body lice have long been recognized as human parasites and although typically prevalent in rural communities in upland areas of countries close to the equator, it is now increasingly encountered in developed countries especially in homeless people or inner city economically deprived population. Fleas are widespread but are not adapted to a specific host and may occasionally bite humans. Most common fleas that parasite humans are the cat, the rat, and the human fleas, Ctenocephalides felis, Xenopsylla cheopis, and Pulex irritans, respectively. Ticks belonging to the family Ixodidae, in particular, the genera Dermacentor, Rhipicephalus, and Ixodes, are frequent parasites in humans. Sarcoptes scabiei var. hominis is a mite (Arachnida class) responsible for scabies. It is an obligate parasite of human skin. The hematophagic-biting mite, Liponyssoides sanguineus, is a mite of the rat, mouse, and other domestic rodents but can also bite humans. Finally, the incidence of skin disease secondary to infestation with the human bedbug, Cimex lectularius, has increased recently. Bacteria, such as Wolbacchia spp. have been detected in bedbug. The threat posed by the ectoparasite in homeless is not the ectoparasite themselves but the associated infectious diseases that they may transmit to humans. Except for scabies all these ectoparasites are potential vectors for infectious agents. Three louse-borne diseases are known at this time. Trench fever caused by Bartonella quintana (B. quintana), epidemic typhus caused by Rickettsia prowazekii, and relapsing fever caused by the spirochete Borrelia recurrentis. Fleas transmit plague (Xenopsylla cheopis and Pulex irritans), murine typhus (Xenopsylla cheopis), flea-borne spotted rickettsiosis on account of the recently described species Rickettsia felis (C. felis), and occasionally cat scratch disease on account of Bartonella henselae (C. felis). The role of fleas as potential vector of B. quintana has recently been suggested. Among the hematophagic-biting mites, L. sanguineus, is responsible for the transmission of Rickettsia akari, the etiologic agent of rickettsialpox. Virtually, no data are available on tick-borne disease in this population. This article will deal with epidemiology, diagnosis, prevention, and treatment of these ectoparasite and the infectious diseases they transmit to the homeless people.

PMID: 17114713 [PubMed - indexed for MEDLINE]

Ann N Y Acad Sci. 2006 Oct;1078:215-22.

Infective endocarditis due to Bartonella spp. and Coxiella burnetii: experience at a cardiology hospital in Sao Paulo, Brazil.

Siciliano RF, Strabelli TM, Zeigler R, Rodrigues C, Castelli JB, Grinberg M, Colombo S, da Silva LJ, Mendes do Nascimento EM, Pereira dos Santos FC, Uip DE.

Rua Cardoso de Almeida 1006/apto13, Perdizes, S�o Paulo/Brazil CEP 05013-001. rinaldo_focaccia@uol.com.br

Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture-negative endocarditis patients at a cardiology hospital in S�o Paulo, Brazil. From January 2004 to December 2004 patients with a diagnosis of endocarditis at our Institute were identified and recorded prospectively. They were considered to have possible or definite endocarditis according to the modified Duke criteria. Those with blood culture-negative were tested serologically using the indirect immunofluorescent assay (IFA) for Bartonella henselae, B. quintana, and C. burnetii. IFA-IgG titers >800 for Bartonella spp. and C. burnetii were considered positive. A total of 61 patients with endocarditis diagnosis were evaluated, 17 (27%) were culture-negative. Two have had IgG titer greater than 800 (>/=3,200) against Bartonella spp. and one against C. burnetii (phase I and II>/=6,400). Those with Bartonella-induced endocarditis had a fatal disease. Necropsy showed calcifications and extensive destruction of the valve tissue, which is diffusely infiltrated with mononuclear inflammatory cells predominantly by foamy macrophages. The patient with C. burnetii endocarditis received specific antibiotic therapy. Reports of infective endocartitis due to Bartonella spp. and C. burnetii in Brazil reveal the importance of investigating the infectious agents in culture-negative endocarditis.

PMID: 17114712 [PubMed - indexed for MEDLINE]

Pediatr Cardiol. 2006 Nov-Dec;27(6):769-71. Epub 2006 Nov 16.

Bartonella henselae endocarditis in a child.

Pitchford CW, Creech CB 2nd, Peters TR, Vnencak-Jones CL.

Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.

