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Khonde P, Byrnes K. The Brief Case: Granulomatous hepatitis in an immunocompromised patient. J Clin Microbiol 2023; 61:e0189222. [PMID: 37732747 PMCID: PMC10512784 DOI: 10.1128/jcm.01892-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Affiliation(s)
- Pooja Khonde
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kathleen Byrnes
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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2
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Drummond MR, Santos LSD, Souza LB, Mitsuushi GN, Cintra ML, França AFEDC, Souza EMD, Velho PENF. Detection of Bartonella henselae DNA in the blood of patients with livedoid vasculopathy. An Bras Dermatol 2023:S0365-0596(23)00066-1. [PMID: 36973097 DOI: 10.1016/j.abd.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Livedoid vasculopathy (LV) manifests as ulcers and atrophic white scars on the lower extremities. The main known etiopathogenesis is hypercoagulability with thrombus formation, followed by inflammation. Thrombophilia, collagen and myeloproliferative diseases may induce LV, but the idiopathic (primary) form predominates. Bartonella sp. may cause intra-endothelial infection and skin manifestations caused by these bacteria may be diverse, including leukocytoclastic vasculitis and ulcers. OBJECTIVE The aim of this study was to investigate the presence of bacteremia by Bartonella spp. in patients with difficult-to-control chronic ulcers diagnosed as primary LV. METHODS Questionnaires and molecular tests (conventional PCR, nested PCR and real-time PCR) were applied and liquid and solid cultures were performed in the blood samples and blood clot of 16 LV patients and 32 healthy volunteers. RESULTS Bartonella henselae DNA was detected in 25% of LV patients and in 12.5% of control subjects but failed to reach statistically significant differences (p = 0.413). STUDY LIMITATIONS Due to the rarity of primary LV, the number of patients studied was small and there was greater exposure of the control group to risk factors for Bartonella spp. INFECTION CONCLUSION Although there was no statistically significant difference between the groups, the DNA of B. henselae was detected in one of every four patients, which reinforces the need to investigate Bartonella spp. in patients with primary LV.
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Affiliation(s)
- Marina Rovani Drummond
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil.
| | - Luciene Silva Dos Santos
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Lais Bomediano Souza
- Department of Medicine, Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, SP, Brazil
| | - Gabriela Nero Mitsuushi
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Maria Letícia Cintra
- Department of Pathological Anatomy, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | | | - Elemir Macedo de Souza
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
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3
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Taber R, Pankowski A, Ludwig AL, Jensen M, Magsamen V, Lashnits E. Bartonellosis in Dogs and Cats, an Update. Vet Clin North Am Small Anim Pract 2022; 52:1163-1192. [DOI: 10.1016/j.cvsm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Vaca DJ, Dobler G, Fischer SF, Keller C, Konrad M, von Loewenich FD, Orenga S, Sapre SU, van Belkum A, Kempf VAJ. Contemporary diagnostics for medically relevant fastidious microorganisms belonging to the genera Anaplasma, Bartonella, Coxiella, Orientia, and Rickettsia. FEMS Microbiol Rev 2022; 46:6530194. [PMID: 35175353 PMCID: PMC9300619 DOI: 10.1093/femsre/fuac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 12/02/2022] Open
Abstract
Many of the human infectious pathogens—especially the zoonotic or vector-borne bacteria—are fastidious organisms that are difficult to cultivate because of their strong adaption to the infected host culminating in their near-complete physiological dependence on this environment. These bacterial species exhibit reduced multiplication rates once they are removed from their optimal ecological niche. This fact complicates the laboratory diagnosis of the disease and hinders the detection and further characterization of the underlying organisms, e.g. at the level of their resistance to antibiotics due to their slow growth. Here, we describe the current state of microbiological diagnostics for five genera of human pathogens with a fastidious laboratory lifestyle. For Anaplasma spp., Bartonella spp., Coxiella burnetii, Orientia spp. and Rickettsia spp., we will summarize the existing diagnostic protocols, the specific limitations for implementation of novel diagnostic approaches and the need for further optimization or expansion of the diagnostic armamentarium. We will reflect upon the diagnostic opportunities provided by new technologies including mass spectrometry and next-generation nucleic acid sequencing. Finally, we will review the (im)possibilities of rapidly developing new in vitro diagnostic tools for diseases of which the causative agents are fastidiously growing and therefore hard to detect.
