Archive for the ‘Bartonella’ Category

New Case Report: Neuropsychiatric Symptoms and Bartonella-Associated Skin Lesions

https://www.galaxydx.com/bartonella-skin-lesions-and-neuro-symptoms-new-cases/

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New Case Report: Neuropsychiatric Symptoms and Bartonella-Associated Skin Lesions

A new case report co-authored by Galaxy Diagnostics scientists highlights the importance of bartonellosis being considered as a differential diagnosis when patients present with neuropsychiatric symptoms and skin lesions.

History

Bartonellosis is an emerging multi-system vector-borne disease caused by one or more bacteria belonging to the Bartonellagenus. Common Bartonella species infections such as cat scratch disease (CSD) or trench fever are often described as acute and, in the case of CSD, self-limiting in the medical literature. However, chronic symptoms and severe disease related to the heart, joints, and central nervous system (CNS) are increasingly described by researchers.

A 2019 publication by Dr. Breitschwerdt, chief scientific officer and co-founder of Galaxy Diagnostics, his team at NC State University, and a group of collaborating physicians described a boy diagnosed with PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) who was found to have Bartonella henselae in his bloodstream. The boy’s severe neuropsychiatric symptoms and skin lesions resolved in association with antibiotic treatment directed at B. henselae.

Bartonella species primarily occupy two niches in their host: the skin and the vascular endothelium (lining of the blood vessels). Vectors such as fleas, ticks, lice, and biting flies give Bartonella a vehicle to enter the skin and then the local blood and lymphatic vessels. The bacteria then travel through the bloodstream, in association with a relapsing bacteremia, to other areas of the body, potentially causing a wide variety of symptoms that can span months, years and possibly decades.

Newly Published Research

A new set of cases described by Dr. Breitschwerdt and a multi-institution collaborative team provide further evidence for neuropsychiatric and dermatological manifestations of bartonellosis in pediatric (< 18 years old) patients.

Dr. Breitschwerdt explained,

“Based upon the limited case reports and this case series, it is imperative to design studies that will determine if, or to what extent, Bartonella species might contribute to concurrent cutaneous [skin] lesions in patients with neuropsychiatric symptoms.”

At the same time as the team at NCSU has been advancing this symptom research, a team from Fujita Health University School of Medicine in Japan has been advancing the signaling work. They found a protein secreted by Bartonella species that activates the vascular endothelial growth factor (VEGF) pathway.

Where Do We Go From Here?

The pathophysiology of Bartonella species infections in people is complex. While the past 30 years of research has helped elucidate how persistent infections may occur, understanding why the host response differs and “atypical” symptoms develop in certain patient populations requires further research. Furthermore, research on these “atypical” manifestations may lead to the development of more accurate tools for Bartonella testing.

More research is needed to document both if Bartonella species might contribute to skin lesions in patients with neuropsychiatric symptoms and the mechanisms by which this might occur. We speculate that long-standing microvascular injury induced by these bacteria may result in chronic inflammation, local mast cell activation and collagen injury.

We encourage dermatologists and veterinarians to consider vector and animal exposures in patients with unusual or unexplained cutaneous lesions and consider testing these patients for Bartonella species infection.

We have found that advances in the understanding of skin lesions so far has been serendipitous, such as when a veterinarian’s own animal develops skin lesions and there are enhanced opportunities to collect samples. The more scientific inquiry is systemized across human and animal health (One Health), the faster our understanding of any potential association between Bartonella species infections and skin lesions will grow.