14-year-old white male with a past medical history of congenital bicuspid aortic valve, Streptococcus viridans endocarditis, and pulmonary valve homograft presented with culture-negative endocarditis. Molecular studies identified the causative organism as Bartonella henselae and subsequent serologic studies supported this diagnosis. This rare cause of endocarditis may be under recognized in children. Bartonella henselae endocarditis should be considered in all children with culture-negative endocarditis, and molecular studies using a polymerase chain reaction-based assay should be routinely utilized in the evaluation of all endocarditis cases that are culture negative to rapidly diagnosis this treatable cause of endocarditis.

PMID: 17111290 [PubMed - indexed for MEDLINE]

J Clin Invest. 2006 Dec;116(12):3160-70. Epub 2006 Nov 16.

Indoleamine 2,3-dioxygenase-expressing dendritic cells form suppurative granulomas following Listeria monocytogenes infection.

Popov A, Abdullah Z, Wickenhauser C, Saric T, Driesen J, Hanisch FG, Domann E, Raven EL, Dehus O, Hermann C, Eggle D, Debey S, Chakraborty T, Kr�nke M, Uterm�hlen O, Schultze JL.

Molecular Tumor Biology and Tumor Immunology at the Clinic I for Internal Medicine, University of Cologne, Cologne, Germany.

Control of pathogens by formation of abscesses and granulomas is a major strategy of the innate immune system, especially when effector mechanisms of adaptive immunity are insufficient. We show in human listeriosis that DCs expressing indoleamine 2,3-dioxygenase (IDO), together with macrophages, are major cellular components of suppurative granulomas in vivo. Induction of IDO by DCs is a cell-autonomous response to Listeria monocytogenes infection and was also observed in other granulomatous infections with intracellular bacteria, such as Bartonella henselae. Reporting on our use of the clinically applied anti-TNF-alpha antibody infliximab, we further demonstrate in vitro that IDO induction is TNF-alpha dependent. Repression of IDO therefore might result in exacerbation of granulomatous diseases observed during anti-TNF-alpha therapy. These findings place IDO(+) DCs not only at the intersection of innate and adaptive immunity but also at the forefront of bacterial containment in granulomatous infections.

PMCID: PMC1636691 PMID: 17111046 [PubMed - indexed for MEDLINE]

Vaccine. 2007 Jan 2;25(1):43-54. Epub 2006 Aug 4.

The identification of two protective DNA vaccines from a panel of five plasmid constructs encoding Brucella melitensis 16M genes.

Commander NJ, Spencer SA, Wren BW, MacMillan AP.

Department of Statutory and Exotic Bacterial Diseases, Veterinary Laboratories Agency, Woodham Lane, New Haw, Addlestone, Surrey KT15 3NB, UK.

Five candidate genes from the Brucella melitensis 16M genome were selected. Eukaryotic expression plasmids encoding these antigens were constructed and expression was verified in vitro from transfected Cos7 cells. Each vaccine was assessed for protective efficacy in a BALB/c mouse brucellosis infection model. From these experiments two protective DNA vaccines were identified: p-omp25 and p-ialB. The Omp25 antigen (BMEI1249) has previously been studied in terms of Brucella virulence, serodiagnosis and as a protective antigen. However, this study represents the first report of a significant protective effect achieved against B. melitensis 16M challenge using the Omp25 antigen in a DNA vaccine approach. The other protective vaccine identified in this study was p-ialB. The ialB candidate (BMEI1584) was selected based upon its' putative function as an invasion protein which was assigned due to shared identity with the invasion protein B (ialB) of Bartonella bacilliformis. This candidate has not previously been investigated with regard to Brucella virulence or pathogenesis. This study is the first report to identify the Brucella invasion protein B (BMEI1584) as a novel protective antigen for brucellosis.

PMID: 17049676 [PubMed - indexed for MEDLINE]

Przegl Epidemiol. 2006;60(2):307-13.

[Cat scratch disease--course, diagnosis]

[Article in Polish]

Sala E, Lipiec A, Zygmunt A, Burdzel Z, Og�rek M, Chyla M.

