Archive for the ‘Heart Issues’ Category

Human Bartonellosis: Perspectives of a Veterinary Internist

https://dta0yqvfnusiq.cloudfront.net/galax57722929/2018/03/Human-Bartonellosis-5ab03952a5057.pdf

HUMAN BARTONELLOSIS:  PERSPECTIVES OF A VETERINARY INTERNIST

Edward B. Breitschwerdt, DVM, DACVIM
Chief Scientific Officer, Galaxy Diagnostics, Inc.
Professor, Internal Medicine, NCSU, Raleigh, NC
Adjunct Professor of Medicine, Duke University Medical Center
INTRODUCTION
Bartonella species are fastidious gram-negative bacteria that are highly adapted to a mammalian reservoir host and within which the bacteria usually cause a long-lasting intraerythrocytic bacteremia.  1-3  These facts are of particular importance to veterinarians and physicians, as an increasing number of animal reservoir hosts have been identified for various Bartonella species. Among numerous other examples, Bartonella henselae has co-evolved with cats, Bartonella vinsonii subsp. berkhoffii has co-evolved with dogs and wild canines, and Bartonella bovid has co-evolved with cattle.  1-2  Importantly, the list of reservoir-adapted Bartonella species, including a large number of rodent species that might serve as “pocket pets,” continues to grow exponentially, as new Bartonella spp. are discovered. Prior to 1990, there were only two named Bartonella species, whereas there are now at least 24 named and numerous unnamed or candidatus species, based upon deposited Gen Bank sequences or preliminary reports, respectively, seventeen Bartonella spp. including B.alsatica, B. bacilliformis, B. clarridgeiae, B. doshiae, B. elizabethae, B. grahamii, B. henselae (Houston 1 and San Antonio 2 strains), B. koehlerae, B. melophagi, B. quintana, B. rochalimaea, B. tamiae, B. vinsonii subsp. berkhoffii (Genotypes I, II and III), and B. washoensis have been associated with an expanding spectrum of human diseases.
Epidemiological evidence and experimental flea transmission studies support an important role for fleas in the transmission of B. henselae, B. clarridgeae and most likely B. koehlerae among cats. 1  Three other Bartonella species, B. bovid, B. quintana and B. vinsonii subsp. berkhoffii have been isolated from cat blood, but the modes of transmission and the reservoir potential of these species in felids has not been definitively established. Recently, we isolated Bartonella vinsonii subsp. berkhoffii from a cat with recurrent osteomyelitis spanning an eighteen month time period. 2  Thus, cats can maintain a chronic bacteremia with at least six Bartonella spp., of which five are known zoonotic pathogens.  1-3 In addition to fleas, an increasing number of arthropod vectors, including biting flies, keds, lice, sandflys and ticks have been implicated in the transmission of Bartonella species. Although there is clinical and epidemiological evidence to support tick transmission of B. vinsonii subspecies berkhoffii to dogs and coyotes, the mode of transmission of this Bartonella subsp. to cats and dogs has not been determined. Recent evidence supports tick transmission of B. henselae by Ixodes scapularis and Ixodes ricinus. Considering the diversity of Bartonella species and subspecies, the large number of reservoir hosts and the spectrum of arthropod vectors, the clinical and diagnostic challenges posed by Bartonella transmission in nature may be much more complex than is currently appreciated in human and veterinary medicine.
In the natural reservoir host, such as a cat or rodent, chronic bacteremia with a Bartonella species can frequently be detected by blood cultre or PCR in outwardly healthy individuals.  1-3  In contrast, the diagnostic detection of a Bartonella spp. in a non-reservoir adapted host, such as a dog, horse or human patient, can be extremely difficult. Most, although not all diseases caused by Bartonella spp. occur in accidental hosts and these organisms are being increasingly implicated as a cause of zoonotic infections.  4-8  It is important to recognize that strains of a Bartonella sp. vary in their virulence. Therefore, highly pathogenic strains of B. henselae, for which the cat is the primary reservoir, can induce granulomatous myocarditis in cats, presumably following flea transmission.  Until recently, mechanisms that facilitate persistent Bartonella bacteremia in mammals were not well understood. Recent reports have identified an intra-endothelial, as well as intra-erythrocytic localization for these bacteria, which represents a unique strategy for bacterial persistence. Non-hemolytic intracellular colonization of erythrocytes in conjunction with the ability to invade and replicate within endothelial cells would preserve the organisms for efficient vector transmission, protect Bartonella from the host immune response, and potentially contribute to decreased antimicrobial efficacy. Although the clinical implications are not understood, other in vitro studies indicate that Bartonella spp. can infect dendritic cells, microglial cells, monocytes and CD34+ bone marrow progenitor cells.
CAT SCRATCH DISEASE
For over a century regional lymphadenopathy has been associated with animal contact, particularly cat scratches. Over the years, numerous microorganisms were implicated as the cause of CSD. In 1992, Regnery and colleagues at the Centers for Disease Control, identified seroreactivity to B. henselae antigens in 88% of 41 human patients with suspected CSD compared to 3% of controls.  Subsequently, additional support for B. henselae as the predominant cause of CSD was provided when Bartonella DNA was amplified from lymph node samples of 21 of 25 (84%) patients with suspected
CSD, using a polymerase chain reaction assay. A similar study from Sweden identified B. henselae DNA, but failed to identify A. felis DNA, in a large number of patients with suspected CSD. Prior to the
recognition of B. henselae as the cause of CSD, Afipia felis, named for the Armed Forces Institute of Pathology, was considered the sole cause of CSD. Subsequently, we blood cultured B. henselae or B. clarridgeae
