汉氏巴尔通体感染1例

1 病历摘要患者,男性,29岁。周身乏力,多汗6月,失眠2月于2000年12月11日入我院。有养猫史10余年,于2000年5月左手被猫抓伤,左手背皮肤出现皮疹及脓疱疹,2周后皮肤愈合。逐渐出现周身乏力,多汗,阵发性面部及双手潮红。近2周出现头晕,失眠,多梦,曾间断应用环丙沙星、头孢菌素药治疗5月,上述症状不减。入院查体:体温:37.2℃,脉搏:80次/分。左侧腋窝可触及一个2×3cm肿大淋巴结,轻度压痛。周身皮肤未见破损及疤痕。心、肺、腹未见异常。实验室检查:     

分子生物学技术检测鼠形动物巴尔通体

目的查明鼠形动物巴尔通体感染情况。方法在天台县采用夹夜法捕捉鼠形动物，采集该动物的肝脏，用PCR方法检测DNA，并对阳性产物克隆测序，计算感染情况。结果采集的55份鼠类肝脏阳性25份，其中黑线姬鼠阳性率为48．84％，黄毛鼠为33．33％，所检测到的巴尔通体与B．doshiae最接近。结论天台县鼠形动物有很高的巴尔通体DNA阳性率，存在传播给人的风险，必须采取措施加以控制。     

北京市宠物猫和流浪猫巴尔通体感染状况调查

目的调查北京市宠物猫和流浪猫巴尔通体感染状况。方法采集猫的抗凝血和血清并收集相关流行病学信息。将抗凝血用灭菌胰酶大豆肉汤按1∶4稀释后,取100μl接种于含5%去纤维羊血的脑心浸液培养基上,置于37℃、含5%CO2培养箱中分离培养至45 d。选择glt A、fts Z、rib C引物对分离到的疑似菌落进行PCR并测序,所测核酸序列进行同源性比较及系统发育分析,确定巴尔通体种。利用间接免疫荧光法检测血清样本汉赛巴尔通体抗体水平。利用SPSS 13.0软件分析实验室数据与现场采集的流行病学数据。结果北京市猫的巴尔通体血培养分离率为13.8%,获得的22株分离株全部为汉赛巴尔通体。血清抗体阳性率为39.4%。流浪猫(30.4%)、染蚤猫(36.6%)、幼猫(27.9%)的血培养阳性率较高,差异有统计学意义。染蚤猫的血清抗体阳性率(61.0%)也显著高于未染蚤猫(31.9%)。结论北京市宠物猫和流浪猫中巴尔通体感染率较高,且均为对人致病的汉赛巴尔通体,需做好宠物猫的防蚤除蚤、流浪猫的管理来预防人类巴尔通体感染。     

用分子生物学技术诊断巴尔通体感染

目的 应用聚合酶链反应(PCR)技术建立巴尔通体的检测鉴定方法并用于诊断临床疑似猫抓病合并双侧支气管肺炎患者。方法 根据16S～23S rRNA ITS基因序列较其他属细菌长,而且位于这段基因序列中的tRNA~(Ile)-tRNA~(Ala)基因间隔区具有高度变异性,tRNA~(Ile)和tRNA~(Ala)基因序列在巴尔通体属中完全保守,设计引物;同时应用文献发表的2对引物直接扩增1例临床可疑猫抓病患者全血基因组DNA。将研究设计引物的PCR产物直接测序,并进行序列分析。结果 3对引物扩增全血基因组DNA均获得巴尔通体特异基因片段,根据其中2对引物扩增产物大小与阳性对照不同,可初步确定样本与阳性对照菌株是不同巴尔通体;序列分析结果显示,研究设计引物TIle.455p-TAla.885n扩增产物核苷酸序列与中国云南省巴尔通体-分离株对应位置的序列相一致,同源性100％。结论 应用PCR技术从血液中直接扩增特异基因片段,可以快速检测巴尔通体感染;测序及序列分析结果进一步提供了此种致病巴尔通体在中国南北方均存在的线索。     