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Affiliation(s)
- Diana J Vaca
- Institute of Medical Microbiology and Infection Control, Goethe University of Frankfurt, Germany
| | - Gerhard Dobler
- Department of Virology and Rickettsiology, Bundeswehr Institute of Microbiology, Germany
| | - Silke F Fischer
- National Consulting Laboratory for Coxiella burnetii, State Health Office Baden-Württemberg, Germany
| | | | - Maik Konrad
- National Consulting Laboratory for Coxiella burnetii, State Health Office Baden-Württemberg, Germany
| | | | | | | | | | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, Goethe University of Frankfurt, Germany
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5
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Buragamadagu B, Song C, GuhaRoy S, Madison G. Isolated hepatosplenic abscess from cat scratch disease in a patient with HIV. Proc AMIA Symp 2021; 34:593-594. [PMID: 34456481 DOI: 10.1080/08998280.2021.1927424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Bartonella henselae infection, or cat scratch disease, typically is a self-limiting disease presenting as lymphadenopathy and fever after a bite or scratch from a cat. The most commonly reported presentation in immunocompromised patients includes bacillary angiomatosis and peliosis hepatitis, which resemble Kaposi's sarcoma. Isolated hepatosplenic abscess without diffuse lymphadenopathy or vasoproliferative disease is seldom reported in adult immunocompromised patients. Although several advances have been made in identifying the organism and antibodies with serological tests, biopsy, and polymerase chain reaction, there is little information about treatment. We report a case of an isolated hepatosplenic abscess without lymphadenopathy or vasoproliferative disease caused by B. henselae in an adult immunocompromised patient with HIV.
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Affiliation(s)
| | - Chen Song
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Shambo GuhaRoy
- Department of Radiology, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Gul Madison
- Department of Infection Control and Antimicrobial Stewardship, Mercy Catholic Medical Center, Darby, Pennsylvania
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6
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Vetos D, Rickstrew J, Siscos S, Wang T. A case of bacillary angiomatosis following solid organ transplant. Int J Dermatol 2021; 61:e257-e259. [PMID: 34245463 DOI: 10.1111/ijd.15776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Develyn Vetos
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Jace Rickstrew
- Division of Dermatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Spyros Siscos
- Division of Dermatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ting Wang
- Division of Dermatology, University of Kansas Medical Center, Kansas City, KS, USA
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7
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Pischel L, Radcliffe C, Vilchez GA, Charifa A, Zhang XC, Grant M. Bartonellosis in transplant recipients: A retrospective single center experience. World J Transplant 2021; 11:244-253. [PMID: 34164299 PMCID: PMC8218350 DOI: 10.5500/wjt.v11.i6.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bartonellosis is a rare but challenging condition to diagnose with a spectrum of clinical presentations in the immunocompromised host.
AIM To further characterize the presentation of Bartonella henselae (B. henselae) infections in solid organ and hematopoietic stem cell transplant recipients.
METHODS We conducted a single-center retrospective study of all B. henselae testing for 5012 transplant recipients receiving care at a single institution between 2011 and 2018.
RESULTS We identified 38 patients who underwent testing for B. henselae, and three of 38 were found to have bartonellosis. Two of the patients were renal transplant recipients who presented with visceral bartonellosis and symptoms concerning for post-transplant lymphoproliferative disorder. One autologous stem cell transplant recipient presented with cat scratch disease. We detail the clinical courses of these three cases and review the literature concerning the clinical presentations, differential diagnosis, and limitations of diagnostic tests for B. henselae infections in transplant recipients.
CONCLUSION Although the incidence of B. henselae infection in transplant recipients is unknown, it merits inclusion in the differential diagnosis for fever of unknown origin in this population.
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Affiliation(s)
- Lauren Pischel
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Christopher Radcliffe
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Gabriel A Vilchez
- Department of Infectious Diseases, University of Kentucky, Lexington, KY 40536, United States
| | - Ahmad Charifa
- Department of Pathology, University of California, Irvine, CA 92868, United States
| | - Xu-Chen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Matthew Grant
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
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8
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Okaro U, George S, Anderson B. What Is in a Cat Scratch? Growth of Bartonella henselae in a Biofilm. Microorganisms 2021; 9:835. [PMID: 33919891 PMCID: PMC8070961 DOI: 10.3390/microorganisms9040835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023] Open
Abstract
Bartonella henselae (B. henselae) is a gram-negative bacterium that causes cat scratch disease, bacteremia, and endocarditis, as well as other clinical presentations. B. henselae has been shown to form a biofilm in vitro that likely plays a role in the establishment and persistence of the bacterium in the host. Biofilms are also known to form in the cat flea vector; hence, the ability of this bacterium to form a biofilm has broad biological significance. The release of B. henselae from a biofilm niche appears to be important in disease persistence and relapse in the vertebrate host but also in transmission by the cat flea vector. It has been shown that the BadA adhesin of B. henselae is critical for adherence and biofilm formation. Thus, the upregulation of badA is important in initiating biofilm formation, and down-regulation is important in the release of the bacterium from the biofilm. We summarize the current knowledge of biofilm formation in Bartonella species and the role of BadA in biofilm formation. We discuss the evidence that defines possible mechanisms for the regulation of the genes required for biofilm formation. We further describe the regulation of those genes in the conditions that mimic both the arthropod vector and the mammalian host for B. henselae. The treatment for persistent B. henselae infection remains a challenge; hence, a better understanding of the mechanisms by which this bacterium persists in its host is critical to inform future efforts to develop drugs to treat such infections.
