BARTONELLA
Bartonellat ovat gram-negatiivisia bakteereja jotka kykenevät tunkeutumaan solujen sisälle esim. makrofagi, puna- ja endoteelisolu. Ne aiheuttavat usein kroonisen infektion. Bakteeria levittävät esim. täit, kärpäset (löydetty esim. hirvikärpäsistä Suomessa) ja kirput.
http://www.ncbi.nlm.nih.gov/pubmed/1838 ... rom=pubmed
Bartonellabakteerin voi saada myös esim. punkinpiston, kissanraapaisun jne. välityksellä.
http://www.cdc.gov/eid/content/14/7/pdfs/1074.pdf
Bartonellabakteeri aiheuttaa erityisesti silmä- ja sydänsairauksia, mutta myös lukuisia muita sairauksia.
http://www.cdc.gov/eid/content/14/7/pdfs/1074.pdf
Transmission of Bartonella henselae by Ixodes ricinus.
Bartonellabakteeri aiheuttaa erilaisia silmäsairauksia: näköhermon turvotus, verkkokalvon irtoaminen, vasoproliferatiivisia verkkokalvovaurioita, lasiaisen irtoaminen, lasiaisen tulehdus, verisuonten tukkeutuminen verkkokalvolla, näköhermonystyn tulehdus, valkeita pisteitä verkkokalvolla jne.
Beyond Cat Scratch Disease: Widening Spectrum of Bartonella henselae Infection.
http://pediatrics.aappublications.org/c ... 21/5/e1413
Ocular Manifestations
Parinaud oculoglandular syndrome, consisting of fever, regional lymphadenopathy, and follicular conjunctivitis, was first described in 1889 and is the most common ocular presentation of B henselae infection, affecting 5% of patients with CSD.10 Only within the last decade was B henselae identified as the causative agent of this syndrome.50 Route of infection is thought to be direct conjunctival inoculation. Typical symptoms include foreign body sensation, unilateral eye redness, serous discharge, and increased tear production. On examination, patients present with a necrotic granuloma with ulceration of the conjunctival epithelium and regional lymphadenopathy that affects the preauricular, submandibular, or cervical lymph nodes.51 The granuloma typically disappears after several weeks without scarring.10
Neuroretinitis, a form of optic neuropathy with optic disk swelling and macular stellate exudate, is the most common posterior segment ocular complication of Bartonella infection.51 B henselae is the most common identified etiology of neuroretinitis, with approximately two thirds of patients with neuroretinitis demonstrating serologic evidence of previous B henselae infection.52 Symptoms include painless visual loss with abrupt onset that is typically unilateral.53 On MRI, unilateral enhancement at the optic nerve-globe junction is highly specific for B henselae infection as cause for optic neuropathy.54 Macular exudates may take months to resolve and, even after resolution, patients may experience abnormal color vision and evoked potentials, subnormal contrast sensitivity, residual disk pallor, afferent pupillary defects, retinal pigment changes, and mildly decreased visual acuity.55
There are reports of ocular Bartonella disease with optic disk edema and retinal detachment without the classic macular stellate exudate seen with neuroretinitis.56 Other posterior segment presentations of B henselae infection include panuveitis with diffuse choroidal thickening, retinal vasoproliferative lesions, macular hole, vitreal detachment, vitritis, branch retinal artery and venous occlusions, retinal white spots, and papillitis.57?60 In HIV-positive patients, ocular B henselae infection presents as a subretinal mass associated with abnormal vascular network, which is best diagnosed by fluorescein angiography.61
Bartonellabakteeri voi aiheuttaa samantyyppisiä neurologisia ja esim. MS-tyyppisiä oireita kuin borreliabakteeri, esim. enkefalopatia, aivotulehdus, levottomuus, ärtyneisyys, jatkuva päänsärky, dementia, lihasten heikkous, puutuneisuus, tuntohäiriöt, tasapainohäiriöt, epilepsiatyyppiset kohtaukset, rakon/suoliston toimintahäiriöt jne. Bartonellainfektion mahdollisuus tulee huomioida myös sellaisissa tapauksissa joissa potilaan oireet jatkuvat borrelioosihoitojen jälkeen.
