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Journal of Feline Medicine and Surgery http://jfm.sagepub.com/ American Association of Feline Practitioners 2006 Panel report on diagnosis, treatment, and prevention of Bartonella spp. infections Jane Brunt, Lynn Guptill, Dorsey L. Kordick, Sandra Kudrak and Michael R. Lappin Journal of Feline Medicine and Surgery 2006 8: 213 DOI: 10.1016/j.jfms.2006.05.006 The online version of this article can be found at: http://jfm.sagepub.com/content/8/4/213 Disclaimer The Journal of Feline Medicine and Surgery is an international journal and authors may discuss products and formulations that are not available or licensed in the individual reader's own country. Furthermore, drugs may be mentioned that are licensed for human use, and not for veterinary use. Readers need to bear this in mind and be aware of the prescribing laws pertaining to their own country. 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Downloaded from jfm.sagepub.com by guest on May 22, 2013 Journal of Feline Medicine and Surgery (2006) 8, 213e226 doi:10.1016/j.jfms.2006.05.006 American Association of Feline Practitioners 2006 Panel report on diagnosis, treatment, and prevention of Bartonella spp. infections 1 2 3 Jane Brunt DVM , Lynn Guptill DVM, PhD, Diplomate ACVIM , Dorsey L Kordick PhD , 4 5 Sandra Kudrak DVM, Diplomate ABVP , Michael R Lappin DVM, PhD, Diplomate ACVIM * 1Cat Hospital At Towson (CHAT), 6701 York Road, Baltimore, MD 21212, USA 2Purdue University e School of Veterinary Medicine, 1248 Lynn Hall, W Lafayette, IN 47907, USA 3IDEXX Pharmaceuticals, 4249- 105 Piedmont Parkway, Greensboro, NC 27410, USA 4Community Animal Hospital, 269 Titusville Road, Poughkeepsie, NY 12603, USA 5Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Department of Clinical Sciences, Fort Collins, CO 80523, USA Date accepted: 23 May 2006 Ó 2006 AAFP. Published by Elsevier Ltd. All rights reserved. syndrome of fever, malaise, and re- the diagnosis, treatment, and prevention of Bar- gional lymphadenopathy in people tonella spp. infections in both cats and people. A that was frequently associated with At the 2004 Fall Forum of The American Asso- contact with kittens or cats was called Cat ciation of Feline Practitioners (AAFP) in San Scratch Disease (CSD) for decades (Debre et al Francisco, two lectures and a roundtable discus- 1950). A novel organism, Rochalimaea henselae, sion were presented on zoonotic diseases of cats was recognized (Regnery et al 1992a,b) and in general (Brown et al 2002) and Bartonella spp. then was associated with CSD shortly thereafter associated diseases in specific. It was noted at (Zangwill et al 1993). A proposal to unify the that time that an obvious consensus had not genera Rochalimaea and Bartonella was made in been reached for many issues concerning Barto- 1993 and the organism was renamed Bartonella nella spp. infections of cats. Subsequently, in the henselae (Brenner et al 1993). Since that time, summer of 2005, the AAFP Guidelines Commit- over 2500 manuscripts regarding B henselae or re- tee decided to convene a panel of interested lated organisms have been published and there individuals to develop a Panel Report on the have been many notable discoveries concerning topic. The panelists completed the first draft of this Panel Report in November 2005. The pro- ject was announced and a brief outline was *Corresponding author. Tel: þ1-970-221-4535; Fax: þ1-970-297- presented on November 14, 2005 at the AAFP 1275. E-mail: [email protected] Meeting in Chicago. After approval of the 1098-612X/06/080213+14 $32.00/0 Ó 2006 AAFP. Published by Elsevier Ltd. All rights reserved. Downloaded from jfm.sagepub.com by guest on May 22, 2013 214 J Brunt et al document by the panelists, the Panel Report of prevalence estimates based on serology should was distributed to select external reviewers that be interpreted cautiously. were considered experts in the field (see Acknowledgements). In addition, AAFP Fellows were contacted and given the opportunity to 3. Which of the Bartonella spp. provide comments. After the comments of the known to infect cats are external reviewers and AAFP Fellows were associated with CSD or incorporated, the Panel Report was approved other human syndromes? by the Guidelines Committee members and the AAFP Board in April 2006. The