from 17 of 19 cats owned by 14 patients with CSD, which indicated that bacteremia is a frequent occurrence in cats that transmit B. henselae
to a human being. 1-2
Historically, atypical manifestations of CSD have included tonsillitis, encephalitis, cerebral arteritis, transverse myelitis, granulomatous hepatitis and/or splenitis, osteolysis, pneumonia, pleural effusion, and thrombocytopenic purpura. With the advent of specific diagnostic techniques, (culture, serology, and PCR), there has been a dramatic increase in reports describing human patients with “atypical” manifestations of CSD. Osteomyelitis, granulomatous hepatitis and granulomatous splenitis have been increasingly recognized in children infected with B. henselae, who frequently lack the classical lymphadenopathy of CSD. Previously, Bartonella infection would not have been considered a likely differential diagnosis by the physician in patients lacking a history of lymphadenopathy or animal contact. As evidenced by reports in the past four years, the spectrum of human disease associated with the genus Bartonella continues to expand, requiring periodic reassessment as new information becomes available. On a comparative medical (“One Health”) basis, our research group has documented many of the same CSD atypical manifestations in cats or dogs, including encephalitis, transverse myelitis, granulomatous hepatitis, osteolysis, pleural effusion, and thrombocytopenic purpura. In this context, a highly prevalent, naturally-occurring human disease (CSD) can be used as a “model” to determine the potential behavior of these bacteria in companion animal patients.
Because cat scratch disease generally denotes a self-limiting illness characterized by fever and lymphadenopathy and because the recognized spectrum of human disease manifestations associated with Bartonella infections (which may not include fever or lymphadenopathy) has expanded considerably in recent years, it is becoming obvious that the designation CSD lacks clinical, microbiologic and zoonotic utility. Although cats are a major reservoir for B. henselae, B. clarridgeiae, and B. koehlerae, some patients deny the possibility of a cat scratch or bite wound, or indicate no contact with cats. Transmission from environmental sources, various arthropod vectors, perinatally or by other animal hosts is probable and the more inclusive term bartonellosis may facilitate enhanced future understanding of diseases caused by members of the genus Bartonella. As physicians have been taught that CSD is self-limiting, there is an ongoing lack of appreciation that B. henselae can cause chronic, asymptomatic or intermittently symptomatic illness, accompanied by persistent bacteremia in people. In this context, the documentation of chronic, relapsing bacteremia in cats, dogs and other animal species provides a “model” for better understanding human bartonellosis.
BARTONELLA ENDOCARDITIS
Endocarditis can be induced by a spectrum of Bartonella species in dogs and human patients and is the best example of documented disease causation for this genus. Historically, Bartonella species have been a cause of culture-negative endocarditis in people and dogs because the diagnostic methods used by microbiology laboratories were not adequate to isolate these bacteria. Now, by using
specialized techniques, a spectrum of Bartonella species have been identified in research and diagnostic laboratories in different parts of the world—in heart valves or in blood cultures from dogs
and people with endocarditis. 3  It is important for physicians and veterinarians to recognize that some of these Bartonella species are found in the blood of cats, dogs, rats, ground squirrels, and rabbits.
ISOLATION AND MOLECULAR DETECTION OF BARTONELLA SPECIES
Because conventional microbiological techniques lack sensitivity, bartonellosis is usually diagnosed by PCR amplification of organism specific DNA sequences and/or through serological testing. Recently, the development of a more sensitive isolation approach, using BAPGM (Bartonella alpha Proteobacteria growth medium) followed by PCR has greatly facilitated the molecular detection or isolation of Bartonella species from the blood of sick or healthy animals, including cats, dogs, horses and human beings. Most importantly, the use of this enrichment growth medium prior to PCR testing has allowed our research group to confirm that immunocompetent human patients, in particular veterinarians and veterinary technicians, can have chronic intravascular infections with Bartonella spp. 4-5 Information relative to this EnrichmentPCRTM testing platform for animal and human patients is available at www.galaxydx.com.
It is increasingly clear that no single diagnostic strategy will confirm infection with a Bartonella sp. in the immunocompetent patient population.  As described in studies from our NCSU laboratory, B. henselae, B. koehlerae and B. vinsonii subsp berkhoffii seroreactivity was found in only 58.6% of the patients in which Bartonella spp. infection was confirmed by EnrichmentPCR TM and sequencing. Therefore, Bartonella serology lacks sensitivity and can only be used to implicate prior exposure to a Bartonella sp. Even when serum from cat scratch disease patients, which is caused by B. henselae, is used in various diagnostic laboratories for IFA testing, test sensitivities have ranged from 14 to 100%.
EVOLVING IMPLICATIONS OF CHRONIC BARTONELLA SPP. BACTEREMIA IN IMMUNOCOMPETENT PEOPLE
Previously, we described B. quintana bacteremia in a woman who was tested following the development of an infected cat bite lesion involving the hand. 6  Two months later, the feral cat that had