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Affiliation(s)
- Udoka Okaro
- Foundational Sciences Directorate, Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD 21702, USA;
| | - Sierra George
- Department of Molecular Medicine, MDC7, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA;
| | - Burt Anderson
- Department of Molecular Medicine, MDC7, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA;
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9
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Prevalence and Predictors of Bacterial Contamination in Excisional Lymph Node Biopsies: Implications for Diagnosis and Management. Am J Surg Pathol 2021; 45:1235-1244. [PMID: 34232607 DOI: 10.1097/pas.0000000000001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Routine tissue handling exposes lymph node specimens to microbial contamination that can confound microbiological culture results and interfere with diagnosis. The scope and impact of this problem remain poorly understood. We combined over 13 years of lymph node pathology, culture data, and patient records to define the prevalence, predisposing factors, microbiology, and clinical management of false-positive lymph node cultures at a large academic medical center. Nearly one third (31.9%) of 216 cultured lymph nodes yielded bacterial growth. Approximately 90% of positive bacterial cultures grew 1 of 2 common skin-resident taxa-coagulase-negative Staphylococcus and Cutibacterium acnes-with well-documented predispositions for contamination in other clinical settings. Lymph nodes excised from axillary, cervical, and inguinal regions yielded higher positive culture rates than nodes excised from the mediastinum, suggesting proximity to the skin surface may increase contamination risk. Accordingly, cultures from thoracoscopic pulmonary resections displayed contamination rates over 5-fold lower than those from percutaneously accessed lymph nodes. Lymph nodal tissue allocated for culture in the operating room yielded unexpectedly high contamination rates, significantly higher than cultures sent from the frozen section processing area. A significant minority of contamination events were noted in the clinical record and prompted antibiotic therapy on multiple occasions. Collectively, our results illuminate the risk factors contributing to bacterial contamination and argue that routine lymph node bacterial cultures provide minimal clinical benefit for adult patients. This widespread bacterial contamination also warrants cautious implementation of increasingly sensitive molecular microbiology tools for excised tissues.
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Bartonella henselae Antibodies in Serum and Oral Fluid Specimens from Cats. Pathogens 2021; 10:pathogens10030329. [PMID: 33799577 PMCID: PMC8001045 DOI: 10.3390/pathogens10030329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/17/2022] Open
Abstract
Cats are the primary reservoir host for Bartonella henselae(B. henselae), an etiological agent of human bartonellosis, including cat scratch disease. Although Bartonella DNA has been amplified from salivary swabs from cats, dogs and humans, we are not aware of studies investigating Bartonella antibodies in oral fluid (OF). Using inhouse and commercial immunofluorescence antibody assays (IFA), the objective of this study was to detect and compare antibodies against B. henselae in paired OF and serum specimens from cats. Specimens were collected from shelter and client-owned cats. For serum specimens, B. henselae seroreactivity was 78% for both the inhouse and commercial IFA assays and 56.8% for OF specimens. Comparing serum and OF specimens, there was moderate Kappa agreement (Cohen's k = 0.434) for detection of B. henselae antibodies. Oral fluid antibodies were more likely measurable in cats with high B. henselae serum antibody titers when compared with low antibody titers. In conclusion, B. henselae OF IFA antibody measurements were less sensitive compared to serum IFA measurements of ≥1:64. Oral fluid antibodies were detected more often in cats with high B. henselae serum antibody titers. Therefore, OF antibodies, detectable by IFA, is of limited utility for epidemiological or diagnostic testing in cats.
