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.     

Serological evidence of Bartonella henselae infection in healthy people in Catalonia, Spain

Cat scratch disease (CSD), bacillary angiomatosis, hepatic peliosis and some cases of bacteraemia, endocarditis, and osteomyelitis are directly caused by some species of the genus Bartonella. The purpose of this study was to determine the prevalence of IgG antibodies against Bartonella henselae in healthy people and to identify the epidemiological factors involved. Serum samples from 218 patients were examined by indirect immunofluorescence assay (IFA). Significance levels for univariate statistical analysis were determined by the Mann-Whitney U test, chi2 test and Fisher's exact test. Of 218 patients, 99 were female and 119 male, with a median age of 34.36 years (range 0-91 years). Nineteen (8.7%) reacted with B. henselae antigens. Of all the factors concerning the seroprevalence rate being studied (age, sex, contact with animals, residential area), only age was statistically significant. Our serological data seems to indicate that B. henselae is present in Catalonia and could be transmitted to humans.     

Cat-scratch disease

Cat-scratch disease (CSD) was first described by Debré in 1950, yet the causative bacterial agent of CSD remained obscure until 1992, when Bartonella (formerly Rochalimaea) henselae was implicated in CSD by serological and microbiologic studies. Bartonella henselae had initially been linked to bacillary angiomatosis (BA), a vascular proliferative disease most commonly associated with long-standing human immunodeficiency virus infection or other significant immunosuppression. Bartonella henselae has also been associated with bacillary peliosis, relapsing bacteraemia and endocarditis in humans. Cats are healthy carriers of B. henselae, and can be bacteraemic for months or years. Cat-to-cat transmission of the organism by the cat flea, with no direct contact transmission, has been demonstrated. Two new Bartonella species have been identified in the cat reservoir, namely: B. clarridgeiae and B. koehlerae. The role of these species in the aetiology of CSD still needs to be confirmed by isolation or DNA identification from lesions in humans. The author discusses the present state of knowledge on the aetiology, clinical features and epidemiological characteristics of CSD/BA, in addition to diagnosis, treatment and prevention.     

间接免疫荧光试验在HIV抗体检测中的应用

目的：评价间接免疫荧光试验（IFA）作为一种确认实验在HIV抗体检测中的应用。方法：用T嗜性的HIV毒株感染MT4细胞制备抗原片,并与不同稀释度的免疫血清相结合,再滴加荧光素标记的羊抗人IgG,在荧光显微镜下检测特异性免疫荧光,结果：用IFA检测43分血清样本（其中包括17份WB阳性血清,14份阴性血清和12份ELISA阳性或WB出现可疑条带但按标准不能判为阳性的可疑血清）,除HIV－2血清呈阴性反应外,其余检测结果与WB相符,IFA对HIV－1抗体检测的敏感性和特异性均达到100％,HIV－1阳性血清抗体最高滴度达到1：10240。结论：IFA可用于HIV－1抗体检测的确认,它可作为Western Blot的一种补充或替代实验。     

Genetic diversity of Bartonella henselae in human infection detected with multispacer typing

We applied multispacer typing (MST) by incorporating 9 variable intergenic spacers to Bartonella henselae DNA detected in lymph node biopsy specimens from 70 patients with cat-scratch disease (CSD), in cardiac valve specimens from 2 patients with endocarditis, and in 3 human isolates from patients with bacillary angiomatosis, CSD, and endocarditis. Sixteen MST genotypes were found, 5 previously identified in cats and 11 new. Of the studied DNA, 78.7% belonged to 2 genotypes, which were phylogenetically organized into 4 lineages. Human strains were mostly grouped within 2 lineages, previously identified as Marseille and Houston-1. Our results suggest a greater genetic diversity in human-infecting B. henselae than what has previously been evaluated by using other genotyping methods. However, the diversity is not significantly different from that of cat strains. MST is thus a suitable genotyping tool for evaluating the genetic heterogeneity of B. henselae among isolates obtained from human patients.     

湖南省郴州地区莱姆病调查

调查郴州地区莱姆病分布情况。方法：采用间接免疫荧光抗体法，于1991年在地处湘粤交界的南岭山区宜章县莽山林场设点凋查。结果：共查林区人群257人，血清抗莱姆病螺旋体抗体（IgG）阳性者16人，阳性率为6．23％。对16例个案调查，有明确蜱叮咬史者6例，占37．5％；并发现典型游走性红斑病例3例。结论：南岭山区可能是莱姆病疫区，人群中有莱姆病的发生和流行。     