induced the bite wound was captured and was also shown to be B. quintana bacteremic. In a cumulative study involving 392 patients with occupational animal contact or extensive arthropod exposure 31.9% were bacteremic with one or more Bartonella spp., when blood, serum and BAPGM enrichment culture PCR results were combined. Although this high prevalence of bacteremia is biased by testing at risk, sick individuals, it clearly demonstrates that intravascular infection with Bartonella sp. is much more common in immunocompetent patients, than was previously suspected. By IFA testing, only 75 out of 128 (58.6%) PCR positive patients were seroreactive to a panel consisting of five Bartonella sp. test antigens.
In a recent study, Bartonella vinsonii subsp. berkhoffii, Bartonella henselae or DNA of both organisms were amplified and sequenced from blood, BAPGM enrichment blood cultures or autopsy tissues from four family members. 7  Historical and microbiological results derived from this family support human perinatal transmission of Bartonella species. To date, there have been a limited number of studies that address the potential impact of intravascular infection with a Bartonella sp. on reproductive performance, however, studies involving experimentally-infected cats, rodents and naturally-infected cows with various Bartonella sp. have identified decreased reproductive performance involving both males and females. The parents of these children had attempted to conceive children for several years prior to resorting to in vitro fertilization.
We have also described a veterinarian, who experienced a needle stick while obtaining a fine needle aspiration sample from a cutaneous histiocytic neoplasm. 8  Subsequently symptoms, including headaches, fatigue and intermittent paresthesias (numbness) developed. This patient seroconverted to B. vinsonii subsp. berkhoffii genotypes I and III and B. vinsonii subsp. berkhoffii genotype I DNA was amplified and sequenced from sequentially obtained blood samples, whereas genotype III DNA was amplified from the cytological specimen. All symptoms resolved following antibiotic treatment.
It is increasingly evident that dogs can serve as a source for human infection with B. vinsonii subsp. berkhoffii. Bartonella vinsonii subsp. berkhoffii genotype II was amplified and sequenced from
a liver biopsy from a patient with epithelioid hemangioendothelioma (soft tissue tumor considered a vascular cancer), after which the organism was isolated by BAPGM blood culture. 9  The unique capability of Bartonella to invade and induce long lasting intraerythrocytic and intraendothelial infections, in conjunction with the ability of at least three Bartonella spp. (Bh, Bq, and B. bacilliformi) to induce VEGF-mediated vasoproliferative disease in immunocompromised or immunocompetent individuals suggests that these novel emerging bacterial pathogens might contribute to the development of vascular tumors.
Bartonella koehlerae bacteremia was documented in eight immunocompetent patients by PCR amplification and DNA sequencing, either prior to or after BAPGM enrichment blood culture.10  Presenting symptoms most often included fatigue, insomnia, joint pain, headache, memory loss, and muscle pain. Four patients were also infected with Bartonella vinsonii subsp. berkhoffii genotype II. Bartonella koehlerae antibodies were not detected (titers<1:16) in 30 healthy human control sera, whereas five of eight patient samples had B. koehlerae antibody titers of 1:64 or greater. Studies are needed to determine if B. koehlerae is a cause or cofactor in the development of arthritis, peripheral neuropathies or tachyarrhythmias in human patients. Co-infection with B. henselae and two hemotropic Mycoplasma variants resembling Mycoplasma obis were also found in the blood of a veterinarian with a historical diagnosis of multiple sclerosis. 11
PUBLIC AND OCCUPATIONAL HEALTH CONSIDERATIONS
Due to extensive contact with a spectrum of animal species, veterinary professionals appear to have an occupational risk of infection because of frequent exposure to Bartonella spp., therefore these individuals should exercise increased precautions to avoid arthropod bites, arthropod feces (i.e. fleas and lice), animal bites or scratches and direct contact with bodily fluids from sick animals. As Bartonella spp. have been isolated from cat, dog or human blood, cerebrospinal fluid, joint fluid,aqueous fluid, seroma fluid and from pleural, pericardial and abdominal effusions, a substantial number of diagnostic biological samples collected on a daily basis in veterinary practices could contain viable bacteria.
The increasing number of defined Bartonella spp., in conjunction with the high level of bacteremia found in reservoir adapted hosts, which represent the veterinary patient population, ensures that all veterinary professionals will experience frequent and repeated exposure to animals harboring these bacteria. Therefore, personal protective equipment, frequent hand washing and avoiding cuts and needle sticks have become more important as our knowledge of this genus has improved and various modes of transmission have been defined.
Physicians should be educated as to the large number of Bartonella spp. in nature, the extensive spectrum of animal reservoir hosts, the diversity of confirmed and potential arthropod vectors, current limitations associated with diagnosis and treatment efficacy, and the ecological and evolving medical complexity of these highly evolved intravascular, endotheliotropic bacteria.
REFERENCES
1  Chomel BB, et al. Vet Res 2009;40:29.
2  Breitschwerdt EB, et al. J Vet Emerg Crit Care 2010; 20:8.
3  Chomel BB, et al. Ann N Y Acad Sci 2009;1166:120.
4  Breitschwerdt EB, et al. J Clin Microbiol 2008;46:2856.
5  Breitschwerdt EB, et al. Parasit Vectors 2010;3:29.
6  Breitschwerdt EB, et al. J Clin Microbiol 2007;45:270.
7  Breitschwerdt EB, et al. J Clin Microbiol 2010;48:2289.
8  Oliveira AM et al. J Vet Intern Med 2010;24:1229.
9  Breitschwerdt EB, et al. J Clin Microbio 2009;47:1957.
10 Breitschwerdt EB, et al. Parasit Vectors 2010;3:76.
11 Sykes JE, et al. J Clin Microbiol 2010;48:3782.
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Category:

Bartonella, Heart Issues, Mycoplasma, research, Testing, Ticks, Transmission

Lyme Carditis: Heart Block & Other Complications of LD

**Please see independent tick researcher John Scott’s comment regarding climate change and tick expansion after the article.**

https://www.lymedisease.org/lyme-carditis-heart-block/

Lyme Carditis: Heart Block and Other Complications of Lyme Disease
Dr-Adrian-Cynthia2-300x219

by Adrian Baranchuk, MD, FACC ,FRCPC, FCCS, and Cynthia Yeung, BSc

The incidence of Lyme disease, a tick-borne bacterial infection, is rapidly increasing in North America. Risk modeling suggests that the incidence of Lyme disease will continue to rise as the migratory birds that are responsible for transmitting the Ixodes tick are affected by climate change and consequently, contribute to the expansion of at-risk regions. Lyme disease can affect many organ systems, including the heart, nerves, and joints.

In this article, the authors intend to highlight one of the most dramatic complications of Lyme disease, early dissemination Lyme carditis.

How Common Are Lyme Disease And Lyme Carditis?

Lyme disease is the most commonly reported vector-borne disease in North America, with an annual incidence of approximately 25, 000 confirmed cases in the United States. However, estimates suggest that the true incidence is closer to 300, 000 cases annually. Lyme disease affects the heart in 0.3-10% of cases.

Lyme Carditis: How Spirochetes Affect The Heart

In Lyme carditis, Borrelia burgdorferi (the spirochete responsible for Lyme disease) directly affects the heart. Damage to the heart tissue occurs from the direct invasion by the bacteria, as well as from the body’s exaggerated immune response to the infection.

In 90% of cases, the most common consequence of Lyme carditis is heart block. Electrical signals from the upper chambers of the heart are not properly relayed to the lower chambers of the heart, which can dramatically slow down the heart rate.

The severity of the heart block can fluctuate rapidly and the progression to complete heart block can be fatal. Importantly, the heart block in Lyme carditis can be transient and usually resolves with antibiotic therapy. Additionally, Lyme carditis can affect other parts of the heart’s conduction system, as well as the heart’s muscle, valves, and outer layer of the heart wall.

Symptoms Of Lyme Carditis

Patients with Lyme carditis may report light-headedness, fainting, shortness of breath, palpitations, and/or chest pain. Conversely, patients with Lyme carditis may also experience no symptoms, which contributes to the elusive nature of the diagnosis.

Systematic Approach For Lyme Carditis

To help healthcare providers consider Lyme carditis as a potential cause for heart block, our research team developed the Suspicious Index in Lyme Carditis (SILC) score.

It allots points for specific risk factors. The resulting score classifies patients into low, intermediate, and high-risk categories for the likelihood that the heart block is due to Lyme carditis. The variables in the SILC score can be associated with the mnemonic “CO-STAR”: Constitutional symptoms, Outdoor activity/endemic area, Sex (male), Tick bite, Age (< 50 years), and Rash.

Table 1. The Suspicious Index in Lyme Carditis (SILC) score evaluates the likelihood that a patient’s high-degree heart block is caused by Lyme carditis. The total score indicates low (0-2), intermediate (3-6), or high (7-12) suspicion of Lyme carditis.

Variable                                                               Value
Age < 50 years                                                     1
Male                                                                     1
Outdoor activity/endemic area                             1
Constitutional symptoms*                                    2
Tick bite                                                              3
Erythema migrans rash                                    4

* fever, malaise, arthralgia, and dyspnea

Patients with high-degree heart block and a SILC score of three or higher should be investigated immediately for Lyme disease. They should also receive antibiotic treatment while awaiting the results of testing.

Importance Of Prompt Recognition And Treatment Of Lyme Carditis

The standard protocol for high-degree heart block calls for implanting a permanent pacemaker. However, the heart block in Lyme carditis will most likely resolve with antibiotic therapy. Thus, identifying Lyme carditis as the underlying cause of the heart block can prevent the unnecessary implantation of permanent pacemakers.

The battery of a pacemaker lasts 7-10 years. Thus, a missed diagnosis could subject an otherwise young, healthy patient to 5-7 battery replacements over a lifetime—with each procedure bringing potential adverse events. These risks associated with the initial pacemaker implantation can be mitigated by intravenous and oral antibiotic treatment for heart block caused by Lyme carditis.