Bartonella henselae and Borrelia burgdorferi infections of the central nervous system.
http://lymepoland.com/pliki/Bart+Borelioza_CNS.pdf
Bartonella encephalitis in Infections of the Central Nervous System:
http://jcm.asm.org/cgi/content/full/46/9/2856
Bartonella spp. Bacteremia in Patients with Neurological and Neurocognitive Dysfunction
http://jcm.asm.org/cgi/content/full/46/9/2856
Bartonella Species in Blood of Immunocompetent Persons with Animal and Arthropod Contact
http://www.cdc.gov/eid/content/13/6/938.htm
Bartonella (Rochalimaea) antibodies, dementia, and cat ownership among men infected with human immunodeficiency virus.
http://www.ncbi.nlm.nih.gov/pubmed/8645 ... t=Abstract
Possible association between the organism Bartonella quintana and pediatric HIV encephalopathy
http://pediatrics.aappublications.org/c ... 21/5/e1413
Bartonella aiheuttaa myös esim. aivosairautta (enkefalopatia) ja agressiviista käyttäytymistä, mutta infektiosta huolimatta selkäydinestenäytteet ovat yleensä normaalit. Bakteeri voi infektoida myös maksan, munuaiset, pernan, keuhkokuumeen jne.
Beyond Cat Scratch Disease: Widening Spectrum of Bartonella henselae Infection
http://pediatrics.aappublications.org/c ... 21/5/e1413
Bartonellatestit antavat vääriä negatiivisia tuloksia esim. bakteerikantojen antigeeneissä esiintyvien erojen vuoksi. Allaolevassa tutkimuksessa 14 henkilöä (30 ? 53 v.) oli ollut vuosien ajan päivittäisessä kontaktissa yli 10 v. ajan eläinten, esim. kissan kanssa. Kaikki olivat myös saaneet useita erilaisten vertaimevien hyönteisten kuten punkkien, kirppujen, kärpästen jne. pistoja. Kaikilla esiintyi kroonisia tai jaksoittaisia oireita, kuten lihas- ja nivelkipuja, muistihäiriöitä, ihon tuntohäiriöitä, fatiikkia, päänsärkyä jne. Oireet olivat pääasiassa lieviä tai keskivaikeita. Hyvät ja huonot kaudet vuorottelivat. Useat olivat käyneet oireidensa vuoksi eri erikoisalojen lääkärien, esim. kardiologin, neurologin, sisätautilääkärin, infektiolääkärin jne. vastaanotoilla.
Bartonella Species in Blood of Immunocompetent Persons with Animal and Arthropod Contact. Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations.
http://www.cdc.gov/eid/content/13/6/938.htm
BARTONELLAINFEKTION HOITO ANTIBIOOTEILLA: Aminoglykosidit, Doksisykliini, Atsitromysiini, Rifampisiini, Levofloksasiini.
Suom.huom. Aminoglykosideihin kuuluvat muun muassa seuraavat lääkeaineet:
amikasiini
gentamisiini
kanamysiini
neomysiini
netilmisiini
streptomysiini
tobramysiini
Bartonella spp. Bacteremia in Patients with Neurological and Neurocognitive Dysfunction
http://jcm.asm.org/cgi/content/full/46/9/2856
Potilaiden hoidot olivat yksilöllisiä. Potilaat saivat tapauksesta riippuen plasmafereesin, antibiootteja, kortikosteroideja, suonensisäistä immunoglobuliinia, kouristuksia ehkäisevää lääkitystä jne.
Potilas 1. Doksisykliini 6 vko. Oireeton 3 v:n seurannassa.
Potilas 5. Doksisykliini 5 vko, atsitromysiini 6 vko, levofloksasiini 9 vko. Potilaan tilanne parani vähitellen ja hän pystyi palaamaan töihin. Viimeisen vuoden aikana hän sai toistamiseen doksisykliiniä ja rifampinia. Oireiden uusiutumista ei sen jälkeen enää tapahtunut.
Potilas 6. Atsitromysiini 6 vko.
Potilaat 2 ja 3. Doksisykliiniä ilman mainittavaa vaikutusta tilanteeseen.
Potilas 4. Jatkuva doksisykliinihoito 2 vuoden ajan. Tänä aikana päänsärky, selkä- ja nivelkivut ovat helpottaneet vaikkakin niveloireet pahenevat aika ajoin.
