Bartonellosis

Infobox_Disease
Name = Bartonellosis


Caption =
DiseasesDB = 1249
ICD10 = A44
ICD9 = ICD9|088.0
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = med
eMedicineTopic = 212
MeshID = D001474

Bartonellosis is an infectious disease produced by bacteria of the genus "Bartonella" [Maguiña C, Gotuzzo E. Bartonellosis-new and old. Infect Dis Clin N Am. 2000;14:1-22] . "Bartonella" species cause diseases, such as Carrion´s disease, Trench fever, and Cat scratch disease, and other recognized diseases, such as (Bacillary Angiomatosis), peliosis hepatis, chronic bacteremia, endocarditis, chronic lymphadenopathy, and neurological disorders. [Maurin M, Birtles R, Raoult D. Current knowledge of Bartonella species. Eur J Clin Microbiol Infect Dis.1997;16:487-506]

History

*Carrion´s diseaseThe disease was named after a medical student Daniel Alcides Carrión of Cerro de Pasco, Peru. Carrion described the disease after being inoculated on his request by Doctor Evaristo M. Chávez, a close friend and coworker in Dos de Mayo National Hospital. Carrion kept a meticulous clinical history until the disease rendered him incapable of so doing. Carrion proved that "Oroya fever" and "Verruga Peruana" were two stages of the same disease, not two different ones as thought at the time.

Carrion was inoculated with the pus of the purple lesion from a patient (Carmen Paredes) in 1885. He developed the disease 3 weeks after the inoculation and died several weeks later. "Bartonella bacilliformis" is considered the most deadly bartonella to date, with a death rate of up to 90% during the acute phase. His sacrifice demonstrated the connection between the 2 phases of the disease. Subsequently, 23 subspecies of bartonella were discovered. His work did not result in a cure at that time, but his research started the process. Peru named October 5th as Peruvian Medicine day in his honor.

The causative bacterial agent of bartonellosis was discovered by the Peruvian microbiologist Alberto Barton in 1905, but his results were not published until 1909. Barton originally identified them as endoglobular structures, bacteria living inside red blood cells. Until 1993, the "Bartonella" genus contained only one species; there are now 23 identified species, all of them within family Bartonellaceae. [cite journal | author = Zeaiter Z, Liang Z, Raoult D | title = Genetic classification and differentiation of Bartonella species based on comparison of partial ftsZ gene sequences | journal = J. Clin. Microbiol. | volume = 40 | issue = 10 | pages = 3641–7 | year = 2002 | pmid = 12354859 | doi = ]

*Cat scratch diseaseIn 1988, English and col [English C, Wear D, Margileth A, Lissner C, Walsh G. Cat scratch disease:isolaton and culture of the bacterial agent. JAMA 1988;259:1347-1351] isolated and cultured a becterium that was named "Afipia felis" in 1992. This agent was considered the etiologic agent of Cat Scratch Disease (CSD) but further studies failed to support this conclusion. Serologic studies associated CSD with "Bartonella henselae", reported in 1992. In 1993 Dolan and col [Dolan M, Wong M, Regnery R, Jorgensen J, garcia M, Pters J, Drehner D. Syndrome of Rochalimae henselae adeitis suggesting cat scratch disease. Ann Intern Med 1993;118:331-336] isolated "Rochalimae henselae" (now called "Bartonella henselae") from the lymph nodes of patients with CSD. Also, "Bartonella henselae" was associated bacteremia, bacillary angiomatosis, and peliosis hepatis in HIV patients, and bacteremia and endocarditis in immunocompetent and immunocompromised patients. [Andreson B, Neuman M. bartonella spp as emerging human pathogens. Clin Micorbiol Rev 1997;10:203-219]

*Trench feverDetailed descriptions of the disease were reported in soldiers during the World War I. Also known as 5-day fever or quintan fever or Wolhinie fever. Actually this disease is known as "urban trench fever" because is described in homeless and alcoholic people [Stein A, Raoult D,. Return of trench fever. Lancet 1995;345:450-1] .