Educating Healthcare Providers

We aim to raise awareness about the cardiac manifestations of Lyme disease in endemic areas, so that healthcare providers are educated and alert about Lyme carditis. The conduction disorders associated with Lyme carditis can progress quickly. Patients often seek medical attention several times before Lyme carditis is suspected. The prompt diagnosis and treatment of Lyme carditis is essential to prevent unnecessary implantation of permanent pacemakers and further complications of Lyme disease.

Additional resources

  1. Wan D, Baranchuk A. Lyme carditis and atrioventricular block. CMAJ 2018;190:E622.
  2. Fuster LS, Gul EE, Baranchuk A. Electrocardiographic progression of acute Lyme disease. Am J Emerg Med 2017;35:1040 e5-1040 e6.
  3. Wan D, Blakely C, Branscombe P, Suarez-Fuster L, Glover B, Baranchuk A. Lyme Carditis and High-Degree Atrioventricular Block. Am J Cardiol 2018;121:1102-1104.

Dr. Baranchuk, a cardiologist and professor of medicine at Queen’s University, Kingston, Canada, is one of the world’s leading experts on Lyme carditis. Cynthia Yeung is a medical student.

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https://www.thewhig.com/2018/02/05/letters-to-the-editor-feb-5/wcm/04cb0a0c-5253-8a4b-1f34-ca2b8ae54057

Birds, not climate change, brought ticks

Re: “Balance key to addressing climate change: expert,” Jan. 19.

I do not agree with Roberta Bondar’s statement: “The migration of deer ticks [blacklegged ticks] into the Kingston area, and the increased incidents of Lyme disease is an example of the kind of environmental changes that climate change is bringing.”

My peer-reviewed scientific research shows that migratory songbirds import blacklegged tick larvae and nymphs into Canada, and are widely dispersing them countrywide. In fact, a heavily tick-infested songbird can initiate a new blacklegged tick population. The number of immature blacklegged ticks on migratory song birds has remained constant for decades — long before climate change was coined. Furthermore, the adult female blacklegged tick does not migrate at all, and crawls a maximum of six metres in her lifetime.

I believe federally funded researchers who publish peer-reviewed papers on tick expansion numbers, ascribed to being caused by climate change, are wasting millions of taxpayer dollars. Moreover, their research is not helping patients get diagnosed and treated in a timely manner. Alarmingly, we have 3,000 patients going to the United States for diagnosis and treatment of Lyme disease and associated tick-borne diseases.

Any daily temperature increases are not putting any extinction stressors on the blacklegged female. She lays her eggs in the cool, moist leaf litter, where she has typically laid them for millennia, and is very comfortable in this microhabitat. She does not have extinction stress in this environment and, thus, does not lay more eggs. The seemingly more ticks in the Kingston area, and everywhere else, is not because of climate changing. In reality, public awareness is the key factor because more people, veterinarians and pet groomers are looking for them.

John D. Scott

Fergus, Ontario

Please know there’s a ton of money when it is ear-marked with the words “climate change,” but regarding tick expansion and therefore the spread of Lyme, it isn’t being honest and it’s taking valuable resources and money away from things that really matter.  Scott goes as far to say it’s a nefarious plot protecting authorities from the lack of helpful research and care for patients that’s occurred over the span of 40 years.

http://www.dutchessny.gov/CountyGov/Departments/Legislature/2017Auerbach.pdf This pdf by Lyme Advocate Jill Auerbach shows that while there were only 5,700 cases of WNV in 2012, research dollars were $29 million, whereas, Lyme cases in 2012 were 312,000 but received only $25 million.  Another stark contrast is Hepatitis C in 2012 with 1,300 cases but with $112 million in research dollars.

While the number of the infected continue to soar, the research dollars for Lyme are radically reduced in successive years.  Go here for a quick table comparing research dollars for various diseases:  https://madisonarealymesupportgroup.com/2018/09/17/study-shows-tick-infection-transmission-potential-for-both-dtv-wnv/

THIS DOES NOT EVEN INCLUDE OTHER TICK-BORNE DISEASES

Don’t kid yourself.  Words mean things and any research ear marked with the words “climate change” have not and will not help patients one iota.

For more:  https://madisonarealymesupportgroup.com/2018/08/13/study-shows-lyme-not-propelled-by-climate-change/

https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/

 

 

 

Category:

Heart Issues, Lyme, Treatment

Bartonella Mastomydis -Novel Species

First proposed in 2016,   https://www.researchgate.net/publication/295893002_Bartonella_spp_in_Small_Mammals_Benin, phenotypic, phylogenetic, and genomic analyses have led researchers to formally propose the creation of Bartonella mastomydia sp.nov. that contains the strain 008 isolated from Senegalese M. erythroleucus (Guinea multimammate mouse) blood samples.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098214/

Bartonella Mastomydis Strain 008Bartonella mastomydis strain 008 (FEI Company, Limeil-Brévannes, France) 

Noncontiguous finished genome sequence and description of Bartonella mastomydis sp. nov.

M. Dahmani,1 G. Diatta,2 N. Labas,1 A. Diop,1 H. Bassene,2 D. Raoult,1 L. Granjon,3 F. Fenollar,4 and O. Mediannikov1,∗

Abstract

Bartonella mastomydis sp. nov. strain 008 is the type strain of B. mastomydis sp. nov., a new species within the genus Bartonella. This strain was isolated from Mastomys erythroleucus rodents trapped in the Sine-Saloum region of Senegal. Here we describe the features of this organism, together with the complete genome sequence and its annotation. The 2 044 960 bp long genomes with 38.44% G + C content contains 1674 protein-coding and 42 RNA genes, including three rRNA genes.