Oddzia� Pediatryczny Samodzielny Publiczny Zesp�� Zak�ad�w Opieki Zdrowotnej w Staszowie. odd.ped_staszow@op.pl

Cat scratch disease is an infection which often causes regional lymphadenopathy. Bartenolloses present a growing health problem both in human and veterinary medicine. They may be etiological fevers of unknown etiology, endocarditis, pneumonia, meningitis. The mildest clinical form is the cat scratch disease which proceeds as a mild regional lymphadenopathy. It is caused by Bartonellosis henselae. Animals, especially cats, are the sourse of infections. Lymphadenitis may remain for many weeks and requires differentiation from other causes of regional lymphadenopathy. Three typical cases of the disease are presented. All sick persons had contact with cats. In none case a primary change was observed. In the case no 1 the possibility of occurrence of the disease was not considered and it was diagnosed only after histopathological examination of lymphnodes. In the two other cases diagnoses were established on the basis of serological examination after a few days of admittance for hospital treatment. Cat scratch disease is rarely diagnosed in Poland probably due to insufficient knowledge of the clinical form of this disease. Swollen lymph nodes together with patient contact with a cat or other animals established during a detailed interviewing, raise suspicion of CSD. Denial by a patient of the primary change does not rule out diagnosis. When regional lymphadenopathy of cat scratch disease is taken into consideration in differential diagnosis and serological tests are carried out, it may be possible in many cases to eliminate any further diagnostics burdening a sick person.

PMID: 16964683 [PubMed - indexed for MEDLINE]

Rev Med Interne. 2006 Oct;27(10):772-5. Epub 2006 Jul 7.

[Hepatosplenic localization of cat scratch disease: two cases in immunocompetent adult patients]

[Article in French]

Family-Pign� D, Mouchet B, Lousteau V, Borie MF, Deforges L, Lesprit P, Godeau B.

Service de m�decine interne, h�pital Henri-Mondor, 51, avenue du Mar�chal-de-Lattre-de-Tassigny, 94000 Cr�teil, France. delphinepigne@hotmail.com

INTRODUCTION: Cat-Scratch Disease (CSD) is a well-recognized benign cause of localized lymphadenopathy, which often recovers spontaneously. However systemic clinical presentations are described in immunodeficient adults (bacillary angiomatosis, bacillary splenitis) and are less common in immunocompetent ones. EXEGESIS: We report two cases of disseminated CSD in immunocompetent patients, presenting hepatosplenic nodules, associated in the second case with an endocarditis. CONCLUSION: Bartonella serology must be achieved in case of hepatosplenic nodules with fever. Treatment of disseminated CSD in immunocompetent adults is still empirical and recovery can occur without antibiotherapy when endocarditis is not associated.

PMID: 16959382 [PubMed - indexed for MEDLINE]

J Am Vet Med Assoc. 2006 Sep 1;229(5):700-5.

Prevalence of DNA of Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum,' Anaplasma phagocytophilum, and species of Bartonella, Neorickettsia, and Ehrlichia in cats used as blood donors in the United States.

Hackett TB, Jensen WA, Lehman TL, Hohenhaus AE, Crawford PC, Giger U, Lappin MR.

Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, 80523, USA.

OBJECTIVE: To identify the prevalence of DNA of Mycoplasma haemofelis; 'Candidatus Mycoplasma haemominutum'; Anaplasma phagocytophilum; and species of Bartonella, Neorickettsia, and Ehrlichia in blood of cats used as blood donors in the United States. DESIGN: Prospective study. ANIMALS: 146 cats that were active blood donors. PROCEDURES: Environmental history was requested for each blood-donor cat from which a blood sample (mixed with EDTA) was available. Polymerase chain reaction assays capable of amplifying the DNA of the microorganisms of interest following DNA extraction from blood were performed. RESULTS: Overall, DNA of one or more of the infectious agents was detected in blood samples from 16 of 146 (11%) feline blood donors. Twenty-eight laboratory-reared cats housed in a teaching hospital had negative results for DNA of all organisms investigated. The DNA of at least 1 infectious agent was amplified from blood samples collected from 16 of 118 (13.6%) community-source cats; assay results were positive for 'Candidatus M haemominutum,' M haemofelis, or Bartonella henselae alone or in various combinations. Of the community-source cats allowed outdoors (n = 61) or with known flea exposure (44), DNA for a hemoplasma or B henselae was detected in 21.3% and 22.7%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: When community-source cats, cats allowed outdoors, or cats exposed to fleas are to be used as blood donors, they should be regularly assessed for infection with M haemofelis, 'Candidatus M haemominutum,' and Bartonella spp, and flea-control treatment should be regularly provided.

PMID: 16948578 [PubMed - indexed for MEDLINE]