Bartonella

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Bartonella
Scientific classification
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Alpha Proteobacteria
Order: Rhizobiales
Family: Bartonellaceae
Genus: Bartonella
Strong et al., 1915
Species

B. alsatica
B. bacilliformis
B. birtlesii
B. bovis
B. capreoli
B. clarridgeiae
B. doshiae
B. elizabethae
B. grahamii
B. henselae
B. koehlerae
B. peromysci
B. quintana
B. rochalimae
B. schoenbuchii
B. talpae
B. taylorii
B. tribocorum
B. vinsonii spp. arupensis
B. vinsonii spp. berkhoffii
B. vinsonii spp. vinsonii
B. washoensis
etc.

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This page is about microbiologic aspects of the organism(s).  For clinical aspects of the disease, see Bartonellosis.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

Bartonella (formerly known as Rochalimaea) is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens.[1] Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies and mosquitoes. At least eight Bartonella species or subspecies are known to infect humans.[2] In June 2007, a new species under the genus, called Bartonella rochalimae, was discovered.[3] This is the sixth species known to infect humans, and the ninth species and subspecies, overall, known to infect humans.

Members of the genus Bartonella are alpha 2 subgroup Proteobacteria. The genus comprises:

Bartonella species Reservoir Disease
Bartonella bacilliformis human Carrion's disease/Verruga peruana
Bartonella quintana human Trench fever, bacteremia, bacillary angiomatosis, endocarditis
Bartonella henselae cats Cat scratch disease, bacillary angiomatosis, bacteremia, endocarditis
Bartonella elizabethae rats Endocarditis
Bartonella grahamii Retinitis
Bartonella vinsoni dogs Endocarditis, bacteremia
Bartonella washonsis rodents Myocarditis
Bartonella clarridgiae cats Bacteremia
Bartonella rochalimae human Carrion's disease like syndrome

Historical Perspective

Bartonella species have been infecting humans for thousands of years, as demonstrated by Bartonella quintana DNA in a 4000 year old tooth.[4] The genus is named after Alberto Leonardo Barton Thompson, a Peruvian scientist born in Argentina.

Bartonella was found to be a tick borne pathogen in 1999.[5]

In 2001 doctors treating Lyme disease first reported that their patients were co-infected with Bartonella.[5] Multiple reports of this finding seem to indicate that Bartonella is not only a tick borne but a tick-transmitted pathogen;[6] however, actual transmission via this route has not yet been proven.

Pathophysiology

Infection cycle

The currently accepted model explaining the infection cycle holds that the transmitting vectors are blood-sucking arthropods and the reservoir hosts are mammals. Immediately after infection, the bacteria colonize a primary niche, the endothelial cells. Every five days, a part of the Bartonella in the endothelial cells are released in the blood stream where they infect erythrocytes. The bacteria then invade and replicate within a phagosomal membrane inside the erythrocytes. Inside the erythrocytes, bacteria multiply until they reach a critical population density. At this point, the Bartonella has simply to wait until it is taken with the erythrocytes by a blood-sucking arthropod.

Bartonella infections are remarkable in the wide range of symptoms an infection can produce: the time course (acute or chronic) as well as the underlying pathology are highly variable.[7]

Bartonella pathophysiology in humans
Species Human reservoir or
incidental host?
Animal
reservoir
Pathophysiology Distribution
B. bacilliformis Reservoir Causes Carrion's disease (Oroya fever, Verruga peruana) Andes
B. quintana Reservoir Causes Trench fever, Bacillary angiomatosis, and endocarditis Worldwide
B. clarridgeiae Incidental Domestic cat Cat-scratch Disease
B .elizabethae Incidental Rat Endocarditis
B. grahamii Incidental Mouse Endocarditis and Neuroretinitis
B. henselae Incidental Domestic cat Cat-scratch Disease, Bacillary angiomatosis, Bacillary peliosis, Endocarditis, Bacteremia with fever and Neuroretinitis Worldwide
B. koehlerae Incidental Domestic cat
B. vinsonii Incidental Mouse, Dog
B. washoensis Incidental Squirrel Myocarditis
B. rochalimae Incidental Unknown symptoms akin to typhoid fever and malaria
References: [8][9][10]