Introduction

Just over a century ago, the first historical record of the emerging Bartonella genus was made during World War I, when a million frontline troops were shown to be plagued by a disease later known as trench fever. This was caused by the louse-borne bacterium now known as Bartonella quintana [1]. Bartonella are small facultative intracellular, vector-transmitted, Gram-negative, haemotropic bacilli, classified within the class of α-proteobacteria [2]….The Bartonellaceae family (Gieszczykiewicz 1939) [4] contains 35 species and three subspecies (http://www.bacterio.net/) as of 1 August 2017 [5]. Bartonellae usually exist in two specific habitats: the gut of the obligately blood-sucking arthropod vector and the bloodstream of the mammalian host [1]. Among the 38 recognized Bartonella species, 17 have been described as pathogenic in humans [6]. In humans, Bartonella bacteria are among the most described as being associated with endocarditis or cardiopathy. In animal hosts, a wide array of clinical syndromes, as well as asymptomatic infection and endocarditis, have been described [6], [7], [8].

New species and subspecies are constantly being proposed. Candidate species belonging to the genus Bartonella from a wide range of animal reservoirs have been described but not yet assigned new species designations [1]. Parasitism by bartonellae is widespread among small mammals. Potentially new Bartonella species infecting bat communities were reported in Madagascar [9], Kenya [10], Puerto Rico [11] and French Guiana [12]. Rodents and insectivores were showed to maintain bartonellae infections. Additionally, a large number of partially characterized Bartonella have been isolated from rodents in Southeast Asia [13], South Africa [14], [15], Europe, North and South America [16], Nigeria [17], the Republic of Congo and Tanzania [16]. In Senegal, West Africa, using the criteria proposed by La Scola et al. [18] based on the multilocus sequence analyses of four genes and the intergenic spacer (ITS) as a tool to the description of bartonellae, three new bartonellae were isolated and described: Bartonella senegalensis, Bartonella massiliensis from the soft tick Ornithodoros sonrai[13] and Bartonella davoustii from cattle [19].

We sought to describe an additional Bartonella species isolated from small mammals in the region of Sine-Saloum, in western Senegal [20]. In this rural region, the biotype is favourable to the spread of commensal mammals harbouring pathogenic microorganisms and is often found in close contact with humans. This situation increases the risk of human and animal transmission of infectious disease from rodent-associated tick-borne pathogens. This work describes the genome sequence of the proposed candidate Bartonella mastomydis strain 008 isolated from Mastomys erythroleucususing a polyphasic approach combining matrix-assisted desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and genomic properties, as well as next-generation sequencing technology to complete description of a potentially new species [21].

Bartonella mastomydis is sensitive to amoxicillin, amoxicillin/clavulanic acid, oxacillin, imipenem, rifampicin, nitrofurantoin, doxycycline, linezolid, tobramycin, gentamycin, trimethoprim/sulfamethoxazole, fosfomycin and ciprofloxacin. Bartonella mastomydis is resistant to metronidazole and colistin.

_______________

**Comment**

I once heard it said that every animal species probably has their own strain of Bartonella.  All I know is many Lyme/MSIDS patients struggle with it as it is extremely tenacious.  Here, we see a novel species in Senegalese mice.  While there are 17 known species of Bart that are pathogenic to humans, as this article points out, more are continually being discovered.

Known for causing heart issues in humans, it does oh so much more:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

https://madisonarealymesupportgroup.com/2011/09/25/the-bartonella-checklist-copyrighted-2011-james-schaller-md-version-11/

Normally thought of as a Lyme “co-infection,” some LLMD’s state that Bartonella can be more debilitating than Lyme.  This doctor says Bartonella is the “new Lyme”:  https://madisonarealymesupportgroup.com/2018/05/07/fox-news-bartonella-is-the-new-lyme-disease/

Category:

Bartonella, Heart Issues, research, Ticks, Treatment

Infective Endocarditis Associated with Bartonella henselae: A Case Series

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010976/

Infective endocarditis associated with Bartonella henselae: A case series

Akio Nakasu,⁎ Tohru Ishimine, Hiroshi Yasumoto, Toshiho Tengan, and Hidemistu Mototake

Abstract
Organisms in the genus Bartonella are cause of blood culture-negative endocarditis. Bartonella infective endocarditis is being increasingly reported worldwide; however, reports from Japan are limited. Here, we report five cases of infective endocarditis associated with Bartonella henselae. All patients had a history of contact with cats or fleas; this information helped achieve an appropriate diagnosis.

________________

**Comment**

The word on Bart is finally getting around.  It is not some benign pathogen to shrug off but can actually kill you.  

While this article discusses cats and fleas, too many people with Lyme/MSIDS are infected with Bart to deny either the direct transmission by a tick, the involvement of other vectors, or the ability for a tick bite to activate a latent infection, or all of the above.  

You will find some claiming tick transmission, while others deny it.  Research must be done to settle the issue once and for all as most doctors are not even considering Bartonella with Lyme/MSIDS patients and for many it’s a big player.