巴尔通体感染性心内膜炎的研究进展

感染性心内膜炎是一类严重威胁生命，临床表现极其复杂且诊断十分困难的疾病。该病的诊断除临床表现外主要依据微生物学检查，如血液、心瓣膜组织等标本病原体的分离培养。通常采用传统的实验室诊断方法，大约92％～95％的感染性心内膜炎患者能够分离到病原体。     

汉赛巴尔通体的研究进展

随着经济全球化和新发传染病在世界范围内的不断涌现，一种新发的虫媒传染病——巴尔通体感染，越来越引起人们的广泛关注。汉赛巴尔通体（Bartonella henselae）是巴尔通体属中重要的致病菌之一，直到20世纪90年代才被发现，由于其对动物和人的广泛致病性和复杂的临床特征，已引起国内外学者的兴趣。本研究针对汉赛巴尔通体的流行病学、临床诊断及治疗、实验室诊断、动物易感性及传播媒介等方面做一综述。     

猫抓病的实验室诊断研究进展

猫抓病(cat scratch disease,CSD)是一类典型的良性、自限性淋巴管疾病,主要是通过猫的抓伤和咬伤而感染,也可通过跳蚤的叮咬传播.儿童和青年人发病较多,少数病人尤其是免疫力低下的病人如人类免疫缺陷病毒(HIV)感染者可表现较为严重的并发症^[1].目前已经证实,汉赛巴尔通体(Bar-tonella henselae)是导致猫抓病的主要病原体,其储存宿主是猫;也有关于五日热巴尔通体(B quintana)和克氏巴尔通体(Bclarridgeiae)感染导致猫抓病的报道^[2].美国Jackson等通过流行病学研究,推算每年大约有24 000例CSD新发病例^[3].     

浙江省家猫中汉赛巴尔通体感染的流行病学调查

目的查明浙江省家猫汉赛巴尔通体感染情况。方法采集家猫股静脉血，一半留全血，一半分离血清，用分离培养和聚合酶链反应检测全血，用ELISA检测血清，计算感染情况。结果浙江省各地家猫汉赛巴尔通体抗体阳性率平均为34．5％，江山、龙游、安吉、淳安、建德和上虞市（县）的阳性率分别为37．5％、30．0％、33．3％、40．0％、50．0％和28．6％，各地之间阳性率差异无统计学意义；雌性猫阳性率为36．0％，雄性为33．3％，二者间的阳性率差异亦无统计学意义。结论浙江省各地家猫汉赛巴尔通体抗体阳性率均较高，存在传播给人的风险，必须采取措施加以控制。     

对巴尔通体感染的新认识

巴尔通体 (Bartonella)是一群革兰染色阴性、氧化酶阴性、营养条件要求苛刻兼性细胞内寄生的需氧杆菌 ,作为新发及老传染病的病原体 ,从 2 0世纪 80年代开始再次肆虐人类 ,并以新的以往人们未知的形式表现出来。由于巴尔通体感染表现出来的复杂的疾病谱 ,以及人们对其认识的改变和加深 ,人们对巴尔通体的研究逐渐重视起来。作者就巴尔通体分类学位置变化、自然历史、临床表现、流行病学等方面予以综述。1　分类学位置　　 190 5年 ,秘鲁医生AlbertoBarton在血液中发现人类巴尔通体病Oroya热的致病因子 ;1919年 ,Battistini、Naguchi等分…     

汉赛巴尔通体媒介和宿主的实验室研究进展

汉赛巴尔通体（Bartonella henselae）是一类革兰阴性的兼性厌氧菌，属于α-变形杆菌纲（Alphaproteobacteria）、根瘤菌目（Rhizobium）、巴尔通体科（Bartonellaceae）、巴尔通体属（Bartonella），该种又可分为2个亚型即：Houston型和Marseille型。汉赛巴尔通体为致病巴尔通体，可以引起猫抓病（CatScratch Disease，CSD）、慢性淋巴结病、心内膜炎、杆菌样血管肉瘤杆菌样紫瘢（BAP）、视神经病变等，其中以CSD最为普遍。     