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11
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Mignano SE, Russell DH. Nodular Vascular Transformation of the Lymph Node Sinuses Mimicking Sarcomatoid Change in Renal Cell Carcinoma: A Potential Diagnostic Pitfall. Int J Surg Pathol 2020; 28:637-642. [PMID: 32390486 DOI: 10.1177/1066896920916243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vascular transformation of the lymph node sinuses (VTS) is an uncommon phenomenon that is believed to occur secondary to obstruction of efferent lymphatics, frequently occuring in retroperitoneal lymph nodes draining cancer. The nodular subtype of VTS, in particular, can mimic metastatic cancer, such as metastatic renal cell carcinoma with sarcomatoid differentiation, potentially resulting in inaccurate tumor grading and/or staging. We present a case of nodular VTS mimicking metastatic renal cell carcinoma with sarcomatoid differentiation in a patient with high-grade clear cell renal cell carcinoma, and explore the relevant differential diagnosis. Awareness of VTS is essential to avoid misdiagnosis of this benign and curative condition.
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12
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Lam JC, Fonseca K, Pabbaraju K, Meatherall BL. Case Report: Bartonella quintana Endocarditis Outside of the Europe-African Gradient: Comprehensive Review of Cases within North America. Am J Trop Med Hyg 2020; 100:1125-1129. [PMID: 30793686 DOI: 10.4269/ajtmh.18-0929] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Clinical syndromes associated with Bartonella quintana infection can be insidious and difficult to diagnose for multiple reasons. Clinically, B. quintana can manifest as asymptomatic bacteremia or with subtle subacute constitutional symptoms. Second, it is a fastidious organism that is difficult to identify using traditional culture methods. Last, the body lice vector of B. quintana transmission is likely not uncommon in most patients affected, who are homeless and of low socioeconomic status. Therefore, barriers in seeking medical care and financial constraints for medications are important considerations. The mainstay of literature surrounding B. quintana endocarditis is from Europe and the developing nations. Herein, we describe a case of native valve endocarditis secondary to B. quintana in a homeless male with preexisting valvular disease and undertake a comprehensive literature review of documented B. quintana endocarditis in North America.
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Affiliation(s)
- John C Lam
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kevin Fonseca
- Provincial Laboratory for Public Health, Calgary, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Canada
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Combined Application of Immunohistochemistry and Warthin-Starry Silver Stain on the Pathologic Diagnosis of Cat Scratch Disease. Appl Immunohistochem Mol Morphol 2020; 28:781-785. [PMID: 31913159 DOI: 10.1097/pai.0000000000000829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Cat scratch disease (CSD) is an infectious disorder caused primarily by the bacterium Bartonella henselae (B. henselae). Immunohistochemistry (IHC) and Warthin-Starry silver stain (WS) are considered to be indispensable to diagnose CSD in combination with morphologic characteristics. In this study, we retrieved and reviewed 46 cases of paraffin-embedded lymphadenitis with histologic and/or clinical suspicion of CSD between 2014 and 2018, and detected B. henselae by IHC and WS, respectively, and evaluated the application significance of IHC and WS for the detection of B. henselae and validated their values in the pathologic diagnosis of CSD. MATERIALS AND METHODS B. henselae was detected by IHC and WS; validation of 2 methods for detecting B. henselae was evaluated by sensitivity, specificity, false-positive rate, false-negative rate, precision, negative predictive value, and agreement rate. RESULTS Microscopically, suppurative granulomas and/or multiple stellate microabscesses were observed in the accessory cortex of lymph nodes, especially near the subcapsule. Our results showed that 80.4% (37/46) of cases were positive for B. henselae by IHC, manifesting mainly punctuate, granular, or linear to outline the shape of bacteria. However, the positive rate of B. henselae by the WS method was 52.2% (24/46). There was a significant difference between IHC and WS (P=0.023). Moreover, a positive percentage of B. henselae was 97.8% (45/46), which was detected by the combined application of IHC and WS. The combination of IHC and WS exhibited high sensitivity (97.8%) and good agreement rate (86.5%). CONCLUSION The combined application of the IHC and WS method may have important clinical advantages, which is with the highest sensitivity and agreement rate for pathologic diagnosis of CSD.
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Álvarez-Fernández A, Breitschwerdt EB, Solano-Gallego L. Bartonella infections in cats and dogs including zoonotic aspects. Parasit Vectors 2018; 11:624. [PMID: 30514361 PMCID: PMC6280416 DOI: 10.1186/s13071-018-3152-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022] Open
Abstract
Bartonellosis is a vector-borne zoonotic disease with worldwide distribution that can infect humans and a large number of mammals including small companion animals (cats and dogs). In recent years, an increasing number of studies from around the world have reported Bartonella infections, although publications have predominantly focused on the North American perspective. Currently, clinico-pathological data from Europe are more limited, suggesting that bartonellosis may be an infrequent or underdiagnosed infectious disease in cats and dogs. Research is needed to confirm or exclude Bartonella infection as a cause of a spectrum of feline and canine diseases. Bartonella spp. can cause acute or chronic infections in cats, dogs and humans. On a comparative medical basis, different clinical manifestations, such as periods of intermittent fever, granulomatous inflammation involving the heart, liver, lymph nodes and other tissues, endocarditis, bacillary angiomatosis, peliosis hepatis, uveitis and vasoproliferative tumors have been reported in cats, dogs and humans. The purpose of this review is to provide an update and European perspective on Bartonella infections in cats and dogs, including clinical, diagnostic, epidemiological, pathological, treatment and zoonotic aspects.
