Serological cross-reaction among Bartonella henselae, Chlamydia pneumoniae and Coxiella burnetii by indirect fluorescence antibody method]

We studied the serological cross-reactions among Bartonella henselae, Chlamydia pneumoniae and Coxiella burnetii by indirect fluorescence antibody (IFA) method, using sera from 8 patients with cat scratch disease (CSD), 13 patients with C. pneumoniae infection and 12 patients with acute Q fever. B. henselae IgG antibody was negative in 13 patients with C. pneumoniae infection, and was positive in 3 (titers being 1:64) of 12 patients with Q fever, whereas B. henselae IgM antibody was negative in all the patients with C. pneumoniae infection or Q fever. C. burnetii IgG antibody was removed by absorption of these 3 sera with C. burnetii antigens, whereas B. henselae IgG antibody did not change. C. pneumoniae IgG antibody was positive in 3 (titers being 1:125 in two, 1:32 in one) of 8 patients with CSD. Both C. pneumoniae and B. henselae IgG antibody titers were significantly reduced by absorption of these 3 sera with B. henselae antigens. C. burnetii IgG or IgM antibodies were negative in all patients with CSD. In conclusion, no serological cross-reaction between B. henselae and C. burnetii was observed. On the other hand. B. henselae IgG antibody cross-reacted to C. pneumoniae antigens, whereas C. pneumoniae IgG antibody did not cross-react to B. henselae antigens. Our findings suggest that determination of B. henselae IgG or IgM antibodies were not influenced by C. pneumoniae and C. burnetii antigens.     

Evaluation of serological response to Bartonella henselae by enzyme immunoassay in cat scratch disease

The IgG and IgM titers to Bartonella henselae were determined by an enzyme immunoassay (EIA). The EIA test for detection of IgG and IgM antibodies to B. henselae concerning CSD showed that 8 (40%) of 20 patients with CSD had a serum IgG antibody titer of 12 EIA unit or more and that 5 (25%) patients had a serum IgM titer of 12 EIA unit or more. Totally 12 (60%) of the 20 patients with CSD were seropositive for B. henselae. The mean age of IgG positive patients were higher than IgM positive patients. The IgM antibodies to B. henselae disappeared within 4 to 12 weeks after onset of disease. The IgG antibodies to B. henselae disappeared within 3 to 8 weeks after onset of the symptoms in 2 cases of CSD. Another 2 cases CSD produced high levels of IgG antibodies in the acute phase of the disease. Different course of IgG and IgM antibody titers were found in sera from patients.     

Longitudinal study of serological response to Bartonella henselae by indirect fluorescence assay in cat scratch disease

Sequential serologic testing for IgG and IgM titers to Bartonella henselae were evaluated by an indirect fluorescence assay (IFA) in patients with CSD. The IFA test for the detection of IgG and IgM antibodies to B. henselae in 52 CSD patients showed that 40 (76.9%) were positive for IgG antibody and 9 (17.3%) were positive for IgM antibody. Two or more consecutive serum samples from 30 patients with CSD were assessed. In regard to the detection of IgG antibody, 5 patients had rapidly elevated titers in the acute phase, 12 patients had high titers from the acute phase, and 5 patients had a positive titer 24 weeks after the onset. B. henselae IgM antibody kinetics varied widely between patients with CSD. The seropositive rate for the antibody to B. henselae was analyzed at overtime after the onset and we found that the IgG-seropositive rate was high from 2 weeks after the onset and low after 25 weeks. The sensitivity of the IgM IFA was low, and IgM antibody to B. henslelae was not detected from 9 weeks. The detection from consecutive serum samples of antibodies to B. henselae by IFA is very useful for diagnosis in the case of clinically suspected CSD.     

Two patients with Bartonella henselae infection from a dog

Two patients were reported as having been infected with Bartonella henselae after having contact with a dog. Both of the patients owned a dog, but had no contact with cats. One patient was a 10-year-old boy who had experienced a fever of 38-39 degrees C for 11 days, as well as having bilateral cervical lymphadenopathy. The boy's serum IgM antibodies to B. henselae were negative on the 6th and 16th day of his illness, whereas his IgG value, using indirect fluorescence antibody (IFA) method, was found to be elevated from 1:256 to 1:1,024. B. henselae DNA was detected, by PCR method, in swabs from the gingiva and buccal membrane of the dog with which the boy had been in contact. The boy was first treated with cefdinir (300 mg daily) for 6 days without beneficial effect. He responded, however, to minocycline (100 mg daily) with symptom resolution in four days. The other patient was a 64-year-old man who had experienced a fever of 38-39 degrees C for 27 days, as well as having right inguinal lymphadenopathy. The man's serum IgM antibody to B. henselae was negative, although his IgG value, determined by IFA, was 1:1,024. In addition, B. henselae DNA was detected, by PCR method, in parafin-embedded tissue obtained from the biopsied inguinal lymph nodes. The man was treated with cefazolin (2 g daily). His fever resolved, but his lymph nodes remained swollen. After a regimen of erythromycin (1,200 mg daily), the swelling in his inguinal lymphnodes gradually disappeared. Careful review of suspected CSD victims' history of contact with animals is important in making a prompt diagnosis of B. henselae infection.     