Serological evidence of Bartonella spp. infection in the UK

We reviewed serological and epidemiological data relating to 1000 consecutive patients from whom specimens were submitted for estimation of bartonella antibodies, using MRL Diagnostics Bartonella IFA IgM and IgG kits. Using 289 control sera, we estimated the specificity of the kits as > or = 99.0%. Evidence of bartonella infection was found in 16.3% of patients examined. Rates varied by patient group: 20% of patients for whom a diagnosis of cat scratch disease (CSD) was considered probable had evidence of infection, as did 10.4% of patients with 'possible CSD', 8.1% of patients with possible bacillary angiomatosis, 18.2% of patients with 'culture negative' endocarditis and 17.6% of patients with possible bartonellosis with ophthalmic involvement. An IgM response was seen in 6.6% of patients and IgG in 15.1%. Cases were more frequent among males than females (18.5% vs. 13.9%). Analysis by age showed that although rates of infection were highest in the decades 0-9 years (19.4%) and 10-19 years (20.7%), they fell only slightly in the next three decades. MRL bartonella kits appears to provide a useful and specific approach to the diagnosis of these infections.     

检测SARS患者血清中抗-SARS-CoV IgG的四种试剂盒比较

目的比较4种试剂盒检测SARS患者血清中抗-SARS-CoX IgG的灵敏度和特异度。方法用2种酶联免疫吸附试验(EIA)和2种间接免疫荧光法(IFA)试剂盒分别检测18例SARS患者的99份系列血清及123份阴性参比血清标本中抗-SARS-CoV IgG。结果在患者发病第1周，4种试剂盒均未检出抗-SARS-CoX IgG；自发病第2周，除EIA甲未能检出外，EIA乙和2种IFA均从血清中检出抗-SARS-CoV IgG，其阳性率分别为57．1％(4／7)、57．1％(4／7)和42．9％(3／7)。4种试剂盒最早检出时间分别为发病后第16、12、13和9天。于发病后第3周该4种试剂盒的检出率分别为52．6％(10／19)、94．7％(18／19)、78．9％(15／19)和84．2％(16／19)。但自发病第4周后，该4种试剂盒的检出率相同。检测123份阴性参比血清表明，除EIA乙的特异度为94．9％外，其余3种试剂盒的特异度均为100％。结论2种IFA的灵敏度和特异度均较2种EIA高；2种国产EIA试剂盒质量尚需进一步提高。     

间接酶联免疫吸附试验检测北京市昌平地区体检人群中汉赛巴尔通体抗体

目的调查北京市昌平地区健康体检人群血清汉赛巴尔通体抗体阳性情况。方法用间接酶联免疫吸附试验（ELISA）和免疫荧光抗体（IFA）试剂盒检测体检人群血清汉赛巴尔通体抗体情况。结果以IFA为参考标准，间接ELISA方法的灵敏度为70．6％，特异度为91．6％；阳性预测值为82．2％（60／73），阴性预测值为84．9％。ELISA共检测了357份健康体检人群血清，汉赛巴尔通体抗体阳性率为34．5％，IFA共检测了239份体检血清，其汉赛巴尔通体抗体阳性率为35．6％。结论间接ELISA方法对于检测汉赛巴尔通体感染是一种快速、敏感、特异的方法，昌平地区健康体检人群中存在汉赛巴尔通体抗体阳性的情况。     

Lymph node biopsy specimens and diagnosis of cat-scratch disease

We report microbiologic analysis of 786 lymph node biopsy specimens from patients with suspected cat-scratch disease (CSD). The specimens were examined by standard, cell culture, and molecular methods. Infectious agents were found in samples from 391 (49.7%) of 786 patients. The most commonly identified infectious agent was Bartonella henselae (245 patients, 31.2%), the agent of CSD. Mycobacteriosis was diagnosed in 54 patients (6.9%) by culture and retrospectively confirmed by using a specific real-time PCR assay. Neoplasm was diagnosed in 181 specimens suitable for histologic analysis (26.0%) from 47 patients. Moreover, 13 patients with confirmed Bartonella infections had concurrent mycobacteriosis (10 cases) or neoplasm (3 cases). A diagnosis of CSD does not eliminate a diagnosis of mycobacteriosis or neoplasm. Histologic analysis of lymph node biopsy specimens should be routinely performed because some patients might have a concurrent malignant disease or mycobacteriosis.     

Cat-scratch disease in children--Texas, September 2000-August 2001

Cat-scratch disease (CSD), a bacterial infection caused by Bartonella henselae, has emerged as a relatively common and occasionally serious zoonotic disease among children and adults. To illustrate the spectrum of clinical manifestations of CSD observed during a 1-year period, Texas Children's Hospital (TCH) in Houston reviewed the medical records of 32 children evaluated at TCH during September 2000-August 2001 whose antibody titers indicated recent Bartonella infection. This report summarizes the evaluations of these cases and highlights four manifestations of infection with this pathogen in children. The findings emphasize that although CSD is generally a mild, self-limited illness, the differential diagnosis often includes more serious conditions (e.g., lymphoma, carcinoma, mycobacterial or fungal infection, or neuroblastoma) that might result in protracted hospital stays and lengthy treatments before diagnosis. Timely assessment of CSD is important, particularly when invasive diagnostic measures are being considered.     