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Affiliation(s)
- Alejandra Álvarez-Fernández
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Edward B. Breitschwerdt
- Department of Clinical Sciences and the Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr, Raleigh, NC 27607 USA
| | - Laia Solano-Gallego
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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15
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Donovan TA, Balakrishnan N, Carvalho Barbosa I, McCoy T, Breitschwerdt EB, Fox PR. Bartonella spp. as a Possible Cause or Cofactor of Feline Endomyocarditis-Left Ventricular Endocardial Fibrosis Complex. J Comp Pathol 2018; 162:29-42. [PMID: 30060840 DOI: 10.1016/j.jcpa.2018.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/02/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
Endomyocarditis is a commonly detected post-mortem finding in domestic cats presenting for sudden onset cardiovascular death, yet the aetiology remains unresolved. Cats are documented reservoir hosts for Bartonella henselae, the infectious cause of cat scratch disease in man. Various Bartonella spp. have been associated with culture-negative endocarditis, myocarditis and sudden death in man and animals. We hypothesized that Bartonella spp. DNA could be amplified more often from the hearts of cats with feline endomyocarditis-left ventricular endocardial fibrosis (FEMC-LVEF) complex compared with cats with hypertrophic cardiomyopathy (HCM) or cats with grossly and microscopically unremarkable hearts (designated non-cardiac disease controls). Formalin-fixed and paraffin wax-embedded, cardiac tissues from 60 domestic and purebred cats aged 3 months to 18 years were examined, and histological features were recorded. Cardiac tissue sections were tested for Bartonella DNA using multiple 16-23S intergenic transcribed spacer region polymerase chain reaction (PCR) primer sets, including two Bartonella genera, a Bartonella koehlerae species-specific and a Bartonella vinsonii subsp. berkhoffii-specific assay, followed by DNA sequence confirmation of the species or genotype. Special precautions were taken to avoid DNA cross-contamination between tissues. Bartonella spp. DNA was amplified by PCR and sequenced from 18 of 36 cats (50%) with FEMC-LVEF and 1/12 (8.3%) cats with HCM. Bartonella spp. DNA was not amplified from any non-cardiac disease control hearts. Based on PCR/DNA sequencing, one Bartonella spp. was amplified from 10 cats, while the remaining eight were coinfected with more than one Bartonella spp. To our knowledge, this study represents the first documentation of B. vinsonii subsp. berkhoffii genotype I infection in cats (n = 11). Fluorescence in-situ hybridization testing facilitated visualization of Bartonella bacteria within the myocardium of four of seven PCR-positive FEMC-LVEF hearts. Collectively, these findings support the hypothesis that Bartonella spp. may play a primary role or act as a cofactor in the pathogenesis of FEMC-LVEF. Studies involving cats from other geographical regions and definitive demonstration of Bartonella spp. within regions of inflammation are needed to confirm an association between Bartonella spp. and FEMC-LVEF induced morbidity and mortality in cats.
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Affiliation(s)
- T A Donovan
- Department of Anatomic Pathology, The Animal Medical Center, New York, New York, USA.
| | - N Balakrishnan
- Clinical Microbiology Unit, State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - I Carvalho Barbosa
- Department of Clinical Sciences, and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - T McCoy
- Department of Clinical Sciences, and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - E B Breitschwerdt
- Department of Clinical Sciences, and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - P R Fox
- Department of Cardiology, The Animal Medical Center, New York, New York, USA
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Abstract
Since the reclassification of the genus Bartonella in 1993, the number of species has grown from 1 to 45 currently designated members. Likewise, the association of different Bartonella species with human disease continues to grow, as does the range of clinical presentations associated with these bacteria. Among these, blood-culture-negative endocarditis stands out as a common, often undiagnosed, clinical presentation of infection with several different Bartonella species. The limitations of laboratory tests resulting in this underdiagnosis of Bartonella endocarditis are discussed. The varied clinical picture of Bartonella infection and a review of clinical aspects of endocarditis caused by Bartonella are presented. We also summarize the current knowledge of the molecular basis of Bartonella pathogenesis, focusing on surface adhesins in the two Bartonella species that most commonly cause endocarditis, B. henselae and B. quintana. We discuss evidence that surface adhesins are important factors for autoaggregation and biofilm formation by Bartonella species. Finally, we propose that biofilm formation is a critical step in the formation of vegetative masses during Bartonella-mediated endocarditis and represents a potential reservoir for persistence by these bacteria.