References

Breitschwerdt, E. B. et al. (2019). Bartonella henselae bloodstream infection in a boy with pediatric acute-onset neuropsychiatric syndrome. Journal of Central Nervous System Disease, 11. doi:10.1177/1179573519832014 https://journals.sagepub.com/doi/10.1177/1179573519832014

Maluki, A. et al. (2020). Imaging analysis of Bartonella species in the skin using single‐photon and multi‐photon (second harmonic generation) laser scanning microscopy. Clinical Case Reports, 2020, 1-7. doi:10.1002/ccr3.2939 https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.2939

Tsukamoto, K. et al. (2020). The Bartonella autotransporter BafA activates the host VEGF pathway to drive angiogenesis. Nature Communications, 11, 3571. doi:10.1038/s41467-020-17391-2 https://www.nature.com/articles/s41467-020-17391-2

Category:

Bartonella, research

Bartonella Endocarditis in Elderly Patient

https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008376

Bartonella henselae endocarditis in an elderly patient

Published: July 30, 2020

https://doi.org/10.1371/journal.pntd.000837

Citation: Drummond MR, de Almeida AR, Valandro L, Pavan MHP, Stucchi RSB, Aoki FH, et al. (2020) Bartonella henselae endocarditis in an elderly patient. PLoS Negl Trop Dis 14(7): e0008376. https://doi.org/10.1371/journal.pntd.0008376

Editor: Joseph M. Vinetz, Yale University School of Medicine, UNITED STATES

Published: July 30, 2020

Copyright: © 2020 Drummond et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was supported by Brazilian National Council for Scientific and Technological Development (CNPq) grant #159717/2013-2 (MRD) and #301900/2015-9 (PENFV). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Summary

We report an 85-year-old white man admitted to the emergency department of the University of Campinas with fever of undetermined origin (FUO) who received antibiotics previously. Initially, the hypothesis was pneumonia. He presented a drug reaction misdiagnosed as staphylococcal desquamation. The follow-up confirmed that prolonged fever was caused by bacterial endocarditis by transthoracic echocardiogram that showed vegetation in the aortic valve. Bartonella henselae etiology was confirmed by PCR.

This case reinforces the difficulty of diagnosing Bartonella sp. infection; this etiology must be considered even in patients with negative serology. The criteria for the diagnosis of bacterial endocarditis should contemplate a molecular positivity investigation for Bartonella spp, such as PCR in blood or serum samples as a major Duke criterion, even if with titers lower than 1 to 800.

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For more:  https://madisonarealymesupportgroup.com/2020/01/05/bartonella-endocarditis-masquerading-as-systemic-vasculitis-with-rapidly-progressive-glomerulonephritis/

https://madisonarealymesupportgroup.com/2019/09/05/rare-presentation-of-endocarditis-mycotic-brain-aneurysm/

https://madisonarealymesupportgroup.com/2019/08/12/tick-borne-pathogens-bartonella-spp-borrelia-burgdorferi-sensu-lato-coxiella-burnetii-rickettsia-spp-may-trigger-endocarditis/

https://madisonarealymesupportgroup.com/2019/08/16/endocarditis-caused-by-bartonella-quintana-a-rare-case-in-the-u-s/

https://madisonarealymesupportgroup.com/2017/01/04/endocarditis-consider-bartonella/

https://madisonarealymesupportgroup.com/2018/09/28/bartonella-infective-endocarditis-with-dissemination-a-case-report-literature-review/

https://madisonarealymesupportgroup.com/2018/07/10/infective-endocarditis-associated-with-bartonella-henselae-a-case-series/

https://madisonarealymesupportgroup.com/2019/04/25/case-of-endocarditis-caused-by-bartonella-after-mitral-valve-repair/

https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

It doesn’t appear to me that endocarditis caused by Bartonella is rare.

https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/05/05/good-news-for-bartonella-patients-identification-of-fda-approved-drugs-with-higher-activity-than-current-front-line-drugs/

Category:

Bartonella, Heart Issues, research

Bartonella: American Academy of Pediatrics

https://pedsinreview.aappublications.org/content/41/8/434

In Briefs

Bartonella

Beth Goodman and Patricia Whitley-Williams
Pediatrics in Review August 2020, 41 (8) 434-436; DOI: https://doi.org/10.1542/pir.2019-0198