Epidemiology

Carrion's disease, or Oroya fever, or Peruvian Wart is a rare infectious disease found only in Peru, Ecuador, and Colombia. [Maguina C, Garcia P, Gotuzzo E, Cordero L, Spach D. Bartonellosis (Carrion’s Disease) in the Modern Era. CID 2001;33:772-779] It is Endemic in some areas of Peru, [cite journal | author = Maco V, Maguiña C, Tirado A, Maco V, Vidal JE | title = Carrion's disease (Bartonellosis bacilliformis) confirmed by histopathology in the High Forest of Peru | journal = Rev. Inst. Med. Trop. Sao Paulo | volume = 46 | issue = 3 | pages = 171–4 | year = 2004 | pmid = 15286824 | doi = /S0036-46652004000300010 | doi_brokendate = 2008-06-23] and is caused by infection with the bacterium "Bartonella bacilliformis" and transmitted by sandflies of genus "Lutzomyia".

Cat scratch disease is a worldwide disease. Cats are the main reservoir of "Bartonella henselae" (etiologic agent), and the bacterium is transmitted to cats by the cat flea "Ctenocephalides felis". [Chomel B, Kasten R, Floyd-Hawkins B, Yamamoto K, Roberts-Wilson J, Gurfield A, Abbot R, Pedersen N, Koehler J. Experimental transmission of "B. henselae" by the cat flea. J Clin Microbiol 1996;34:1952-1956]

Trench fever is produced by the infection of "Bartonella quintana", and the bacterium is transmitted by the human body louse "Pediculus humanus corporis" and humans are the only known reservoir. [Maurin M, Raoult D. Bartonella (Rochalimae) quintana infections. Clin Microbiol Rev 1996;9:273-292 ]

Microbiology

Members of the genus "Bartonella" are facultative intracellular bacteria, alpha 2 subgroup Proteobacteria. The genus comprises:

Pathophysiology

In mammals, each "Bartonella" species is highly adapted to its reservoir host as the result of intracellular parasitism and can persist in the bloodstream of the host. Intraerythrocytic parasitism is only observed in the acute phase of Carrion´s disease. Bartonella also have a tropism for endothelial cells, observed in the chronic phase of Carrion´s disease (also known as Verruga peruana) and bacillary angiomatosis.Pathological response can varies with the immune status of the host. Infection with "Bartonella henselae" can result in a focal suppurative reaction (CSD in immunocompetent patients), a multifocal angioproliferative response (bacillary angiomatosis in immunocompromised patients), endocarditis or meningitis.Some of the diseases can resolve spontaneously without treatment. [Resto-Ruiz S, Burgess A, An derson B. The role of the host immune response in pathogenesis of Bartonella henselae. DNA Cell Biol.2003;22:431-440]

Clinical manifestations

*Carrion´s diseasePatients can develop two clinical phases: an acute (hematic) stage and a chronic (eruptive) phase associated with skin eruptions. [Maguiña C. Bartonellosis o enfermedad de Carrion. Nuevos aspectos de una vieja enfermedad. AFA edit. Lima-Peru] In the acute phase (also known as Oroya fever or "Fiebre de la Oroya"), "Bartonella bacilliformis" infection is a sudden, potentially life-threatening infection associated with high fever and decreased levels of circulating red blood cells (i.e., hemolytic anemia)and transient immunosupression. The acute phase typically lasts two-to-four weeks. Peripheral blood smears shows anisomacrocytosis with many bacilli adherent to red blood cells. Thrombocytopenia is also seen and can be very severe. Neurologic involvement is sometimes seen (neurobartonellosis) and the prognosis in this case is very guarded. It can present as spinal meningitis or as paralysis. In the acute stage, the most feared complication is overwhelming infections by mainly enterobacterias"Salmonella",and other parasites such as "Toxoplasmosis". The chronic manifestation—"Verruga Peruana"—consists of a benign skin eruption with raised, reddish-purple nodules (angiomatous tumours). Visualization of the bacterium is possible using a silver stain (the Warthin–Starry method) of biopsy .