Two cases of suspected Bartonella henselae infection from a dog]

A 55-year-old male was admitted to our hospital because of fever and left submaxillary, right axillary, and left inguinal lymphadenopathy. A presumptive diagnosis of rickettsiosis was made and treatment with oral doxycycline was started. Lymphadenopathy was partialy resolved after antibiotics treatment. Ablation of the left inguinal node was done and histopathological examination showed non-Hodgkin's lymphoma. Lymphadenopathy was resolved by chemotherapy. The second patient, a 40-year-old male, developed a tender submandibular node. Excisional biopsy of the node was performed to eliminate lymphoma. Histopathological examination revealed granulomatous lymphadenitis with follicular hyperplasia. The patients had no history of cat contact, but owned a dog. Diagnosis of both cases was confirmed by the detection of IgG antibodies to Bartonella henselae with an enzyme immunoassay. Our findings suggest that dogs are implicated in B. henselae infection and can serve as a reservoir of the organism as well as cats. In the abscence of other bacterial and especially after exposure to dogs, B. henselae should be included as possible cause of lymphadenopathy.     

Clinical evaluation of commercial serological test for Bartonella infection

We evaluated the usefulness of a serological diagnostic kit (Bartonella IFA IgG, IgM; MRL Diagnostics) for Bartonella henselae infection. Of the 110 healthy individuals, 107 (97.3%) were with titers being less than 1:64 for IgG antibody to B. henselae, 2 were with titers being 1:64 and 1 with 1:128, IgM antibody to B. henselae was negative in all individuals. Serological diagnosis of cat scratch disease (CSD) using indirect fluorescence antibody (IFA) methods (in-house and diagnostic kit) was made in either elevated titers of IgM (> or = 1:20) or IgG (> or = 1:256) antibodies, or a four-fold rise in IgG titer between acute and convalescent sera. Of the 18 individuals with serological diagnosis of CSD by in-house IFA method in 26 CSD clinical diagnosed patients, 15 (83%) were compatible with the results of the diagnostic kit, whereas 3 (17%) were not compatible. Of the 8 without serological diagnosis, 1 (13%) was serologically diagnosed as CSD, and the others were negative. Overall, the serological diagnosis was made in 16 of 26 (62%). The specificity and sensitivity of this kit were 100% and 62%, respectively. The cross-reaction between B. henselae and Bartonella quintana was observed in sera from controls and patients. Our results show that the diagnostic kit as well as in-house method is an useful tool for the serological diagnosis of cat scratch disease.     

Bartonella henselae causing severe and protracted illness in an otherwise healthy person

Bartonella henselae is an emerging pathogen capable of causing severe disease. We report a case of severe protracted illness in an otherwise healthy police dog handler. The patient recovered slowly after antibiotic treatment. This case report emphasizes the importance of considering B. henselae infections in patients with fever of unknown origin.     

Bartonella seroprevalence in rural Thailand

We estimated the prevalence of anti-Bartonella antibodies among febrile and non-febrile patients presenting to community hospitals in rural Thailand from February 2002 through March 2003. Single serum specimens were tested for IgG titers to four Bartonella species, B. henselae, B. quintana, B. elizabethae and B. vinsonii subsp vinsonii using an indirect immunofluorescent assay. A titer 21:256 was considered positive. Forty-two febrile patients (9.9%) and 19 non-febrile patients (19%) had positive serology titers to at least one Bartonella species. Age-standardized Bartonella seroprevalence differed significantly between febrile (10%) and non-febrile patients (18%, p=0.047), but did not differ by gender. Among all 521 patients, IgG titers 21:256 to B. henselae were found in 20 participants (3.8%), while 17 (3.3%) had seropositivity to B. quintana, 51 (9.8%) to B. elizabethae, and 19 (3.6%) to B. vinsonii subsp vinsonii. These results suggest exposure to Bartonella species is more common in rural Thailand than previously suspected.     