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Field AS, Geddie WR. Role of fine needle aspiration biopsy cytology in the diagnosis of infections. Diagn Cytopathol 2016; 44:1024-1038. [PMID: 27555237 DOI: 10.1002/dc.23568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022]
Abstract
The role of fine needle aspiration biopsy (FNAB) cytology in diagnosing infections has expanded due to the increase in the number of immune compromised patients and the increasing role of FNAB in the developing world where infection is a major cause of illness. FNAB has become the first procedural test in cases where the clinical and imaging findings suggest an infectious lesion or where there is a differential diagnosis of infection or metastatic or primary tumor. This applies to FNAB of palpable or image directed or deep seated lesions accessed by EUS and EBUS. This article details a recommended approach and technique for FNAB of infectious lesions, and discusses the role of rapid on site evaluation and the application of ancillary testing including the rapidly expanding array of molecular tests based on FNAB material. The utility of recognizing suppurative and granulomatous infectious patterns in FNAB direct smears, and the specific cytomorphological features on routine Papanicolaou and Giemsa stains and on special stains of FNAB smears is described for a large number of bacterial, fungal, viral, parasitic, and protozoan infections. The role of cytopathologists is to now train cytopathologists in sufficient numbers to provide FNAB services, teach trainee cytopathologists and cytotechnologists, and to encourage our clinical colleagues to use FNAB in the diagnosis of infections and other lesions to the benefit of patients and the medical system. Diagn. Cytopathol. 2016;44:1024-1038. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew S Field
- Department of Anatomical Pathology, St. Vincent's Hospital and Notre Dame University Medical School, Sydney, Australia
| | - William R Geddie
- Department of Anatomical Pathology, University Health Network, Toronto, Canada
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Chang CC, Lee CJ, Ou LS, Wang CJ, Huang YC. Disseminated cat-scratch disease: case report and review of the literature. Paediatr Int Child Health 2016; 36:232-4. [PMID: 25940800 DOI: 10.1179/2046905515y.0000000005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cat scratch disease (CSD) can present as a systemic disease in 5-10% of cases and lead to various disease entities. A previously healthy 16-month-old boy presented with fever for 7 days without other obvious symptoms. Abdominal computed tomography scan demonstrated enlarged right inguinal lymph nodes and multiple small round hypodensities in the spleen. Despite antibiotic treatment for 1 week, the fever persisted and the intrasplenic lesions progressed. Inguinal lymph node biopsy confirmed CSD by immunohistochemistry staining. The diagnosis of CSD was also supported by a history of contact, imaging and serological findings. The patient recovered after treatment with azithromycin for a total of 5 weeks and, in serial follow-up, the hepatosplenic micro-abscesses resolved after 4th months.
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Affiliation(s)
- Chih-Chen Chang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Chia-Jie Lee
- b Department of Pediatrics , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Liang-Shiou Ou
- c Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Chao-Jan Wang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Yhu-Chering Huang
- b Department of Pediatrics , Chang Gung Memorial Hospital , Linkou , Taiwan.,d Chang Gung University College of Medicine , Kweishan, Taoyuan , Taiwan
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Choi AH, Bolaris M, Nguyen DK, Panosyan EH, Lasky JL, Duane GB. Clinicocytopathologic correlation in an atypical presentation of lymphadenopathy with review of literature. Am J Clin Pathol 2015; 143:749-54. [PMID: 25873511 DOI: 10.1309/ajcppskwrx0gd8hj] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To present a clinicocytopathologic correlation of an atypical case of cat scratch disease (CSD) involving retroperitoneal lymph nodes, with emphasis on communication between service teams for managing lymphadenopathy of unknown origin. We consider clinical and cytologic differential diagnoses and review the literature on atypical cases of CSD, with emphasis on abdominal presentation and cytologic findings. METHODS Clinical services met with the cytology service to review clinical and pathologic features. Literature was reviewed via PubMed search (Harbor-UCLA subscriptions). Immunohistochemistry and Steiner silver stains were performed by Harbor-UCLA Department of Pathology. Enzyme-linked immunosorbent assay IgG and IgM Bartonella henselae titers were carried out by Quest Nichols Institute. RESULTS Fine-needle aspirate Diff-Quik and Papanicolaou smears and H&E-stained cell block showed abundant histiocytes, monocytoid B cells, and numerous neutrophils associated with necrosis corresponding to a late stage of CSD infection. Silver stain was positive for clumps of pleomorphic organisms. IgM and IgG antibody titers were elevated. CONCLUSIONS The cytologic findings of CSD in an atypical abdominal presentation are similar to those of a classic presentation. Laboratory workup for atypical CSD should include at least two other modalities aside from cytomorphologic features. Close clinical and cytologic correlation avoided potentially unnecessary and harmful surgery and enabled timely treatment.