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

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  1. Beth Goodman, MD*
  2. Patricia Whitley-Williams, MD†
  1. *Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
  2. †Department of Pediatrics and Division of Allergy, Immunology, and Infectious Disease, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ

  • AUTHOR DISCLOSURE

    Drs Goodman and Whitley-Williams have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Pediatricians are often familiar with cat-scratch disease (CSD), but many are not familiar with the other manifestations of Bartonella infection. The Bartonella genus of bacteria are fastidious and slow-growing gram-negative bacilli. From 1889 to the present, 8 different Bartonella species have been identified, with differing manifestations. This In Brief reviews the illnesses caused by 3 of the more common Bartonella strains: henselae, quintana, and bacilliformis.

CSD, caused by Bartonella henselae, is the most common Bartonella infection, but it is also a “newer” manifestation. CSD was first reported clinically in 1950, yet B henselae was not identified as the etiologic agent until 1983.

In immunocompetent patients, typical (uncomplicated) CSD is characterized by regional lymphadenopathy, the most common manifestation of B henselae infection, along with a history of cat exposure. For most patients with CSD, regional lymphadenopathy is the only symptom. In approximately 30% of patients with CSD, mild systemic symptoms are also present, including low-grade fever, fatigue, and headache. A skin papule, vesicle, or pustule may be present at the presumed site of inoculation, which is often a bite or scratch from an infected cat. Regional lymphadenopathy develops approximately 1 to 2 weeks after the inoculation. The affected nodes are most frequently in the axillary, cervical, and inguinal areas, and the skin overlying the affected lymph nodes is often tender, warm, erythematous, and indurated, consistent with a bacterial lymphadenitis. Approximately 10% of affected nodes suppurate spontaneously.

Atypical (complicated) CSD is a disseminated infection that develops in 5% to 14% of immunocompetent patients and may involve almost any organ system. Ocular manifestations of B henselae occur in 5% to 10% …

(See link for article you can purchase)

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**Comment**

Due to the increasing prevalence of Bartonella, I hope doctors are utilizing articles like this one and learning what to look for.

Here’s 18 pediatric cases of Bartonella in a singular Hawaiian facility:  https://madisonarealymesupportgroup.com/2020/06/20/disseminated-cat-scratch-disease-in-pediatric-patients-in-hawaii/

https://madisonarealymesupportgroup.com/2019/02/06/uh-study-shows-hawaii-kids-more-vulnerable-to-bartonella/  University of Hawaii study shows Hawaii keiki are more than three times more likely to get severe forms of cat scratch disease than mainland kids.

This adolescent had sudden onset schizophrenia caused by Bartonella:  https://madisonarealymesupportgroup.com/2019/03/21/bartonella-sudden-onset-adolescent-schizophrenia-a-case-study/

For more:  https://madisonarealymesupportgroup.com/2020/07/16/5-questions-to-discuss-with-your-physician-when-bartonellosis-is-suspected/

https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

 

 

 

 

 

Category:

Bartonella, Uncategorized

Bartonella Causing Encephalitis

https://pubmed.ncbi.nlm.nih.gov/32675979/

. 2020 Apr 24;33(3):440-441.

doi: 10.1080/08998280.2020.1756141. eCollection 2020 Jul.

Cat scratch disease causing encephalitis

Jerry Fan 1, Hameed Ali 1

Free PMC article

Abstract

Cat scratch disease is often a benign infection caused by Bartonella henselae, which is transmitted from scratches or bites from kittens. Presentations can vary from localized lymphadenopathy to neurologic manifestations. We present a case of a 22-year-old man with a 3-week history of an enlarged inguinal lymph node who presented with status epilepticus.

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**Comment**

Unfortunately, many still consider Bartonella “benign” when for many it is extremely severe and tenacious.  I would consider it as bad if not worse than Lyme in many respects.  Many also do not have lymph node involvement. Some patient’s only manifestation is psychological.