Antibiooteista telitromysiini oli tehokkainta, mutta myös makrolidit, erityisesti klaritromysiini, doksisykliini ja rifampisiini olivat tehokkaita. Etesti saattaa olla luotettava bartonellatesti.
In vitro susceptibility of Bartonella species to 17 antimicrobial compounds: comparison of Etest and agar dilution
http://jac.oxfordjournals.org/cgi/reprint/58/4/784.pdf
Bakteeria ei välttämättä saada helpolla hoidettua antibiooteilla. ?Bartonella ja brucella ovat samankaltaisia bakteereja. Kummatkin voivat aiheuttaa vaikeahoitoisen kroonisen infektion ihmisessä. Aminoglykosidi-ryhmän antibiootit saattavat olla tehokkaita kroonisen bartonellainfektion hoidossa. Kyseiset antibiootit olivat bakterisidisiä (bakteereja tappavaa).?
(Suom.huom. Aminoglykosideihin kuuluvat muun muassa seuraavat lääkeaineet: amikasiini, gentamisiini, kanamysiini, neomysiini, netilmisiini, streptomysiini, tobramysiini).
Bactericidal effect of antibiotics on Bartonella and Brucella spp.: clinical implications http://jac.oxfordjournals.org/cgi/content/full/46/5/811
Kaikilla antibiooteilla (in vitro), aminoglykosidejä lukuunottamatta oli ainoastaan bakteerien kasvua estävä vaikutus (bakteriostaattinen). Siitä sekä antibioottien huonosta soluläpäisevyydestä johtuen epäillään, että antibiootit eivät pysty tuhoamaan solujen sisällä olevia bartonellabakteereita. Tieto bartonellan aiheuttamista oireista lisääntyy koko ajan, mutta hoitoa koskeva tietoa on saatavissa lähinnä tapausselostuksista. Neuroretiniitin hoidossa käytetään yleisimmin doksisykliiniä sen hyvän läpäisevyyden vuoksi (silmät, keskushermosto). Yhdessä Rifampinin kanssa se lyhentää taudin kestoa, vähentää silmähermon turvotusta ja parantaa näkökykyä. Hoitoa jatketaan jopa 4 kk. Sydäntulehduksia hoidetaan aminoglykosidien ja doksisykliinin/keftriaksonin yhdistelmällä.
Beyond Cat Scratch Disease: Widening Spectrum of Bartonella henselae Infection
http://pediatrics.aappublications.org/c ... 21/5/e1413
?Ainoastaan sellaiset antibiootit jotka kykenevät tunkeutumaan solujen sisälle ja ovat bakteereja tappavia, kuten aminoglykosidit, voivat tuottaa tulosta kroonisen bartonellainfektion hoidossa.?
In Vitro Susceptibilities of Four Bartonella bacilliformis Strains to 30 Antibiotic Compounds.
http://aac.asm.org/cgi/content/full/43/ ... e6206c02ed
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Kirja bartonellasta: Epätyypillisen bartonellan diagnostiikka, hoito ja ennaltaehkäisy; lisäinfektio on yleinen syy borrelioosin hoidon epäonnistumiseen.
James Schaller, MD. The Diagnosis, Treatment and Prevention of Atypical Bartonella: A Common Cause of Lyme Disease Treatment Failure
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"Kissanraapimatauti on tunnettu jo 60 vuotta, mutta sen aiheuttaja on selvinnyt vasta viime vuosina. Diagnoosi on perustunut useisiin seikkoihin, jotka ovat kontakti kissaan ja usein pieni papula raapimakohdalla, paikallisten imusolmukkeiden suurentuminen, lämpöily, muiden samankaltaisten tautien pois sulkeminen sekä histologisesti imusolmukkeessa todettava hyperplasia sekä pienet absessit. Warthin-Starryn hopeavärjäyksellä imusolmukkeessa voidaan lisäksi todeta monimuotoisia mikrobeja (Margileth ja Hayden 1993). Viisi vuotta sitten kissanraapimatautipotilaiden imusolmukkeista onnistuttiin eristämään bakteeri, jolle annettiin nimeksi Afipia felis. Myöhemmin potilaiden imusolmukkeista kasvoi myös toinen bakteeri, riketsioihin kuuluva Rochalimaea henselae (Tompkins ja Steigbigel 1993). Vasta-aine- ja DNA-tutkimusten perusteella näyttää siltä, että R. henselae olisi kissanraapimataudin todellinen aiheuttaja.