*Cat scratch diseaseCat scratch disease is manifested by gradual regional lymph nodes enlargement (axilla, groin, neck) and a distal scratch and/or red-brown skin papule (not always seen at the time of the disease). The enlarged lymph node is painful and tender. The "Bartonella henselae" infection is self-limited and the lymph nodes compromise last 2-3 months or longer. [Margileth A. Cat scratch disease. Adv Pediatr Infect Dis. 1993;8:1-21] The lymph nodes may suppurate and most patients can remain afebrile or asymptomatic. Atypical presentations include Unknown Origin Fever, Parinaud's oculoglandular syndrome, encephalopathy and neuroretinitis. [Bass J, Vincent J, Person D. The expanding spectrum of Bartonella infections. Cat-scratch disease. Pediatr Infect Dis J 1997;16:163-179]

*Trench feverTrench fever, also known as 5-day fever or quintan fever is the initial manifestation of "Bartonella quintana" infection. Clinical manifestations range from asymptomatic infection to severe illness. Classical presentation include a febrile illness of acute onset, headache, dizziness, and shin pain. Chronic infection manifestation include attacks of fever and aching in some cases and persistent bacteremia in soldiers and homeless people. [Brouqui P, La Scola B, Roux V, Raoult D. Chronic "Bartonella quintana" bacteremia in homeless patients. N Eng J Med 1999;340:184-189]

*Bacillary AngiomatosisBacillary Angiomatosis is a vascular proliferative disease involving mainly the skin, and other organs. The disease was first described in Human Immunodificiency Virus (HIV)patients and organ transplant recipients [Kemper C, Lombard C, Deresinski S, Tompkins L. Visceral bacillary epithelioid angiomatosis: possible manifestations of diseminated cat scratch disease in the immunocompromised host: a report of two cases. Am J Med 1990;89:216-222] . Severe, progressive and disseminated disease may occur in HIV patients. [Stoler M, Bonfiglio T, Steigbigel R, Pereira M. An atypical subcutaneous infection associated with acquired immune deficiency syndrome. Am J Clin Pathol 1983;80:714-718] Differential diagnosis include Kaposi´s sarcoma, pyogenic granuloma, hemangioma, Verruga peruana, subcutanous tumors. Lesions can affect bone marrow, liver, spleen or lymph nodes. "Bartonella henselae" y "Bartonella quintana" can cause bacillary angiomatosis.

*Peliosis hepatisPeliosis hepatis is defined as a vascular proliferation of sinusoid hepatic capillaries resulting in blood-filled spaces in the liver. "Bartonella henselae" is recognized as the etiologic agent in HIV patients and organ transplant recipients. Peliosis hepatis can be associated by peliosis of the spleen, as well as bacillary angiomatosis of the skin in HIV patients. [Perkocha L, Geaghan B, Yen T, Nishimura S, Chan S, Garcia-Kennedy R, Honda G, Stoloff A, Klein H, Goldman R, Van Meter S, Ferrel L, LeBoit P. Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus nfection. N Eng J Med 1990;323:1581-1586]

Treatment

Treatment of infections caused by "Bartonella" species. [Rolain J, Brouqui P, Koehler J, Maguiña C, Dolan M, Raoult D. Recommendations for treatment of human infections caused by "Bartonella" species. Antimicrob Agents Chemother 2004;48:1921-1933] [Blanco J, Raoult D. Enfermedades producidas por "Bartonella" spp. Enfer Infecc Microbiol Clin 2005;23:313-320]

References

External links

* [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11512081&dopt=Abstract Bartonellosis (Carrion's disease) in the modern era]
* [http://www.biology-online.org/dictionary/carrions_disease Oroya fever]
* [http://www.pitt.edu/~super1/lecture/lec8711/index.htm Human Bartonellosis caused by "Bartonella bacilliformis"]