Analysis and preparation of Bartonella bacilliformis antigens

Twenty-four antigens of Bartonella bacilliformis, a bacterium which causes bartonellosis in residents of high altitude valleys of the Andes, were identified by immunoblot and immunoprecipitation using rabbit anti-Bartonella sera as well as sera of patients. The antigens were designated according to their relative molecular mass which ranged from 16 to 160 kDa. Twelve antigens were detected by antibodies in sera of bartonellosis patients using immunoblot, of which six antigens were detected by immunoprecipitation. Antigens 25, 46, 65, 75, 99, and 160 were identified as probable cell wall antigens. Antigens 50, 65, and 75 detected long-persisting antibodies. Crude Bartonella antigen applied to ELISA reacted with anti-Chlamydia psittaci antibody as well as with antibody of unknown identity in human sera, whereas immunoblot and immunoprecipitation with Triton soluble antigens revealed Bartonella-specific results. Seven Bartonella antigens were prepared by high performance liquid chromatography of which one antigen (48 kDa) reacted Bartonella-specific when applied to ELISA. It was concluded that specificity of antibody determination with crude Bartonella antigen should be confirmed by either immunoblot or immunoprecipitation.     

Report of an unusual case of persistent bacteremia by Bartonella bacilliformis in a splenectomized patient

We report a case of a 56-year-old man with a history of splenectomy for idiopathic thrombocytopenic purpura who developed persistent bacteremia in the acute phase of human bartonellosis. This patient did not develop hemolytic anemia. Only after several courses of antibiotic treatment was the infection eradicated. This is an unusual case of overwhelming post-splenectomy infection by Bartonella bacilliformis, which provides clinical evidence that the spleen is a critical effector organ of clearance of this infection as well as the effector organ of bartonellosis-associated hemolytic anemia.     

Case Report: Histopathological Features of Tungiasis in Peru

Tungiasis is an ectoparasitic skin disease caused by Tunga penetrans and Tunga trimamillata. There is a lack of histopathological studies that evaluate the recognition of this flea in tissues. We describe the ex vivo dermoscopic and the histopathological patterns of six cases and relate the findings to the developmental stage of the parasite as defined by the Fortaleza classification: two were classified as Fortaleza 3b, 3 as 4a, and 1 as 4b. Two dermoscopic patterns were observed: a brown pigmented ring and a radial crown with a central pore. The most common histopathological findings were an eosinophilic cuticle, eggs in different stages of development, tracheal rings (parasite), and basal hyperplasia (host). The eosinophilic cuticle, eggs in different stages of evolution, and tracheal rings can help to establish the diagnosis when other parts of the parasite are lacking. The Fortaleza staging may represent a tool for pathology reporting purposes.     

Common surface epitope of Bartonella bacilliformis and Chlamydia psittaci

A serosurvey revealed intense cross-reactivity between Bartonella bacilliformis and Chlamydia psittaci. One of the cross-reacting Bartonella antigens was identified as lipopolysaccharide which reacted with Bartonella as well as with Chlamydia serum antibodies. A monoclonal Bartonella antibody bound to Bartonella lipopolysaccharide as well as to the surfaces of Bartonella bacilliformis and Chlamydia psittaci. It was thus demonstrated that Chlamydia psittaci carries a surface epitope identical to an epitope of Bartonella lipopolysaccharide. The lipopolysaccharide was preliminarily characterized by polyacrylamide gel electrophoresis and by a lectin-binding assay. The lipopolysaccharides of Bartonella bacilliformis and Chlamydia psittaci are not identical.     

Case Report: An Ectopic Case of Tunga spp. Infection in Peru

Tungiasis is a neglected ectoparasitism of impoverished areas in South America and sub-Saharan Africa. The sand flea Tunga spp. preferably infests the soles and the periungueal and interdigital regions of the feet. Ectopic tungiasis is rare, even in highly endemic areas. We describe a case of an indigenous patient in Peru who presented with a nodular lesion in the extensor aspect of the knee and whose biopsy was compatible with Tunga spp. This is the first documented case of knee tungiasis in an endemic country. The historical, clinical, histological, and current epidemiological aspects of tungiasis in Peru are discussed here.     