For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/  There is a checklist within this link of symptoms.

https://madisonarealymesupportgroup.com/2019/05/05/good-news-for-bartonella-patients-identification-of-fda-approved-drugs-with-higher-activity-than-current-front-line-drugs/  My husband and I use Berberine for Bartonella maintenance successfully.

https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

https://madisonarealymesupportgroup.com/2020/07/16/5-questions-to-discuss-with-your-physician-when-bartonellosis-is-suspected/

https://madisonarealymesupportgroup.com/2019/02/27/advanced-imaging-found-bartonella-around-pic-line/

 

Category:

Bartonella, research

5 Questions to Discuss With Your Physician When Bartonellosis is Suspected

https://www.galaxydx.com/how-to-discuss-bartonellosis-with-a-doctor/

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5 Questions to Discuss with Your Physician When Bartonellosis Is Suspected

Laboratory tests are important tools that physicians use to diagnose patients. When it comes to stealth pathogens, however, testing is often only a piece of the puzzle. Physicians must understand the pathogens and the symptoms they may cause as well as assess the likelihood that the patient is infected to arrive at an accurate diagnosis.   

Bartonellosis is the umbrella term used to describe diseases caused by Bartonella species infection in people. Current medical literature focuses mostly on acute infections of the following species:

  • B. henselae (cat scratch disease of cat scratch fever)
  • B. quintana (trench fever)
  • B. bacilliformis (Carrion’s disease)

“Atypical” bartonellosis in the form of acute and chronic infections has been explored in emerging research and case reports, but not to the extent needed to fully understand the pathogenesis of Bartonella species infection and the susceptibility of certain patient populations to chronic bartonellosis. Because of this, many physicians may not have bartonellosis on their radar when seeing a patient who has complex, non-specific symptoms that are seemingly unexplainable.

Start with these 5 questions/topics to have a productive conversation about bartonellosis with your physician(s):

1. Do you live and/or work with dogs, cats, or other animals?

Research indicates that sharing an environment with animals can lead to a higher risk of bartonellosis for people and their families. This may be because animals are brought into the home as companions or because vermin cannot be kept out of the living area, including when an individual is underhoused or unhoused. There are about 40 named Bartonella species, 17 of which are implicated in human illnesses, meaning that exposure to at least one could occur depending on your and your family’s lifestyle.

Bartonella species are adapted to living in small mammals, where they may or may not cause clinical symptoms, like Bartonella washoensis in squirrels, B. henselae in cats or B. vinsonii berkhoffii in dogs. However, zoonotic species, like B. henselae, are considered opportunistic pathogens and can lead to disease in humans if the conditions are right. Transmission to humans is much more likely when flea or other arthropod infestations occur, but there are reported cases of patients becoming directly infected from animals. For example, a woman in Ohio became blind in one eye from B. henselaeinfection after her cat licked her eyeball.

Veterinarians and other animal health workers who are prone to animal-related injuries seem to be at the highest risk for bartonellosis. A study from 2014 showed that 28% of symptomatic veterinarians had at least one Bartonella species in their bloodstream. There are also numerous case reports of veterinarians with chronic symptoms due to bartonellosis. One example of this is a veterinarian who developed severe symptoms and was found to have B. henselae in her hip joint despite receiving treatment for cat scratch disease years prior.

2. Have you had any animal-related injuries or known exposure to Bartonella vectors?

Bartonella species are typically found in the bloodstream of mammalian reservoir hosts and are transmitted by arthropod vectors such as fleas, lice, and biting flies. The bacteria may gain entry to humans directly by a vector, such as sandflies and B. bacilliformis, or with help from the reservoir host.

Trench fever (B. quintana infection), often referred to as urban fever, is transmitted by human body lice. It is historically known for causing fever and shin bone pain in WWI soldiers, but nowadays may be found among homeless populations.

Cat scratch disease (CSD) is the most common Bartonella species infection resulting from animal injury that is reported globally. A recent study from the CDC estimates that 80-95% of reported CSD cases follow the typical presentation of the disease (fever, swollen lymph nodes near site of inoculation), but the remainder manifest as atypical with more severe symptoms. Infection commonly occurs when flea dirt (feces) containing viable B. henselae is trapped under the cat’s claws and forced into an open wound following a scratch.