panel members The large majority of people with CSD, bacillary felt that presentation of the materials would be peliosis, or bacillary angiomatosis have been best in a question and answer format; we used infected by B henselae or B quintana (Koehler the questions that were commonly presented to et al 1992, 1997, Breitschwerdt and Kordick us as veterinary clinicians or Bartonella spp. 2000, Chomel et al 2003a, 2004, Boulouis et al researchers. We have attempted to formulate con- 2005). Persistent fever has also been detected in sensus viewpoints when possible, using evidence- people infected by B henselae (Jacobs and Schutze based medicine and thus have provided pertinent 1998). Based on serological test results, B clarridg- references for most statements. This Panel Report eiae has been suspected as a cause of CSD-like ill- will be amended as indicated as new published ness in people (Clarridge et al 1995, Kordick et al data become available. 1997b). Bartonella koehlerae DNA was recently amplified from the blood of a person with endo- carditis (Avidor et al 2004). Bartonella quintana 1. How are Bartonella spp. infection is the cause of trench fever, endocardi- tis, bacillary angiomatosis and other clinical currently classified? conditions (Slater and Welch 2004). However, Bartonella spp. are gram-negative, hemotropic, B quintana is transmitted to people by lice; cats bacterial organisms that infect people and a num- are not thought to be an important factor in ber of domestic and wild mammals (Brenner et al transmission to people. 1993, Breitschwerdt and Kordick 2000, Chomel et al 2004, Boulouis et al 2005, Guptill 2005). 4. Are there multiple variants of B henselae? 2. Which Bartonella spp. There is marked genetic diversity among B hense- infect cats? lae isolates from cats. Two 16S rRNA genotypes, By use of culture or DNA amplification tech- genotype I (Houston) and genotype II (Marseille) niques, cats are known to be infected by Barto- of B henselae exist and other methods of genetic nella henselae (Regnery et al 1992b, Koehler et al classification define additional differences. Prev- 1994, Breitschwerdt and Kordick 2000, Chomel alence of Type I and Type II genotypes in cats or et al 2004, Boulouis et al 2005, Guptill 2005), people has been most widely reported on and re- B clarridgeiae (Clarridge et al 1995, Kordick et al sults varied in different studies which may relate 1997b, Gurfield 1997, Heller et al 1997, Maruyama to geographical or other factors (Gurfield et al et al 2000), Bkoehlerae(Avidor et al 2004, Droz et al 1997, Heller et al 1997, Koehler et al 1997, Sander 1999, Rolain et al 2003a), B quintana (La et al et al 1998, Maruyama 2000, Guptill et al 2004, 2005) and B bovis (Regnery et al 2000, Bermond Fabbi et al 2004). Results of multilocus sequence et al 2002). Cats are thought to be the main typing (MLST) suggest that the type II genotype reservoir hosts for B henselae and B clarridgeiae is ancestral with the type I appearing later and and probably are the reservoir for B koehlerae that horizontal gene transfer occurs with Bartonella (Boulouis et al 2005). There is limited informa- (Iredell et al 2003). Most studies suggest that tion about other Bartonella spp. infections of strains that infect humans are less genetically cats and the role of cats in the ecology of other diverse than those that infect cats (Arvand et al Bartonella spp. is unknown. In serological stud- 2001, Dillon et al 2002, Iredell et al 2003). Genetic ies, antibodies against B quintana (Al-Majali variations between isolates may also relate to 2004) and B elizabethae (Hjelm et al 2002) have virulence in people (Bergmans et al 1996, Chang been detected in some cats. Because of serologi- et al 2002, Dillon et al 2002, Iredell et al 2003, cal cross reactivity among Bartonella spp., results Woestyn et al 2004). Downloaded from jfm.sagepub.com by guest on May 22, 2013 American Association of Feline Practitioners 2006 Panel report 215 5. How common are Bartonella spp. et al 2004, Boulouis et al 2005). Other risk factors infections of cats around the world? include being allowed outdoors or being other- wise associated with multiple cats. Bartonella spp. infections of cats have been documented by culture or amplification of DNA by PCR assay in multiple countries within 8. How are Bartonella spp.