Natural history of infection with Bartonella bacilliformis in a nonendemic population

An investigation was performed after an outbreak of bartonellosis in a region of Peru nonendemic for this disorder. Symptoms of acute and chronic bartonellosis were recorded. Serological analysis was performed on 55% of the affected population (554 individuals), 77.5% of whom demonstrated previous infection with Bartonella bacilliformis. The attack rate of Oroya fever was 13.8% (123 cases); the case-fatality rate was 0.7%. The attack rate of verruga peruana was 17.6%. A new specific immunostain was developed and used to confirm the presence of B. bacilliformis in the biopsied skin lesions. Most seropositive individuals (56%) were asymptomatic. The symptoms that were associated with prior infection, as determined by Western blot, included fever (37.2% of the seropositive vs. 17.2% of the seronegative population; P<.001), bone and joint pain (27% vs. 9%; P<.001), headache (27% vs. 12.3%; P <.001), and skin lesions described as verruga peruana (26.8% vs. 4.9%; P<.001). Our findings suggest that infection with B. bacilliformis causes a broad spectrum of disease that is significantly milder in severity than that frequently reported.     

Bb65, a major immunoreactive protein of Bartonella bacilliformis.

A 65 kDa protein (Bb65) has been identified as one of the major specific antigens of Bartonella bacilliformis, the causative agent of bartonellosis which is a bacterial infectious disease of inhabitants of the Andes. The gene encoding this antigen (7B2) was isolated from an expression library made directly from randomly generated fragments of B. bacilliformis genomic DNA using Bartonella antibodies raised in rabbits and sera of bartonellosis patients. The Bartonella 7B2 gene was expressed in Escherichia coli and the recombinant Bb65 protein was purified by column chromatography. Using polyclonal antibodies raised in rabbits, the antigen was shown to be present in all of 13 B. bacilliformis isolates from different Peruvian regions. Immune electron microscopy demonstrated the probable cytoplasmatic localization of Bb65. When applied to enzyme immunoassays, Bb65 sensitively and specifically bound to IgG antibody of sera of bartonellosis patients, convalescents, and immunes from various Peruvian regions. IgM antibody was not recognized by Bb65, neither was IgG antibody circulating during the first 2 weeks of illness. The amino-terminal amino acid sequence of Bb65 was 53% homologous to the 65 kDa heat shock protein of Mycobacterium tuberculosis.     

Dried Blood Spots for qPCR Diagnosis of Acute Bartonella bacilliformis Infection

Bartonella bacilliformis is the etiological agent of a life-threatening illness. Thin blood smear is the most common diagnostic method for acute infection in endemic areas of Peru but remains of limited value because of low sensitivity. The aim of this study was to adapt a B. bacilliformis-specific real-time polymerase chain reaction (PCR) assay for use with dried blood spots (DBS) as a sampling method and assess its performance and use for the diagnosis and surveillance of acute Bartonella infection. Only two of 65 children (3%) that participated in this study had positive blood smears for B. bacilliformis, whereas 16 (including these two) were positive by PCR performed on DBS samples (24.6%). The use of DBS in combination with B. bacilliformis-specific PCR could be a useful tool for public health in identifying and monitoring outbreaks of infection and designing control programs to reduce the burden of this life-threatening illness.     

Case Report: Congenital Transmission of Multidrug-Resistant Tuberculosis

This article presents a case of multidrug-resistant tuberculosis (TB) in a Peruvian infant. His mother was diagnosed with disseminated TB, and treatment commenced 11 days postpartum. The infant was diagnosed with TB after 40 days and died at 2 months and 2 days of age. Congenital transmission of TB to the infant was suspected, because direct postpartum transmission was considered unlikely; also, thorough screening of contacts for TB was negative. Spoligotyping confirmed that both mother and baby were infected with identical strains of the Beijing family (SIT1).     

Epidemiology of endemic Bartonella bacilliformis: a prospective cohort study in a Peruvian mountain valley community

Bartonella bacilliformis has caused debilitating illness since pre-Incan times, but relatively little is known about its epidemiology. A population-based, prospective cohort investigation was conducted in a Peruvian community with endemic bartonellosis. By use of house-to-house and hospital surveillance methods, cohort participants were monitored for evidence of bartonellosis. Of 690 participants, 0.5% had asymptomatic bacteremia at study initiation. After 2 years of follow-up, the incidence of infection was 12.7/100 person-years. The highest rates were in children <5 years old, and there was a linear decrease in incidence with increasing age. Seventy percent of cases were clustered in 18% of households. Age and bartonellosis in a family member were the best predictors of B. bacilliformis infection. There were multiple clinical presentations and significant subclinical infection. A cost-effective control strategy should include vector control and surveillance efforts focused on children and clusters of households with highest endemicity.     

Leber's Optic Atrophy: A Possible Example of Vertical Transmission of a Slow Virus in Man

It is demonstrated that the unusual form of inheritance seen in Leber's disease could be due to the presence of a slow virus acting upon individuals with a variable and partly inherited resistance to the infection. A study of a family afflicted by Leber's disease has demonstrated a pattern strongly suggestive of vertical (i.e. parent-child) transmission of a slow viral agent with late neurological effects.     