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Affiliation(s)
- Alexander H. Choi
- Department of Pathology, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA
| | - Michael Bolaris
- Department of Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA
| | - Diana K. Nguyen
- Department of Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA
| | - Eduard H. Panosyan
- Department of Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA
| | - Joseph L. Lasky
- Department of Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA
| | - Gloria B. Duane
- Department of Pathology, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA
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Bieraugel K, Oehler D, NeSmith M, Chiovaro J. Cat got your spleen? Hepatosplenic Bartonella infection. Am J Med 2015; 128:246-9. [PMID: 25460524 DOI: 10.1016/j.amjmed.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Karen Bieraugel
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Drew Oehler
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Meghan NeSmith
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Joseph Chiovaro
- Department of Medicine, Oregon Health and Science University, Portland, OR; Department of Medicine, Portland Veterans Affairs Medical Center, Portland, OR.
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Staggemeier R, Pilger DA, Spilki FR, Cantarelli VV. Multiplex SYBR® green-real time PCR (qPCR) assay for the detection and differentiation of Bartonella henselae and Bartonella clarridgeiae in cats. Rev Inst Med Trop Sao Paulo 2014; 56:93-5. [PMID: 24626408 PMCID: PMC4085843 DOI: 10.1590/s0036-46652014000200001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 07/31/2013] [Indexed: 11/26/2022] Open
Abstract
A novel SYBR® green-real time polymerase chain reaction
(qPCR) was developed to detect two Bartonella species,
B. henselae and B. clarridgeiae, directly
from blood samples. The test was used in blood samples obtained from cats living
in animal shelters in Southern Brazil. Results were compared with those obtained
by conventional PCR targeting Bartonella spp. Among the 47
samples analyzed, eight were positive using the conventional PCR and 12 were
positive using qPCR. Importantly, the new qPCR detected the presence of both
B. henselae and B. clarridgeiae in two
samples. The results show that the qPCR described here may be a reliable tool
for the screening and differentiation of two important
Bartonella species.
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Affiliation(s)
- Rodrigo Staggemeier
- Laboratório de Microbiologia Molecular, Universidade Feevale, 93352-000Novo HamburgoRS, Brazil, Laboratório de Microbiologia Molecular, Universidade Feevale, RS 239 n° 2755, 93352-000 Novo Hamburgo, RS, Brazil
| | - Diogo André Pilger
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Fernando Rosado Spilki
- Laboratório de Microbiologia Molecular, Universidade Feevale, 93352-000Novo HamburgoRS, Brazil, Laboratório de Microbiologia Molecular, Universidade Feevale, RS 239 n° 2755, 93352-000 Novo Hamburgo, RS, Brazil
| | - Vlademir Vicente Cantarelli
- Laboratório de Microbiologia Molecular, Universidade Feevale, 93352-000Novo HamburgoRS, Brazil, Laboratório de Microbiologia Molecular, Universidade Feevale, RS 239 n° 2755, 93352-000 Novo Hamburgo, RS, Brazil
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Hutchins RG, Breitschwerdt EB, Cullen JM, Bissett SA, Gookin JL. Limited yield of diagnoses of intrahepatic infectious causes of canine granulomatous hepatitis from archival liver tissue. J Vet Diagn Invest 2012; 24:888-94. [PMID: 22855374 DOI: 10.1177/1040638712453583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Canine granulomatous hepatitis is an uncommon morphologic diagnosis that has been associated with a variety of diseases, including a number of systemic infectious etiologies. Formalin-fixed, paraffin-embedded (FFPE) tissues are typically the only source of liver tissue remaining for additional testing for the presence of infectious disease within granulomas. It is unclear if the more common infectious culprits of granulomatous hepatitis can be identified from such specimens. The aim of the current study was to retrospectively investigate archival FFPE liver tissue from dogs with granulomatous hepatitis for the presence of infectious agents. Semiquantitative analysis of copper accumulation in liver specimens was also performed. Medical records were examined for recorded evidence of systemic infectious disease diagnosis. Formalin-fixed, paraffin-embedded liver was prospectively evaluated for infectious agents via differential staining techniques (n = 13), eubacterial fluorescent in situ hybridization (n = 11), and Bartonella polymerase chain reaction assays (n = 15). An infectious cause of granulomatous hepatitis was not identified within liver tissue from any dog using these diagnostic methodologies. Six out of 25 (24%) dogs were diagnosed with concurrent systemic or localized bacterial infections at the time of presentation. Nine out of 17 (53%) dogs had excessive hepatic copper accumulation when evaluated by a semiquantitative histologic grading scheme or quantitative copper analysis. As definitive infectious causes of granulomatous hepatitis were not identified within archival liver biopsy samples, it was concluded that investigation of infectious etiologies within FFPE liver specimens using these diagnostic approaches may be of low yield.