Bartonella henselae in porpoise blood

We report detection of Bartonella henselae DNA in blood samples from 2 harbor porpoises (Phocoena phocoena). By using real-time polymerase chain reaction, we directly amplified Bartonella species DNA from blood of a harbor porpoise stranded along the northern North Carolina coast and from a pre-enrichment blood culture from a second harbor porpoise. The second porpoise was captured out of habitat (in a low-salinity canal along the northern North Carolina coast) and relocated back into the ocean. Subsequently, DNA was amplified by conventional polymerase chain reaction for DNA sequencing. The 16S-23S intergenic transcribed spacer region obtained from each porpoise was 99.8% similar to that of B. henselae strain San Antonio 2 (SA2), whereas both heme-binding phage-associated pap31 gene sequences were 100% homologous to that of B. henselae SA2. Currently, the geographic distribution, mode of transmission, reservoir potential, and pathogenicity of bloodborne Bartonella species in porpoises have not been determined.     

Transmission of Bartonella henselae by Ixodes ricinus

Bartonella spp. are facultative intracellular bacteria associated with several emerging diseases in humans and animals. B. henselae causes cat-scratch disease and is increasingly associated with several other syndromes, particularly ocular infections and endocarditis. Cats are the main reservoir for B. henselae and the bacteria are transmitted to cats by cat fleas. However, new potential vectors are suspected of transmitting B. henselae, in particular, Ixodes ricinus, the most abundant ixodid tick that bites humans in western Europe. We used a membrane-feeding technique to infect I. ricinus with B. henselae and demonstrate transmission of B. henselae within I. ricinus across developmental stages, migration or multiplication of B. henselae in salivary glands after a second meal, and transmission of viable and infective B. henselae from ticks to blood. These results provide evidence that I. ricinus is a competent vector for B. henselae.     

Molecular Epidemiology of Feline and Human Bartonella henselae Isolates

Multiple locus variable number tandem repeat analysis was performed on 178 Bartonella henselae isolates from 9 countries; 99 profiles were distributed into 2 groups. Human isolates/strains were placed into the second group. Genotype I and II isolates shared no common profile. All genotype I isolates clustered within group B. The evolutive implications are discussed.     

Prolonged Bartonella henselae bacteremia caused by reinfection in cats

We analyzed the genetic relatedness of blood culture isolates of Bartonella henselae from 2 cats of patients with cat-scratch disease at admission and after 12 months. Isolates from each cat at different times were clonally unrelated, which suggested reinfection by a second strain.     

Seroprevalence of Bartonella henselae and Bartonella quintana infections in Poland in 1998-2001

Bartonella henselae and Bartonella quintana infections result in illnesses with symptoms of severity ranging from mild lymphadenopathy (CSD) to systemic disease. The aim of the study was to estimate a prevalence of B. henselae and B. quintana infections in human in Poland. Serum samples collected from 265 patients in 1998-2001 were tested for the presence of antibodies specific to B. henselae and B. quintana. Levels of serum IgM and IgG antibodies to Bartonella henselae and Bartonella quintana were measured with indirect microimmunofluorescence test (MRL Diagnostic, USA). Cats' sera were assessed with indirect microimmunofluorescence test (MRL Diagnostic, USA) and goat immune serum anti-cat IgG FITC conjugate (Sigma, USA). Bartonella henselae specific antibodies were detected in 146 (57.0%) patients with lymphadenopathy. From that number 11.3% have shown specific Bartonella henselae IgM serum antibodies. Bartonella quintana infection was detected with serological methods in 4 patients. It has been found that CSD is a seasonal infection, with most cases occurring in autumn. Most cases of the disease have been recognized in children 8-16 years old. Most of CSD cases (30.1%) were detected in Mazowieckie voivodeship. There were no cases of CSD in Pomorskie, Podkarpackie, Lubuskie and Opolskie voivodeship. The seroprevalence of Bartonella sp. infections in cats was estimated on 86% (31/36). The highest titer of specific Bartonella henselae antibodies detected in cats was 1024. The number of detected Bartonella henselae infections in Poland is very low. It is very probable that the number of cases is underestimated in our country. Cat scratch disease is the most frequently clinically and serologically identified bartonellosis.