Prevalence and Diversity of Bartonella spp. in Bats in Peru

Abstract. Bartonella infections were investigated in bats in the Amazon part of Peru. A total of 112 bats belonging to 19 species were surveyed. Bartonella bacteria were cultured from 24.1% of the bats (27/112). Infection rates ranged from 0% to 100% per bat species. Phylogenetic analyses of gltA of the Bartonella isolates revealed 21 genetic variants clustering into 13 divergent phylogroups. Some Bartonella strains were shared by bats of multiple species, and bats of some species were infected with multiple Bartonella strains, showing no evident specific Bartonella sp.-bat relationships. Rarely found in other bat species, the Bartonella strains of phylogroups I and III discovered from the common vampire bats (Desmodus rotundus) were more specific to the host bat species, suggesting some level of host specificity.     

Carrion's disease (Bartonellosis bacilliformis) confirmed by histopathology in the High Forest of Peru

Bartonellosis or Carrion's disease is endemic in some regions of Peru, classically found in the inter-Andean valleys located between 500 and 3200 meters above sea level. We report the case of a 43 year-old male patient, farmer, who was born in the Pichanaki district (Chanchamayo, Junin), located in the High Forest of Peru. He presented with disseminated, raised, erythematous cutaneous lesions, some of which bled. The distribution of these lesions included the nasal mucosa and penile region. Additionally subcutaneous nodules were distributed over the trunk and extremities. Hematologic exams showed a moderate anemia. Serologic studies for HIV and Treponema pallidum were negative. The histopathologic results of two biopsies were compatible with Peruvian wart. Oral treatment with ciprofloxacin (500 mg BID) was begun. Over 10 days, the patient showed clinical improvement. This is the first report of a confirmed case of bartonellosis in the eruptive phase originating from the Peruvian High Forest, showing the geographical expansion of the Carrion's disease.     

Thrombotic Thrombocy openic Purpura: Report of a Case With Possible Immune Etiology

Thrombotic thrombocytopenic purpura(TTP) is a disorder of unknown etiology. An immunologic basis has beensuggested, although proof is lacking.The immunologic, hematologic, andautopsy findings in a case of TTP occurring 6 wk postpartum are described.Immunofluorescent studies revealedthe presence of IgM and complement,as well as fibrin in the vicinity of theendothelium and in thrombi in smallblood vessels in multiple organs.These findings suggest an active immunologic process in this case. WhileTTP is probably of diverse etiology,confirmation of these findings infurther cases would provide a rationalbasis for the use of immunosuppressive therapy.

Submitted on January 31, 1972 Revised on March 30, 1972 Accepted on April 26, 1972     

Case Report: First Reported Australian Case of Cladophilophora arxii: Features Consistent with Possible Primary Pulmonary Chromoblastomycosis

We describe the first case of possible pulmonary chromoblastomycosis in the absence of any identified cutaneous lesions in a relatively immunosuppressed man. The causative organism was Cladophialophora arxii, which is a rare pathogen that has only been described as causing human disease two times previously.     

Transmission of Hepatitis C Virus by Anti-HCV-Negative Blood Transfusion: Case Report

Acute posttransfusion hepatitis C was reported in a recipient of 3 units of red cells. The recipient became acutely icteric 6 weeks after transfusion, and HCV infection was diagnosed. Stored serum samples of the 3 implicated donations, which were negative with ELISA-2, were retested by PCR and 3rd-generation antibody tests. One implicated donation was PCR positive, but anti-HCV negative. Both other donations were negative in all tests. The donor was recalled to the Blood Bank 13 weeks after the implicated donation and was found to be ELISA-3 plus RIBA-3 positive. Eight months after the implicated donation, the donor is still PCR and RIBA-3 positive, whereas the recipient became PCR negative but remained anti-HCV RIBA-3 positive. The case shows that blood products from donors collected during the open window period of an HCV infection can transmit HCV to recipients.     

First molecular evidence of new Bartonella spp. in fleas and a tick from Peru

Fleas, lice, and ticks collected in Peru in a suburban area of Cusco in November 1998 were tested by polymerase chain reaction for the presence of Bartonella DNA using primers amplifying a fragment of the intergenic spacer region (ITS) gene. Three new Bartonella genotypes were detected in Pulex fleas self-collected from the beds and clothes of schoolchildren and adults. A fourth new genotype was also detected from a tick found on a sheep in the same area. One of the genotypes is closely related to B. vinsoni subsp. berkhoffii, and the others seem to originate from unknown Bartonella species, whose medical importance has yet to be clarified.