Case reports of infection following animal bites indicates that saliva may also be a route of transmission for these bacteria.

3. Are you immunocompromised or do you have a naturally weaker immune system?

Bartonella species were essentially re-discovered as a human pathogen in the 1990s during research on HIV/AIDS patients experiencing moderate to severe symptoms that were not typical. Researchers found that B. henselae and B. quintana were the culprits of serious health conditions including bacillary angiomatosis and bacillary pelosis. These findings showed that bartonellosis was not always a self-limiting infection as had previously been thought and that individuals with compromised immune systems were at a higher risk of developing severe disease.

Since the 1990s, research has proven this to be true in a variety of cases, such as organ transplant recipients and patients receiving cancer treatment. These conditions result in a weaker immune system that makes clearing infections difficult.

Individuals with developing or naturally weaker immune systems, like children or older adults, may be more likely to develop atypical symptoms. In a recent study, the CDC estimated that children younger than 14 accounted for 36% of atypical cases, with ocular conditions such as neuroretinitis accounting for about 60% of bartonellosis-related hospitalizations between 2005 and 2014.

4. Have you traveled recently?

The risk of tick and flea exposure varies in different areas of large countries like the United States and in the world in general. In addition, transportation depots may facilitate exposure to vermin as well as to other people’s companion animals or stray animals.

Certain species of Bartonella may be endemic to certain regions, such as Bartonella bacilliformis in South America.

Your physician may not be familiar with tick and flea exposure risks from other regions. If you are aware of published research or case reports, bring them with you.

5. Why do you think bartonellosis could be causing your symptoms?

If you have read research or case reports linking your symptoms to bartonellosis, bring them with you. Many of these cases are new, and physicians may not be aware of unusual presentations of bartonellosis.

Conclusion

Prepare for a conversation with your physician about bartonellosis by being prepared to talk about your risk factors for having encountered Bartonella  species in your environment. Bring any materials you may have that link your specific symptoms to bartonellosis, and be prepared to listen to your physician discuss other possible causes of your symptoms. Diagnosing bartonellosis is a clinical process of evaluating signs and symptoms against their possible causes. An accurate diagnosis, whatever it is, is the first step in managing or treating your condition.

 

References

Nawrocki, C. C. et al. (2020). Atypical manifestations of cat-scratch disease, United States, 2005-2014. Emerging Infectious Diseases, 26(7). doi:10.3201/eid2607.200034 https://wwwnc.cdc.gov/eid/article/26/7/20-0034_article?deliveryName=USCDC_331-DM31124

Breitschwerdt, E. B. (2014). Bartonellosis: One health perspectives for an emerging infectious disease. ILAR Journal, 55(1), 46-58. doi:10.1093/ilar/ilu015 https://academic.oup.com/ilarjournal/article/55/1/46/846503

Cheslock, M. A., & Embers, M. E. (2019). Human Bartonellosis: An underappreciated public health problem? Tropical Medicine and Infectious Disease, 4(2), 69. doi:10.3390/tropicalmed4020069 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630881/

Lantos, P. M. et al. (2014). Detection of Bartonella species in the blood of veterinarians and veterinary technicians: A newly recognized occupational hazard? Vector-Borne and Zoonotic Diseases, 14(8), 563-570. doi:10.1089/vbz.2013.1512 https://www.liebertpub.com/doi/abs/10.1089/vbz.2013.1512

Ericson, M. et al. (2016). Culture, PCR, DNA sequencing, and second harmonic generation (SHG) visualization of Bartonella henselae from a surgically excised human femoral head. Clinical Rheumatology, 36(7), 1669-1675. doi:10.1007/s10067-016-3524-2 https://pubmed.ncbi.nlm.nih.gov/28028681/

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For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/

Category:

Bartonella, Testing