Bartonella henselae and Bartonella clarridgeiae infection in domestic cats from The Philippines.

One hundred seven domestic cats from The Philippines were serologically tested to establish the prevalence of Bartonella infection. A subset of 31 of these cats also had whole blood collected to tentatively isolate Bartonella strains. Bartonella henselae and B. clarridgeiae were isolated from 19 (61%) of these cats. Bartonella henselae type I was isolated from 17 (89%) of the 19 culture-positive cats. Six cats (31%) were infected with B. clarridgeiae, of which four were coinfected with B. henselae. Sixty-eight percent (73 of 107) and 65% (70 of 107) of the cats had antibodies to B. henselae and B. clarridgeiae, respectively, detected by an immunofluorescence antibody (IFA) test at a titer > or = 1:64. When tested by enzyme immunoassay (EIA), 67 cats (62.6%) had antibodies to B. henselae and 71 cats (66.4%) had antibodies to B. clarridgeiae. Compared with the IFA test, the B. henselae EIA had a sensitivity of 90.4% and a specificity of 97%, with positive and negative predictive values of 98.5% and 82.5%, respectively. Similarly, the B. clarridgeiae EIA had a sensitivity of 97% and a specificity of 92% specificity, with positive and negative predictive values of 95.8% and 94.4%, respectively. The presence of antibodies to Bartonella was strongly associated with flea infestation. Domestic cats represent a large reservoir of Bartonella infection in the Philippines.     

Occurrence of Bartonella henselae and Bartonella quintana in a healthy Greek population

The purpose of this study was to determine the prevalence of IgM and IgG antibodies against Bartonella henselae and B. quintana in a healthy Greek population using a commercially available immunofluorescent test (Focus test). Five hundred healthy individuals were divided by sex into four age groups and three groups according to contact with cats. IgM antibodies were not detected in any of the subjects examined, while 99 (19.8%) and 75 (15%) were IgG seropositive to B. henselae and to B. quintana, respectively. No statistical difference in the seropositivity was observed among these groups. The IgG antibody titers ranged from 1/64 to 1/256 for B. henselae and from 1/64 to 1/512 for B. quintana. A high percentage (12.4%) of cross-reactivity between the two species was observed. Our data show that the prevalence of both Bartonella species in Greece is high. However, low IgG antibody levels are not sufficient evidence of active infection.     

Bartonella henselae and inflammatory bowel disease

Sustained fever and increased thickness of the distal ileum on ultrasound suggested Crohn's disease in an adolescent boy. Bartonella henselae infection was diagnosed by specific serology and the patient recovered. Ileitis could be related to B. henselae infection.     

A case of hepatosplenic cat scratch disease]

A 43-year-old man was admitted with idiopathic fever. Abdominal ultrasonogram demonstrated multiple hypoechoic lesions in the spleen. Abdominal CT scan showed multiple hypodense lesions in the liver and spleen. The patient had a cat in his house, and the presence of a very high serous antibody titer for Bartonella henselae led to the diagnosis of hepatosplenic cat scratch disease. It is important to consider this disease in the differential diagnosis of idiopathic fever when multiple lesions are detected in the liver and spleen.     

Bartonella henselae endocarditis. Report of a case and review of the literature

Bartonella spp are small Gram-negative rods, aerobic and highly fastidious. They are difficult to culture, in the routine bacterial cultures. They are considered as emergent human pathogens. Since 1993, three species of Bartonella (B. quintana, B. henselae, and B. elizabethae) have been described as causative agents of infectious endocarditis. In this paper we describe the case of a 43 year-old woman with a previous valvular heart disease, probably of rheumatic origin, owner of cats, that suffered an infectious endocarditis by Bartonella henselae in the aortic valve. This patient presented IgG titers against B. henselae of 1/4096 and against B. quintana of 1/256. She also had low IgM titers against B. henselae and B. quintana: 1/64 and 1/32, respectively. The patient received antibiotics for 12 weeks and suffered a valvular replacement due to the severe lesion on the aortic valve. On the endocardiac tissue of the removed valve DNA of B. henselae was detected (polymerase chain reaction-based assay). Clinical evolution of the patient was good. Diagnosis of Bartonella spp infection must be considered in every patient with infectious endocarditis and negative blood cultures, and particularly B. henselae in patients with previous valvular heart disease and regular contact with cats.     

