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ESCMID Online Lecture Library © by Author 29.08.2013 Bartonella • Gram negative rod • Oxidase negative Bartonella • aerobic (5% CO2) infections • GC content about 40% • Growth on blood agar Gilbert GREUB Institute of Microbiology University Hospital Center Lausanne, Switzerland New permissive Angiogenesis cells Sanctuary site Multiplication VEGF Bartonella Bone marrow BadA = erythroblast ? VirB operon Alpha-2 proteobacteria Endothelial Related to: cells 4 to 8 days Invasion Endocytosis infection waves Potential for dissemination ICAM-1 Brucella Omp43 in many organs Invasome Agrobacterium tumefaciens Erythrocytes Bosea Afipia Adhesion Invasion Multiplication Persistence Spectrin Deformin Glycophorin Invasion-associated locus Bundle-forming pili Polar flagella Blood-sucking arthropods B. quintana in homeless red blood cell, as seen by confocal microscopy © by authorGreub & Raoult J Med Microbiol 2002 Transmission B. vinsonii subsp. vinsonii B. vinsonii subsp. arupensis ESCMIDBartonella Online LectureB. vinsonii subsp. berkhoffi Library Animal = reservoir of many Bartonella species B. washoensis B. quintana - in cats: retinitis, endocarditis, stomatitis B. henselae - in dogs: endocarditis, granulomatous hepatitis B. alsatica - in horses: osteoarthitis B. doshiae - in pigs, koalas, marsupials, sea mammals, … B. taylorii B. grahamii B. tribocorum 14 species may infect humans B. elizabethae B. bacilliformis B. clarridgeiae B. weissi B. birtlesii Brucella abortus 0.1 1 29.08.2013 Bartonella Bartonella B. bacilliformis Carrion disease B. bacilliformis Carrion disease verruaga peruana verruaga peruana Oroya fever Lutzomya Hemolytic anemia + fever Bartonella Bartonella B. bacilliformis Carrion disease B. bacilliformis Carrion disease B. quintana Trench fever B. quintana Trench fever Chronic bacteremia 1914-1918 Quintan fieber - Trench fever © by author ESCMIDBartonella Online LectureBartonella Library B. bacilliformis Carrion disease B. bacilliformis Carrion disease B. quintana Trench fever B. quintana Trench fever Chronic bacteremia Chronic bacteremia Bacillary angiomatosis Bacillary angiomatosis Hepatic peliosis Hepatic peliosis B. henselae Cat-scratch disease 2 29.08.2013 Bartonella B. bacilliformis B. quintana B. henselae B. bacilliformis Carrion disease B. quintana Trench fever Carrion disease Fièvre des Maladie des - verruaga peruana tranchées griffes de chat Chronic bacteremia - fièvre d’Oroya Bacillary angiomatosis Hepatic peliosis B. henselae Cat-scratch disease Endocarditis Angiomatose Endocardite bacillaire Risk factors Risk factors B. henselae B. henselae Contact with a cat Cat-scratch disease Contact with a cat Cat-scratch disease + valvular disease Endocarditis + valvular disease Endocarditis + HIV infection Bacillary angiomatosis + HIV infection Bacillary angiomatosis B. quintana Homeless, OH Chronic bacteremia Endocarditis + HIV infection Bacillary angiomatosis Boillat & Greub. Rev Med Suisse 2008 © by authorBoillat & Greub. Rev Med Suisse 2008 ESCMIDRisk factorsOnline LectureCat-scratch diseaseLibrary B. henselae Contact with a cat Cat-scratch disease + valvular disease Endocarditis + HIV infection Bacillary angiomatosis B. quintana Homeless, OH Chronic bacteremia Endocarditis + HIV infection Bacillary angiomatosis B. bacilliformis Travellers (Peru, Bolivia, Ecuador) Oroya fever Autochtonous (Peru, Bolivia, Ecuador) Verruaga peruana Boillat & Greub. Rev Med Suisse 2008 Dehio et al. Nat Microbiol Rev 3 29.08.2013 Inoculation lesions - present in 60% of cases - appear 3 to 10 days after inoculation Cat-scratch disease - 10 days before lymphadenopathy - persist during 1 to 3 weeks - Isolated adenopathy - Persist during 2 to 6 months - Generally, spontaneous resolution - Fever, myalgia, asthenia Oculo-glandular sy. = Parinaud syndrome - following a conjounctival inoculation: - pre-auricular adenopathy What to do ? - conjonctivitis and/or retinitis Complications of cat-scratch disease - suppuration (10-15%) - hepatosplenic lesions - neurological lesions - arthritis / osteomyelitis - endocarditis - … © by author ESCMIDDiagnosis Online LectureDiagnosis (difficult Library to grow) Molecular diagnosis (PCR) Cell culture >> axenic culture - cat-scratch disease, endocarditis, … Endothelial cells + centrifugation Serology Sensitivity 10x better than blood agar - endocarditis (very high titres) p<0.001 from valves - microimmunofluorescence + W-blot p=0.045 from blood Fournier et al. J clin Microbiol 2002 (poor senitivity for bacillary angiomatosis) Better sensitivity when: - Subculture blood cultures bottles on agar after 7 days Histology + immunohistology - Congelation / saponin Culture Attention: low CO2 production (undetected by automated systems) 4 29.08.2013 Diagnosis (difficult to grow) Shell vial Treatment Cat scratch disease Practically: Treatif major adenopathy or in case of immunosuppression - human endothelial cells (ECV304) - azithromycin 500 mg/day J1; then 250 mg/day for 2-5 days in RPMI 15% fetal calf serum 2% glutamine If retinitis or neurological involvment: - read-out: Gimenez staining, immunofluorescence - doxy 2x100 mg/day + rifampicine 2x 300 mg/day for 4-6 weeks on day 15 (30/45 if negative) Gouriet et al. J Clin Microbiol 2005 Bacteriemia / endocarditis - doxy 2x 100 mg/day for 4-6 weeks + gentamycin 3mg/kg for 2 weeks - Sensitivity: serology >> PCR >> culture 89.5% (39/48) 47.6% (10/21) 25.0% ( 9/36) on blood Bacillary angiomatosis 97.7% (44/45) 37.5% (18/48) on valve - Erythromycin 4 x 500 mg/day or doxy 2x100 mg/d for 3 months Houpikian et al. Medicine 2002 Fournier et al. CDLI 2002 Boillat & Greub. Rev Med Suisse 2008; Rolain et al Ant Agents Chemother 2005 Conclusions Recommended readings: No need of antibiotic for uncomplicated Diagnosis and treatment Boillat & Greub cat-scratch disease Rev Med Suisse romande 2008;4:901-907 Include bartonella in the differential diagnosis Greub & Raoult of blood-culture negative endocarditis Chapter 2 in « Emerging Infectious Diseases » Kluwer 2003 Bacillary angiomatosis should be part of Rolain et al. differential diagnosis in HIV-infected patients Antimicrob Ag Chemother 2004 with low CD4 count and fever Pathogenesis Greub & Raoult Riess & al. J Med Microbiology 2002. J Exp Med 2004 Consider Carrion disease in a traveller returning from Andean with hemolytic anaemia Dehio et al Vayssier-Taussat et al. J Cell Sci 1997 PLOS pathogens 2010 © by author ESCMID Online Lecture Library 5.
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