Prevalence of Bartonella species in domestic cats in The Netherlands.

Bergmans-AM; de-Jong-CM; van-Amerongen-G; Schot-CS; Schouls-LM

J-Clin-Microbiol. 1997 Sep; 35(9): 2256-61

Cats have been shown to provide the only known reservoir of Bartonella henselae, the causative agent of cat scratch disease. To determine the prevalence of Bartonella bacteremia and antibodies in Dutch cats, blood samples from 113 cats from shelters (sheltered cats), 50 pet cats, and 25 specific-pathogen-free (SPF) cats were analyzed. Culture and subsequent PCR-restriction fragment length polymorphism (RFLP) analysis of the 16S-23S rRNA intergenic region and 16S rRNA gene PCR-hybridization assays revealed a prevalence of Bartonella bacteremia in 22% of the sheltered cats and showed no bacteremia in the SPF cats. Three spacer RFLP types were found: types A, B, and G, with type B being predominant over types A and G. An important finding was the existence of mixtures of different Bartonella species. Bartonella DNA was detected in 7 of 27 DNA extracts from fleas combed from the sheltered cats (26%). Seropositivity was 50% for sheltered cats and 56% for pet cats, as determined by a B. henselae enzyme-linked immunoassay.

Coinfection with Bartonella clarridgeiae and Bartonella henselae and with different Bartonella henselae strains in domestic cats.

Gurfield-AN; Boulouis-HJ; Chomel-BB; Heller-R; Kasten-RW; Yamamoto-K; Piemont-Y

J-Clin-Microbiol. 1997 Aug; 35(8): 2120-3

Bartonella clarridgeiae and several strains of Bartonella henselae, the agent of cat scratch disease, with variations in the 16S rRNA gene have been found to infect the blood of cats. An epidemiologic study of Bartonella infection in domestic French cats revealed that of 436 cats sampled, 5 cats (1.1%) were coinfected with B. henselae and B. clarridgeiae and 2 cats (0.5%) were coinfected with two strains of B. henselae with variations in the 16S rRNA gene, B. henselae type I and type II. In an indirect immunofluorescence assay, coinfected cats tested positive for both Bartonella species at titers of > or = 128. Identification of the colonies was achieved by preformed enzyme analysis, PCR-restriction fragment length polymorphism analysis of the citrate synthase gene, and 16S rRNA gene sequencing. Colony size differences in mixed culture allowed differentiation of the Bartonella species. The coinfection of cats with two Bartonella species or variants of the same species raises concern about the possibility of dual infection in humans. The development of a polyvalent vaccine targeted against the most pathogenic or invasive strains may be a means of protecting cats and man from infection.

Detection in Humans:

The genus Bartonella now includes four species which may infect humans : B. bacilliformis, B. quintana, B. henselae, and B. elizabethae. B. bacilliformis, the agent of Carrion's disease, was the only species of the genus since 1993 when Rochalimaea species were removed from the genus Rochalimaea and included in the genus Bartonella, within the family Bartonellaceae. B. quintana is the etiologic agent of trench fever, bacillary angiomatosis, septicemia, endocarditis, and chronic lymphadenopathy. B. henselae is responsible for bacillary angiomatosis, peliosis of the liver or the spleen, septicemia, endocarditis, and cat scratch disease. There is a single isolate of B. elizabethae, which was recovered from the blood of a patient involved with endocarditis. The spectrum of clinical manifestations related to Bartonella species has extended since 1990, partly because of newly available molecular biological techniques. However, some aspects of Bartonella-related diseases remain unsettled, including epidemiology, physiopathology, and optimum therapy to be administered.

APPENDIX IV - CAT SCRATCH DISEASE

Classical cat scratch disease (CSD) is considered a relatively benign, self-limiting disease in people. Frequently, an inoculation papule, which can persist for months, is located at the site of a bite or scratch. Intermittent fever, lymphadenopathy and lethargy may be the only clinical manifestations of CSD. Approximately 10% of currently recognized CSD cases are accompanied by atypical manifestations, including tonsillitis, encephalitis, endocarditis, cerebral arteriosis, transverse myelitis, granulomatous hepatitis and/or splenitis, osteolysis, pneumonia, pleural effusion, and thrombocytopenic purura. Until recently, physicians would not have considered bartonella infection in the differential diagnosis of patients with atypical CSD manifestations, particularly if a history of lymphadenopathy or animal contact was not obtained. Infection with Bartonella henselae can produce distinct clinical entities in immunocompromised people, including acute febrile illness with bacteremia, bacillary angiomatosis, peliosis hepatis, bacillary splenitis, and other chronic disease manifestations such as AIDS encephalopathy.