For more on Bartonella:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

https://madisonarealymesupportgroup.com/2018/05/07/fox-news-bartonella-is-the-new-lyme-disease/

More on tick borne illness and heart issues:  https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/  (Please know viruses, bacteria, and parasites can cause heart issues and many are transmitted by a tick or reactivate latent infections within the body)

Category:

Bartonella, Heart Issues, research

Heart Problems & Tick Borne Disease

Recently some articles have come out on Heart issues with Tick Borne Disease (TBD).  Most talk about Lyme; however, as you will see – there are many other players.

http://davidjernigan.blogspot.com/2015/05/functional-heart-problems-and-lyme.html  The Hansa Center in their blog states that a common symptom of chronic Lyme is Postural Orthostatic Tachycardia Syndrome or POTS.  POTS can cause headaches, lightheadedness, heart palpitations, fatigue, shaking, fainting, cold or pain in extremities, chest pain, shortness of breath, and even nausea.  Evidently, POTS can be caused by Lyme Endocarditis.

For an excellent read on Lyme Carditis, please see:  https://www.bayarealyme.org/blog/lyme-carditis-why-early-diagnosis-is-critical/  In a nutshell, it’s inflammation caused by an infection such as Lyme, viruses, and other pathogens.  This inflammation messes up electrical signal conduction and can cause AV block, a serious oxygen depriving condition, hence all the symptoms listed above.  Lyme Carditis is the more general term but it can be in any part of the heart: myocardium, pericardium, endocardium, cardiac muscle, valves, and aorta.  The good news is it can usually be reversed with appropriate treatment.  Sometimes a pacemaker is also needed.  The article states about 4-10% of people with TBD develop this.

CDC Expert Commentary by Joseph D Forrester, MD, MSc

Forrester states Lyme Carditis is “rare,” but even 4-10% of patients is a chunk of people.  PEOPLE HAVE DIED FROM THIS and even the CDC reported 3 cases of sudden cardiac death between Nov 2012 & July 2013 among patients with unrecognized Lyme carditis.  If one person died from Zika there would be a media blitz.  

https://www.ctvnews.ca/health/rare-but-serious-complication-of-lyme-disease-can-attack-the-heart-doctor-1.3952476  Recently a heart specialist in Ontario is warning doctors to be on the look out for Lyme carditis.  Dr. Baranchuk points out that numerous people with heart symptoms were admitted to the ER two to three times before anyone considered Lyme carditis.  He also states many don’t get the bullseye rash or notice vague symptoms of fever and muscle aches.

https://www.ctvnews.ca/mobile/video?clipId=1406334  CTV News Video

Baranchuk wrote a paper http://www.cmaj.ca/content/190/20/E622 advising doctors to treat young patients with strange heart problems with antibiotics while waiting for results of Lyme blood tests.

He states: “These patients may not require pacemakers to be implanted. They can be treated with IV antibiotics for 10 to 12 days and the electricity of the heart will recover completely forever,” he said.

Interestingly the title of the article by CTV News states, “Rare but serious complication of LD….” and yet they even quote Baranchuk saying,

“We have the suspicion that there are way more cases than are reported, because doctors are failing to report it,” he said.

That’s kind of a big deal.

QUIT SAYING THE WORD RARE IN YOUR REPORTING ON TBD.

Then there’s the story of Dr. Neil Spector, an oncologist who rubbed shoulders with experts and the best that medical care can offer and yet, due to doctors with heads in the sand suffered for years with bizarre and frustrating heart symptoms until he nearly crossed over to the other side. (He was told it couldn’t be Lyme as he lived in Florida.  The doctors were happy to diagnose him over the phone but ALL stated unequivocally he did NOT have Lyme!) After a heart transplant, Spector is speaking out about Lyme Disease and has even written the book, Gone in a heartbeat – A Physician’s Search for True Healing.  For a great review of the book:  https://www.lymedisease.org/when-lyme-disease-affects-the-heart/

Lyme and carditis:

https://madisonarealymesupportgroup.com/2017/06/10/lyme-carditis-with-complete-heart-block/

https://madisonarealymesupportgroup.com/2017/06/07/early-onset-lyme-carditis-concurrent-disseminated-erythema-migrans/

https://madisonarealymesupportgroup.com/2018/02/22/new-lyme-cme-course-available-lyme-carditis-more-than-blocked-beats/  Course for doctors to become educated.

But Lyme (Bb) isn’t the only culprit.

