Bartonella and Afipia Bartonella

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Classification. The genus Bartonella includes, among others, the species B. bacilliformis, B. quintana, B. henselae, and B. clarridgeia.

Morphology and culture. Bartonella bacteria are small (0.6-1 im), Gramnegative, frequently pleomorphic rods. Bartonellae can be grown on culture mediums enriched with blood or serum.

Table 4.15 Pathogens and Clinical Pictures of Bartonelloses

Pathogen Transmission/ Disease Clinical picture host

Bartonella bacilliformis

Sand fly/ humans

B. quintana Lice/humans

B. henselae Cats to humans/cats

Oroya fever (Carrion's disease)

Verruga peruana phase of Oroya fever

Five-day fever (Wolhynian fever, trench fever)

Cat scratch disease

Sepsis, bacillary angiomatosis

B. clarridgeia

Bacterial peliosis hepatis/splenica

Cat scratch disease See above

Incubation: 15-40 days; high fever; lymphadenitis; spleno-hepatomegaly; hemolytic anemia due to lysis of erythrocytes invaded by B. bacilliformis

Multiple, wartlike skin lesions on extremities, face, mucosa; onset either months after abating of Oroya fever or without an acute preceding infection

Periodic relapses of fever (3-8) every 5 days, sepsis; bacillary angiomatosis (see below); also endocarditis

Lymphadenopathy; fever; cutaneous lesion (not always present)

In patients with immune deficiencies (HIV); vascular proliferation in skin and mucosa (similar to verruga peruana)

Cystic, blood-filled lesions in liver and spleen

Diagnosis. Special staining techniques are used to render bartonellae visible under the microscope in tissue specimens. Growth in cultures more than seven days. Amplification of specific DNA in tissue samples or blood, followed by sequencing. Antibody assay with IF or EIA.

Therapy. Tetracyclines, macrolides.

Epidemiology and prevention. Oroya fever (also known as Carrion disease) is observed only in humans and is restricted to mountain valleys with elevations above 800 m in the western and central Cordilleras in South America because an essential vector, the sand fly, lives only there. Cat scratch disease, on the other hand, is known all over the world. It is transmitted directly from cats to humans or indirectly by cat fleas. The cats involved are usually not sick. Table 4.14 lists the pathogens and clinical pictures for the various bartonel-loses.

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