Ocular bartonellosis in an HIV-HVC coinfected patient

Bartonella henselae is the etiologic agent of the cat scratch disease and in immunocompromised patients, of bacillary angiomatosis and peliosis hepatis. Less often, ocular complications associated with B. henselae infection have been reported in immunocompetent patients and five times in HIV-infected patients. We report the case of a 42-year-old woman, coinfected by HIV-HCV, presenting with cirrhosis, who owned a cat and was hospitalized for bilateral loss of visual acuity. Ophthalmologic examination revealed bilateral papillitis with hyalitis. Nuclear magnetic resonance revealed a retrobulbar neuritis. Confirmation was given by blood tests positive for B. henselae and the exclusion of other causes of neuroretinitis with biological data. Doxycycline cured the disease rapidly.     

Characterization of Rickettsia spp. circulating in a silent peri-urban focus for Brazilian spotted fever in Caratinga, Minas Gerais, Brazil

The present study was intended to characterize Rickettsia spp. circulating in arthropod vectors in Caratinga, Minas Gerais, Brazil, by PCR and to investigate the presence of antibodies against the spotted fever Rickettsiae group (SFRG) in dogs and horses. 2,610 arthropods were collected and taxonomically identified. DNA samples obtained from these vectors were submitted to PCR and cycle-sequenced. Ctenocephalides and Amblyomma cajennense showed sequences presenting 100.0% homology with R. felis. A sequence obtained from Rhipicephalus sanguineus showed 99.0% homology with R. felis, and a sequence from A. cajennense showed 97.0% homology with R. honei and R. rickettsii. Canine (73) and equine (18) serum samples were tested by indirect fluorescent antibody (IFA) using R. rickettsii antigen. Only three of the equine sera tested (17.0%) had positive antibody titers. Molecular detection of rickettsiae species potentially pathogenic to humans in arthropod vectors and the presence of seroreactivity to SFRG in horses show the risk of transmission of rickettsiosis in this area and the need to maintain continuous epidemiological surveillance for rickettsial diseases.     

Serosurvey of Rickettsia spp. in dogs and humans from an endemic area for Brazilian spotted fever in the State of São Paulo, Brazil

The present study provides a rickettsial serosurvey in 25 dogs and 35 humans in an endemic area for Brazilian spotted fever in the State of S?o Paulo, where the tick Amblyomma aureolatum is the main vector. Testing canine and human sera by indirect immunofluorescence against four Rickettsia antigens (R. rickettsii, R. parkeri, R. felis and R. bellii) showed that 16 (64%) of canine sera and 1 (2.8%) of human sera reacted to at least one of these rickettsial antigens with titers >0r= 64. Seven canine sera and the single reactive human serum showed titers to R. rickettsii at least four times those of any of the other three antigens. The antibody titers in these 7 animals and 1 human were attributed to stimulation by R. rickettsii infection. No positive canine or human serum was attributed to stimulation by R. parkeri, R. felis, or R. bellii. Our serological results showed that dogs are important sentinels for the presence of R. rickettsii in areas where the tick A. aureolatum is the main vector of Brazilian spotted fever.     

Serological differentiation between past and present infection in hepatic amoebiasis

The indirect fluorescent antibody (IFA) test and the amoebic gel diffusion (AGD) test were assessed as tools for differentiating between past and present infection in invasive amoebiasis; in the case of the IFA test the Entamoeba histolytica-specific IgG and IgM were monitored. In a pilot study in which sera from 56 patients with suspected invasive amoebiasis were tested the IgM was positive in 40% of confirmed intestinal and 83% of confirmed hepatic cases, the IgG and AGD were positive in all confirmed cases. A subsequent study was then carried out, in which the tests were used to monitor longitudinally antibody levels of patients with confirmed amoebic liver abscess, from the time of admission to hospital, to one year after successful treatment. The specific IgM levels became negative sooner than the IgG or AGD, with more than half the subjects giving negative results at six months and all cases becoming negative 46 weeks after treatment. The results of this study suggest that the presence of specific IgM, together with specific IgG and a strongly positive AGD test, is indicative of an active infection; conversely, when the IgM is negative, while the other tests are positive, active disease was usually absent.     