Similar to inflammation caused by Borrelia burgdorferi (Bb), inflammation can be caused by many bacteria and viruses:  https://www.myocarditisfoundation.org/research-and-grants/faqs/causes-of-myocarditis/

Most common viruses causing carditis:

  • Parvovirus B19
  • Human Herpes Virus 6
  • Enterovirus (Coxsackie Virus)
  • (Research needed.  Tons of viruses involved with TBD)

Most common bacteria causing carditis:

  • Corynebacterium diptheriae
  • Staphylococcus aureus
  • (Research needed.  Tons of bacteria involved with TBD)

Most common parasites causing carditis:

  • Borrelia burgdorferi
  • Ehrlichia species
  • Babesia species
  • Trypanosoma cruzi (Chagas Disease)
  • Bartonella (My addition due to the following…..)
  • (Research needed.  Tons of parasites involved with TBD)

I added Bartonella to the list due to the following (add it up, it isn’t rare):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010976/  Five cases of infective endocarditis associated with Bartonella henselae.

https://www.ncbi.nlm.nih.gov/pubmed/9196420  Two cases of Bartonella Carditis.

https://www.ncbi.nlm.nih.gov/pubmed/11496560 One case.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5942242/ Four cases.

https://www.ncbi.nlm.nih.gov/pubmed/8849149 22 cases – 13 that had undetermined Bartonella species.

https://www.ncbi.nlm.nih.gov/pubmed/16762254  A total of 6 cases reported in Spain.  Conclusion states it is likely to be underestimated and to suspect it with negative blood cultures, history of chronic alcoholism, the homeless, and those in contact with cats or bitten by fleas or lice, as well as patients with endocarditis and positive serology against Chlamydia spp.  This abstract, written in 2006 wouldn’t have considered that ticks carry a Chlamydia-like organisms (CLO):  https://madisonarealymesupportgroup.com/2016/10/07/chlamydia-like-organisms-found-in-ticks/  These results suggest that CLO DNA is present in human skin; ticks carry CLOs and could potentially transmit CLOs to humans.  Two other studies have come to the same conclusion: that there exists a high prevalence and diversity of Chlamydiales DNA in ticks and the very real possibility of human infection. https://www.ncbi.nlm.nih.gov/pubmed/24698831 and https://www.ncbi.nlm.nih.gov/pubmed/26386066
All of this continues to demonstrate why Lyme Disease isn’t typically just Lyme Disease but MSIDS, multi systemic infectious disease syndrome, a literal menagerie of pathogens invading the human host making our cases extremely complex and difficult.

Bartonella and carditis:

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

https://madisonarealymesupportgroup.com/2017/05/11/bartonella-henselae-in-children-with-congenital-heart-disease/

https://madisonarealymesupportgroup.com/2018/02/07/finally-rt-pcr-detected-bartonella-henselae-dna-on-tissue-valve/

https://madisonarealymesupportgroup.com/2017/05/20/bartonella-endocarditis-opportunistic-infection-in-cancer-patients-and-eye-inflammation/

Babesia and carditis:

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

Mycoplasma, Chlamydia, Bb and carditis:

https://madisonarealymesupportgroup.com/2018/04/04/correlation-of-natural-autoantibodies-heart-disease-related-antibacterial-antibodies-in-pericardial-fluid-mycoplasma-bb-chlamydia/  Mycoplasma pneumoniae antibody positive patients had significantly higher anti-CS IgM levels. In CABG patients we found a correlation between anti-CS IgG levels and Mycoplasma pneumoniae, Chlamydia pneumoniae and Borrelia burgdorferi antibody titers. Our results provide the first evidence that natural autoantibodies are present in the PF and they show significant correlation with certain antibacterial antibody titers in a disease specific manner.

Hopefully by now it’s clear that carditis caused by TBD’s is not even close to rare.  It should also be painfully clear that we are truly in the dark ages on this and that much work needs to be done – and quickly.

Ending on a personal note, I had these bizarre heart symptoms early in my journey.  To say they were frightening would be an understatement.  I would wake in the middle of the night with my heart flopping like a fish out of water.  It felt like an elephant was sitting on my chest and my biceps were often numb.  I gasped for air as well.

Upon my first dose of Mepron, Artemisinin, and an intracellular antibiotic, I felt as if I was having a heart attack.  Thankfully we pulsed the artemisinin as that allowed the frightening herxes to dissipate some.  Due to my response to these drugs my guess is Babesia was the culprit.  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/  We treated Babesia for an entire year as it’s a notoriously persistent pathogen.  It’s important to hit it hard and long as it’s been known to build resistance to drugs.

There has been debate among some as to the effectiveness of Artemisinin and I do feel quality matters.  I’m a huge fan of this kind:  https://www.allergyresearchgroup.com/quality-artemisinin.  And no, I’m not affiliated with them in any way.  BTW:  We used 500mg morning and night MWF.  It makes your mouth taste metallic.

Do not mess around with heart symptoms.  Be a clanging gong until someone takes you seriously and feel free to copy this article and take it to your doctors.  They need to be educated and We the People are up to bat.

Lastly, please remember all the testing for ALL TBD is horrible.  You need a doctor who will diagnose and treat you clinically.  Your reaction to the medication is important to track as it will alert your doctor to what you are dealing with based on symptoms:  https://madisonarealymesupportgroup.com/2015/08/15/herxheimer-die-off-reaction-explained/

https://madisonarealymesupportgroup.com/2017/06/28/jarisch-herxheimer-a-review/

https://madisonarealymesupportgroup.com/2017/11/03/first-report-of-bartonella-quintana-immune-reconstitution-inflammatory-syndrome-complicated-by-jarisch-herxheimer-reaction/

Let’s suffice it to say, heart problems with tick borne illness is NOT rare.

 

 

Category:

Activism, Babesia, Bartonella, Ehrlichiosis, Heart Issues, Inflammation, Lyme, Mycoplasma, research, Treatment, Viruses