Medical Treatment

  • 1. Bartonella quintana
  • 1.1 Acute or chronic infections without endocarditis[12]
  • Preferred regimen: Doxycycline 200 mg PO qd or 100 mg bid for 4 weeks AND Gentamicin 3 mg/kg IV qd for the first 2 weeks
  • 1.2 Endocarditis[13]
  • 2. Bartonella elizabethae
  • 2.1 Endocarditis[13]
  • 3. Bartonella bacilliformis
  • 3.1 Oroya fever
  • Preferred regimen: Ciprofloxacin 500 mg PO bid for 14 days
  • Note: If severe disease, add Ceftriaxone 1 g IV qd for 14 days
  • 3.2 Verruga peruana[14]
  • Preferred regimen: Azithromycin 500 mg PO qd for 7 days
  • Alternative regimen (1): Rifampin 600 mg PO qd for 14-21 days
  • Alternative regimen (2): Ciprofloxacin 500 mg bid for 7-10 days
  • 4. Bartonella henselae[15]
  • 4.1 Cat scratch disease
  • No treatment recommended for typical cat scratch disease, consider treatment if there is an extensive lymphadenopathy
  • 4.1.1 If extensive lymphadenopathy
  • Preferred regimen (1) (pediatrics): Azithromycin 500 mg PO on day 1 THEN 250 mg PO qd on days 2 to 5
  • Preferred regimen (2) (adults): Azithromycin 1 g PO at day 1 THEN 500 mg PO for 4 days
  • 4.2 Endocarditis
  • 4.3 Retinitis
  • 4.4 Bacillary angiomatosis[16]
  • Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 2 months at least
  • 4.5 Bacillary Pelliosis[16]
  • Preferred regimen (1): Erythromycin 500 mg PO qid for 4 months at least
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months at least

References

  1. Walker DH (1996). Rickettsiae. In: Barron's Medical Microbiology (Barron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.
  2. Chomel BB, Boulouis HJ (2005). "[Zoonotic diseases caused by bacteria of the genus Bartonella genus: new reservoirs ? New vectors?]". Bull. Acad. Natl. Med. (in French). 189 (3): 465–77, discussion 477-80. PMID 16149211.
  3. Eremeeva ME, Gerns HL, Lydy SL; et al. (2007). "Bacteremia, Fever, and Splenomegaly Caused by a Newly Recognized Bartonella Species". N Engl J Med. 356: 2381–7.
  4. Drancourt M, Tran-Hung L, Courtin J, Lumley H, Raoult D (2005). "Bartonella quintana in a 4000-year-old human tooth". J. Infect. Dis. 191 (4): 607–11. doi:10.1086/427041. PMID 15655785.
  5. 5.0 5.1 Schouls LM, Van De Pol I, Rijpkema SG, Schot CS (1999). "Detection and identification of Ehrlichia, Borrelia burgdorferi sensu lato, and Bartonella species in Dutch Ixodes ricinus ticks". J. Clin. Microbiol. 37 (7): 2215–22. PMID 10364588.
  6. Stricker RB, Brewer JH, Burrascano JJ; et al. (2006). "Possible role of tick-borne infection in "cat-scratch disease": comment on the article by Giladi et al". Arthritis Rheum. 54 (7): 2347–8. doi:10.1002/art.21925. PMID 16802385.
  7. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob. Agents Chemother. 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMID 15155180.
  8. Zeaiter Z, Liang Z, Raoult D (2002). "Genetic classification and differentiation of Bartonella species based on comparison of partial ftsZ gene sequences". J. Clin. Microbiol. 40 (10): 3641–7. PMID 12354859.
  9. Jacomo V, Kelly PJ, Raoult D (2002). "[[Koch's postulates|Koch's postulate]]". Clin. Diagn. Lab. Immunol. 9 (1): 8–18. PMID 11777823. URL–wikilink conflict (help)
  10. Maco V, Maguiña C, Tirado A, Maco V, Vidal JE (2004). "Carrion's disease (Bartonellosis bacilliformis) confirmed by histopathology in the High Forest of Peru". Rev. Inst. Med. Trop. Sao Paulo. 46 (3): 171–4. doi:/S0036-46652004000300010 Check |doi= value (help). PMID 15286824.
  11. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  12. Foucault C, Raoult D, Brouqui P (2003). "Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia". Antimicrob Agents Chemother. 47 (7): 2204–7. PMC 161867. PMID 12821469.
  13. 13.0 13.1 Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
  14. Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.
  15. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother. 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.
  16. 16.0 16.1 Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.

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