Bartonella

Alberto Barton, 1909. Until 1990, only two diseases caused by Bartonella species were known (see also Bartonelloses):

Carrión's disease, caused by Bartonella bacilliformis, and

the five-day (or Wolhynic) fever, caused by B. quintana.

More recently, B. quintana has also been associated with endocarditis and bacteremia in the homeless and with bacillary angiomatosis (BA), first described in 1983, which is an AIDS-related disease.

Bartonella is a small 0.6-1.0 μm long gram-negative rod that may also be curved. Pili are found on the surface, but no flagella. The bacterium uses the pili to adhere to, for example, endothelial cells. Bartonella was formerly assigned to the order Rickettsiales together with the Rickettsiaceae (Rickettsia). The species B. quintana and B. henselae were formerly listed under the genus Rochalimaea. Closer genetic relationship exists with Brucella and Agrobacterium.

Bartonella infest endothelial cells in mammals. However, they can multiply not only within endothelial cells but also within erythrocytes (hemotropism) - intraerythrocytic bacteremia. The species B. bacilliformis moves around with the help of flagella, the species B. quintana and B. henselae with pili.

Outside the body, Bartonella shows fastidious growth. Inside the cell, Bartonella destroys the cytoskeleton.

Three major pathogens of human bartonellosis are known and well described:

Bartonella bacilliformis (endemic to limited areas of the Andes) causes 2 distinct diseases:

• Oroya fever as a severe and often septic form of the disease.
• Verruca peruana as a cutaneous form with verrucous papules and nodules on the hands and face.

Bartonella quintana(Febris quintana =Wolhynian fever). Five-day fever transmitted by lice and originally seen in soldiers of World War 1 and 2.

Bartonella henselae(cat scratch disease; in immunocompromised patients; bacillary angiomatosis, edocarditis, encephalitis).

The genus Bartonella yet other less well described species, several of which are human pathogenic (Jacomo V 2002).

Bartonella clarridgeiae is possibly another causative agent of cat scratch disease

Bartonella elizabethae

Bartonellavinsonii subsp. berkhoffii can cause endocarditis

Bartonellavinsonii subsp. arupensis was found in a patient with fever and valvulopathy

Bartonella grahamii can cause uveitis (Jacomo V 2002).

Bartonella bacilliformis only occurs in the Andes in South America between 1000 and 3000 m and is transmitted by ticks and mosquitoes (species Lutzomyia). The clinical picture is described as an acute form of Oroya fever . The chronic form of the infection is known as Verucca peruana.

Bartonella quintana is transmitted via the louse (Pediculus humanus) and is found in persons with low hygiene standards. B. quintana was common worldwide but is now very rare (Hof H et al. 2019).

Bartonella henselae also has a worldwide distribution. An animal reservoir appears to be the cat, in which bacteremia is also very commonly found when bacilliform angiomatosis develops. Transmission of B. henselae to humans is associated with contact with cats(cat scratch disease).

Bartonella quintana (very rare today) and B. henselae: The incubation period is 3-38 days. Acute signs of illness are chills and fever, fever persists for about 1-3 weeks. Fever in episodes may last for 6 weeks. Other disease manifestations may include: headache, retrobulbar pain, swollen lymph nodes, nystagmus, myalgia, arthralgia, hepatosplenomegaly.

Chronic infections with relapsing fever-like episodes are common in patients with immunologic incompetence. Bartonella frequently causes endocarditis; affected patients are usually afebrile.

In HIV-infected patients, bacillary (epithelioid) angiomatosis develops. Lesions may be a few millimeters to centimeters in size and may resemble Kaposi's sarcoma. Swollen regional lymph nodes are typical of Bartonella-related skin lesions. Encephalopathy is very rare, and deaths from B. henselae infection are equally rare. A chronic disease process over many months has only been described in immunosuppressed individuals (e.g., due to HIV).

Antibody: IgG and IgM Western blot tests have been developed with a specificity of 70-95% (Mallqui V et al. (2000). The most common detection is by immunofluorescence, with bartonella growing intracellularly (Vero cells) as substrate. The sensitivity is about 90%. ELISA are available on the market. There is high cross-reactivity between antibodies to B. henselae and quintana.

Growing in culture: Bartonella grows on fastidious culture media such as fresh blood agar and chocolate agar, if the transport time to the laboratory is short, as small yellowish appearing, smooth, pleomorphic colonies. Blood culture is positive for bacteremia. Bartonella has been isolated from tissues such as liver, spleen, lymph nodes, and skin. Microscopically, gram negative rods and also round forms can be seen.

A PCR method to distinguish pathogenic Bartonella has been described (Handley SA et al. 2000).

Therapy: First choice are tetracycline, rifampicin and macrolides, among them preferably azithromycin,

furthermore cephalosporins and quinolones are effective.

Blood donors: No studies are available on the prevalence in blood donors: in Germany, and no transmissions have been reported (Kordick DL et al. 1997).

1. Del Prete R et al (1999) Prevalence of antibodies to Bartonella henselae in patients with suspected cat scratch disease (CSD) in Italy. Eur J Epidemiol 15:583-587
2. Jacomo V (2002) Natural history of Bartonella infections (an exception to Koch's postulates) Clin Diagn Lab Immunol 9: 8-18.
3. McGill S et al (2001) Serological and epidemiological analysis of the prevalence of B spp antibodies in Swedish elite orienteers 1992-93. Scand J Infect Dis 33:423-428.
4. Mallqui V et al (2000) Sonicated diagnostic immunoblot for bartonellosis. Clin Diagn Lab Immunol 7:1-5
5. Handley SA et al (2000) Differentiation of pathogenic Bartonella species by infrequent restriction site PCR. J Clin Microbiol 38:3010-3015
6. Kordick DL et al (1997) Relapsing bacteriemia after blood transfusion of Bartonella henselae to cats. Am J Vet Res 58:492-497