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Affiliation(s)
- Rae G Hutchins
- Department of Clinical Sciences, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
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VanderHeyden TR, Yong SL, Breitschwerdt EB, Maggi RG, Mihalik AR, Parada JP, Fimmel CJ. Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient. BMC Infect Dis 2012; 12:17. [PMID: 22269175 PMCID: PMC3287964 DOI: 10.1186/1471-2334-12-17] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/23/2012] [Indexed: 11/15/2022] Open
Abstract
Background Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis. Due to the fastidious growth characteristics of the bacteria, the limited sensitivity of histopathological stains, and the non-specific histological findings on liver biopsy, the diagnosis of hepatic bartonellosis can be difficult to establish. Furthermore, the optimal treatment of established hepatic bartonellosis remains controversial. Case presentation We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five cm right hepatic lobe mass on CT scan. The patient underwent a right hepatic lobectomy. Surgical pathology revealed florid necrotizing granulomatous hepatitis, favoring an infectious etiology. Despite extensive histological and serological evaluation a definitive diagnosis was not established initially. Thirteen months after initial presentation, hepatic bartonellosis was diagnosed by PCR studies from surgically excised liver tissue. Interestingly, the hepatic granulomas persisted and Bartonella henselae was isolated from the patient's enriched blood culture after several courses of antibiotic therapy. Conclusion The diagnosis of hepatic bartonellosis is exceedingly difficult to establish and requires a high degree of clinical suspicion. Recently developed, PCR-based approaches may be required in select patients to make the diagnosis. The optimal antimicrobial therapy for hepatic bartonellosis has not been established, and close follow-up is needed to ensure successful eradication of the infection.
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Affiliation(s)
- Thomas R VanderHeyden
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.
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Chondrogiannis K, Vezakis A, Derpapas M, Melemeni A, Fragulidis G. Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella henselae DNA in lymph node samples. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70284-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Varanat M, Broadhurst J, Linder KE, Maggi RG, Breitschwerdt EB. Identification of Bartonella henselae in 2 cats with pyogranulomatous myocarditis and diaphragmatic myositis. Vet Pathol 2011; 49:608-11. [PMID: 21490304 DOI: 10.1177/0300985811404709] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most cats infected with Bartonella henselae remain outwardly healthy carriers for years; however, self-limiting fever, transient anemia, neurologic dysfunction, lymphadenopathy, reproductive disorders, aortic valvular endocarditis, and neutrophilic myocarditis have been described in experimentally or naturally infected cats. Two cats in a North Carolina shelter died with pyogranulomatous myocarditis and diaphragmatic myositis. Bacteria were visualized in the lesions by Warthin-Starry silver impregnation and by B. henselae immunohistochemistry. B. henselae DNA was amplified and sequenced from the heart of 1 cat and from multiple tissue samples, including heart and diaphragm, from the second cat. This study supports a potential association between B. henselae and what has been historically described as "transmissible myocarditis and diaphragmitis" of undetermined cause in cats.
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Affiliation(s)
- M Varanat
- Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough Street, Raleigh, NC 27606, USA
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Youssef D, Shams WE, El Abbassi A, Moorman JP, Al-Abbadi MA. Combining cytomorphology and serology for the diagnosis of cat scratch disease. Diagn Cytopathol 2011; 39:210-3. [PMID: 21319324 DOI: 10.1002/dc.21401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cat scratch disease (CSD) is a self limited zoonotic disease that presents most commonly as a regional lymphadenopathy. We are reporting a case of a 25-year-old male patient who presented with fever and large right inguinal lymphadenopathy. The diagnosis of cat scratch disease was confirmed based on the characteristic cytopathological features on aspirate smears from the lymph node and the serological titers for Bartonella henselae. This case report emphasizes the importance of combining Bartonella serology, and cytopathology in the diagnostic work-up of febrile lymphadenopathy and suspected CSD since the culture of this organism is arduous.
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Affiliation(s)
- Dima Youssef
- Department of Medicine, Division of Infectious Diseases, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37684, USA
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