四川省南川县莱姆病的调查

四川东部南川县是莱姆病流行区。本文对300例居民进行了血清学调查,抗莱姆病螺旋体IgG抗体阳性54人,人群自然感染率为18%。35例经临床和血清学确诊的莱姆病患者,其临床表现为慢性游走性红斑7例,关节炎13例,面神经麻痹7例,多发性神经炎7例,脑膜炎2例和心脏异常1例。47只微小牛蜱的中肠标本,有3只检出了螺旋体,带菌率为6.4%。     

固相免疫吸附血凝抑制试验快速检测甲型肝炎IgM抗体

本文报告一种新建立的快速检测抗-HAV IgM的固相免疫吸附血凝抑制试验。本试验与ELISA对比检测血清标本336份,总符合率为99.4%。被检的甲肝感染者血清抗-HAV IgM滴度范围为1:20~1:327 680。阻断试验、2-ME破坏试验及非甲肝病人血清检测结果表明本试验具有良好的特异性。本试验不需标记抗体,不受类风湿因子的干扰,不需要特殊仪器,且经济简便,能在3小时内得出结果,可用作甲肝的早期诊断和流行病学监测,尤其适于基层单位应用。     

湖南省平江县莱姆病调查研究

目的：调查湖南省平江县莱姆病的分布情况。方法：采用间接免疫荧光抗体法和直接荧光抗体染色法,于1999－2000年在平江县选点调查。结果：共查山林地区居民500人,血清抗莱姆病螺旋体抗体（IgG)阳性者32人,阳性率6.40%。38例临床和血清学确诊的莱姆病患者,其主要的临床表现有环形或慢性游走性红斑、关节炎、面神经麻痹、多发性神经炎、脑膜炎和心脏损害等。当地的蜱类以二棘血蜱为优势种,占85％,该蜱中肠携带莱姆病螺旋体率为12.0%(6/50)。结论：平江县存在莱姆病的自然疫源地,人群中有莱姆病的发生和流行。     

天津市农牧地区2007--2009年莫氏立克次体、横赛巴尔通体、恙虫病东方体血清流行病学调查

目的 分析天津市农牧地区高危人群蚤传及螨传立克次体病流行趋势.方法 2007-2009年,利用现场流行病学调查方法,以农户为单位随机调查天津地区直属的8个区(县)从事农牧业的人群,并现场采集886份血液标本,采用微量间接免疫荧光检测人群莫氏立克次体、横赛巴尔通体及恙虫病东方体特异IgG抗体,并分析比较不同年份、地区、性别及年龄组人群抗体阳性率变化趋势.结果 3种立克次体抗体阳性率均呈上升趋势.其中莫氏立克次体阳性率变化范围为5.0%～58.2%;横赛巴尔通体为2.6%～14.5%;恙虫病东方体为1.8%～39.8%.3种病原体阳性率较高的地区主要集中在天津市东南部及中部近海低海拔地区.结论 天津地区农牧人群普遍存在蚤传及螨传立克次体感染,并且有逐年上升趋势.

Abstract：

Objective To study the sero-epidemiological starus regarding Rickettsia (R.) typhi,Bartonella (B.) henselae and Orientia (O.) tsutsugamushi in farmers from rural areas of Tianjin.Methods Field epidemiological surveys were performed in 8 districts (county) of Tianjin city from 2007 to 2009.886 farmers were randomly recruited and their serum samples collected to detect the specific antibodies of R.typhi,B.henselae and O.tsutsugamushi by micro-indirect immunoflorescence (IFA).Results The total antibody positive rates of R.typhi increased from 5.0% to 58.2% while B.heaselae had an increase from 2.6% to 14.5% and O.tsutsugamushi increased from 1.8% to 39.8%.Geographic distribution showed that farmers living in the central and southeast areas were higher than that in other areas.Conclusion Infections of both R.typhi,B.henselae and O.tsutsugamushi in farmers from Tianjin areas were popular and the antibody positive rates ofR.typhi,B.henselae and O.tsutsugamushi had an annual increase.     

Rodent-associated Bartonella febrile illness, Southwestern United States

Serum specimens from 114 patients hospitalized with a febrile illness were tested with an indirect immunofluorescence assay (IFA) using Bartonella antigens prepared from 6 species of sigmodontine rodents and 3 known human Bartonella pathogens: B. henselae, B. quintana, and B. elizabethae. Acute- and convalescent-phase serum samples from 5 of these patients showed seroconversion with an IFA titer >512 to rodent-associated Bartonella antigens. The highest titer was against antigen derived from the white-throated woodrat (Neotoma albigula), although this rodent is not necessarily implicated as the source of infection. Three of the 5 who seroconverted showed no cross-reaction to the 3 Bartonella human pathogens. Common clinical characteristics were fever, chills, myalgias, leukopenia, thrombocytopenia, and transaminasemia. Although antibodies to Bartonella are cross-reactive, high-titer seroconversions to rodent-associated Bartonella antigens in adults with common clinical characteristics should stimulate the search for additional Bartonella human pathogens.