The diagnosis of bartonella infection should be confirmed by culturing the organism or amplifying DNA from tissues, such as lymph node or spleen, using PCR. B. henselae are intraerythrocytic bacteria, therefore cell lysis, using a lysis centrifugation technique, greatly facilitates bacterial isolation from blood. Bacteria in the genus Bartonella are very fastidious, requiring up to 60 days to identify bacterial colonies. Seroconversion, using IFA or ELISA, can be used to confirm a diagnosis in people with acute disease.

Because of disparate results among studies and an overall lack of microbiologic data in clinical therapeutic trials, numerous issues related to treatment of human bartonella infection remains controversial. In contrast to the apparent lack of response to antimicrobial treatment in human CSD patients, bacillary angiomatosis, parenchymal bacillary peliosis, and acute bartonella bacteremia appear to respond to antimicrobial treatment, particularly in immunocompromised individuals. Doxycycline, erythromycin, and rifampin are recommended antibiotics, but clinical improvement has been reported following the use of penicillin, gentamicin, ceftriaxone, ciprofloxacin, and azithromycin.

Although a source of serious morbidity, infection with Bartonella species is an extremely rare cause of human mortality. Following a cat scratch or bite, the skin should be cleansed thoroughly with soap and warm water. If an inoculation papule develops, a physician should be consulted.

Cat Scratch Disease and Associated Syndromes Antibody Profile   (163162)

CPT 86609 (x4)

Synonyms: Bacillary Angiomatosis (BA); Bartonella henselae; Bartonella quintana; CSD; Cat Scratch Disease; Rochalimaea
Test: Includes Bartonella henselae, IgG; Bartonella henselae, IgM; Bartonella quintana, IgG; Bartonella
quintana, IgM
Specimen: Serum
Volume: 2 mL
Minimum Volume: 1 mL
Container: Red-stopper tube or serum-separator tube
Storage Instructions: Refrigerate
Causes for Rejection: Hemolysis; lipemia; gross bacterial contamination
Use: Bartonella (formerly Rochalimaea) henselae has become firmly established as the primary etiologic agent for cat scratch disease (CDS). Bartonella quintana, known for some time as a cause of trench fever, is also associated with CSD and bacillary angiomatosis (BA). Both diseases frequently affect immunocompromised patients, particularly those infected with HIV-1. Although CSD is generally a self-limiting disease, it can be life-threatening.
Limitations: There is some cross-reactivity between the IgG classes of B. henselae and B. quintana.
Methodology: Indirect fluorescent antibody (IFA)

References:

Anderson BE and Neumann MA, "Bartonella spp as Emerging Human Pathogens,"Clin Micro Rev, 1997, 10:203-19.

Bartonella henselae Prevalence in Domestic Cats in California: Risk Factors and Association Between Bacteremia and Antibody Titers,"J Clin Micro, 1995, 33:2445-50.

Regnery RL, Anderson BE, Claridge JE, et al, "Characterization of a Novel Rochalimaea Species, R. henselae sp nov, Isolated From Blood of a Febrile Human Immunodeficiency Virus-Positive Patient,"J Clin Micro, 1992, 30:265-74.

Regnery RL and Tappero J, "Unravelling Mysteries Associated With Cat Scratch Disease, Bacillary Angiomatosis, and Related Syndromes,"Emerg Infect Dis, 1995, 1:1-13.

Welch DF, Pickett DA, Slater LN, et al, "Rochalimaea sp nov: A Case of Septicemia, Bacillary Angiomatosis, an Parenchymal Bacillary Peliosis, J Clin Micro, 1992, 30:275-80.

Cat Scratch Disease

MM Carr DDS MD MEd

What is it?

Cat scratch disease is a granulomatous lymphadenitis, commonly related to scratches from domestic cats, and most common in the head and neck.

It is caused by Bartonella henselae.

Signs & Symptoms

There are no systemic signs or symptoms. Patients, most commonly children, present with lymphadenopathy.

Investigations

Diagnosis can be made with a history of cat exposure, a positive Hanger-Rose skin test, and a biopsy specimen stained with Warthin-Starry silver which shows the bacilli. There is a serum immunofluorescenct antibody test for the bacteria which is newly available and relatively sensitive.

Treatment

The disease is self-limited. There is some beneficial effect from lymph node aspiration. Severe or persistent cases respond to erythromycin or doxycycline.

References

Smith DL. Cat-scratch disease and related clinical syndromes. Am Family Physician 1997;55(5):1783-8.