Time course of the levels of antibodies to Coxiella burnetii and detection of C. burnetii-DNA in three imported cases of acute Q fever]

Three patients developed acute Q fever after returning from an inspection tour of farms and abattoirs to Australia. Serum levels of antibodies to Coxiella burnetii and the presence of C. burnetii-DNA in blood samples were examined for more than 100 days. Four-fold raises of IgM and IgG antibodies against C. burnetii phase 2 were observed within the first three weeks in all the three cases. Maximum titers of IgM and IgG antibodies were 1,024-2,048 and 512-4,096, respectively. According to the temporal diagnostic criteria of acute Q fever in the convalescent serum: the IgM titer of > or = 64 and IgG titer of > or = 512 against phase 2, patient A, B and C were determined to be antibody positive for 45, 199 and 122 days, respectively. The result suggests that this standard is practical and reasonable for diagnosis of acute Q fever. C. burnetti-DNA was detected in the sera and buffy coat samples of patient A who developed high fever, severe thrombocytopenia and liver disfunction, but not in those of patient B and C. This study provides useful information for optimization and standardization of Q fever diagnosis in Japan.     

A case of Bartonella henselae infection from a dog

A 50-year-old male with left cervical lymphadenopathy visited our hospital. Infectious and lymphomatous diseases were suspected in the patient. Since the patient owned a dog, which often licked the patient's face, Bartonella infection was also suspected. Histopathological examination in the lymph node biopsy revealed the epithelioid granuloma, but B. henselae was not detected from the culture of the lymphnode. B. henselae DNA also was not detected from the lymph node. Since the antibody titer (lgG) to B. henselae showed 1:128 by immunofluorescent antibody technique (IFA), he was serdogicalg diagnosed as cat-scratch disease. 'Cat-scratch disease' is named after cat scratch, however we propose 'B. henselae infection' which is more appropriate since other animals could serve as a cause of infection.     

Fulminant Japanese spotted fever--the second fatal case in Japan

A 77-year-old woman who have no past history, was admitted in a local hospital in Muroto City, Kochi, Japan, after several days of fever and severe general fatigue and generalized skin erythema. She was suspected to have Japanease spotted fever, which was a local pandemic disease. She was treated with minocycline immediately. The next day, she had consciousness disturbance and low blood pressure. Laboratory findings indicated disseminated intravascular coagulation (DIC) and multiple organ failure. She was referred to our hospital. An eschar was identified in the back of It. femur. Treatment included minocycline, ciprofloxain, gabexate mesilate, methylprednisolone, hemodialysis and mechanical ventilation. In spite of the avobe treatment, she died 3 days after admission of the local hospital. Though the serological test showed no positive antibody titer against Rickettsia japonica, Rickettsia japonica was isoleted from blood culture, to confirm Japanese spotted fever, Japanese spotted fever is generaly a curative disease with early diagnosis and minocycline. In this case, the patient died 3 days after proper diagnosis and treatment was started. We reported the second fatal Japanese spotted fever case in Japan.     

吉林省林区家畜中斑点热群立克次体与莱姆病螺旋体复合感染的血清学调查

目的了解吉林珲春地区家畜中斑点热、莱姆病及其复合感染的情况。方法应用间接免疫荧光法检测家畜血清中斑点热群立克次体和伯氏疏螺旋体的IgG抗体。结果牛血清中斑点热感染率为18.0%,莱姆病感染率为27.5%,复合感染率为9.5%;羊血清中斑点热感染率为19.2%,莱姆病感染率为31.5%,复合感染率为12.8%。结论吉林珲春地区家畜中广泛存在斑点热和莱姆病的复合感染。     

Association of Bartonella species and Coxiella burnetii infection with coronary artery disease

Coronary artery disease is an inflammatory condition associated with several infections. We prospectively evaluated 155 consecutive patients undergoing coronary angiography for evidence of Bartonella species and Coxiella burnetii infection. All Bartonella cultures were found to be negative. Multivariable logistic regression analysis that controlled for potential confounding factors revealed no association between coronary artery disease and seropositivity to Bartonella henselae (odds ratio [OR], 0.852; 95% confidence interval [CI], 0.293-2.476), Bartonella quintana (OR, 0.425; 95% CI, 0.127-1.479), C. burnetii phase 1 (OR, undefined), and C. burnetii phase 2 (OR, 0.731; 95% CI, 0.199-2.680). The geometric mean titer (GMT) for C. burnetii phase 1 assay was slightly higher in persons with coronary artery disease than in those without such disease (P<.02). B. henselae, B. quintana, and C. burnetii seropositivity was not strongly associated with coronary artery disease. On the basis of GMTs, C. burnetii infection may have a modest association with coronary artery disease.