Kissanraapimatauti on nykyään selvästi yleisin zoonoosi Yhdysvalloissa. Yleensä potilaat ovat lapsia, mutta myös aikuiset voivat sairastua. Tauti paranee yleensä itsestään 2 - 4 kuukaudessa. Siihen liittyvä kuumeilu, suurentuneet imusolmukkeet sekä joillakin potilailla todettavat keskushermosto-oireet, maksan granulomatoottiset muutokset sekä lyyttiset muutokset luustossa saattavat kuitenkin aiheuttaa erotusdiagnostisia ongelmia (Cohen- Abbo ym. 1992).
Kissanraapimatautia tavataan jonkin verran myös Suomessa. Sen todellisesta esiintymisestä maassamme ei kuitenkaan ole tietoa, koska vasta-aineiden mittaamiseen perustuvaa selvitystä ei ole vielä tehty. Taudin diagnoosi on tähän saakka ollut kliininen. R. henselae -vasta-aineita voidaan mitata joko entsyymi- immunologisilla tai immunofluoresenssimenetelmillä. Vasta-ainetestiä ei tiettävästi vielä tehdä Suomessa missään laboratoriossa. Bakteerin viljely esimerkiksi imusolmukenäytteestä tai verestä on mahdollinen, mutta bakteerin kasvuaika on useita viikkoja
Mikrobilääkkeiden tehosta kissanraapimataudin hoidossa ei ole varmaa näyttöä. Hoidossa on kokeiltu mm. sulfa-trimetopriimia, rifampisiinia, siprofloksasiinia sekä gentamysiiniä (Tompkins ja Steigbigel 1993). Kissanraapimatautia tutkitaan edelleen, ja ainakin mikrobilääkehoito vaatii vielä lisäselvityksiä, samoin kissoissa esiintyvien kirppujen ja punkkien osuus taudin levittäjinä (Margileth ja Hayden 1993). Immuunipuutteisilla potilailla on todettu niin ikään kissoihin liittyvä R. henselae ja R. quintana -bakteereiden aiheuttama tauti, basillaarinen angiomatoosi. Tätä tautia on todettu joitakin tapauksia myös aiemmin terveillä henkilöillä (Tompkins ja Steigbigel 1993). Potilaiden iholla havaitaan punertavia kyhmyjä, joissa voi olla haavaumia. Sisäelimissä saatetaan todeta useita veren täyttämiä onteloita. Basillaarinen angiomatoosi ei parane itsestään. Tautia voidaan hoitaa tehokkaasti tetrasykliineillä tai erytromysiinillä (Tompkins ja Steigbigel 1993). "
http://www.duodecimlehti.fi/web/guest/e ... ku_p_auth=
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Huonosti tunnettu hirvikärpänen saattaa levittää ihmiselle haitallisia tauteja.
Kotimaa 22.09.2006 23.12
- Hirvikärpänen on vaarallisempi otus kuin tiedetäänkään, kertoo metsäeläintieteen professori Kari Heliövaara Helsingin yliopistosta.
Helsingin yliopiston soveltavan biologian laitos teki yhdessä Metsäkeskuksen kanssa verkkokyselyn, jossa tiedusteltiin kokemuksia hirvikärpästen puremista. Kolmasosa vastaajista kertoi kärsineensä pitkäaikaisesta, jopa kuukausien mittaisesta tulehduksesta. Toinen kolmasosa oli kärsinyt kutinasta ja paukamista.
Toistaiseksi puremista ei ole koitunut vakavia seurauksia, mutta Keski-Euroopassa hirvikärpästen on todettu kantavan ihmiselle riskin muodostavia bakteereja.
Hirvikärpästen kantamien bartonellasuvun bakteerien tiedetään aiheuttaneen sydänlihastuleduksia ja Trypanosoma-suvun alkueläimet aiheuttavat unitautia - samaa tautia, jota tsetsekärpäset levittävät. Kärpäslajit muistuttavat muutenkin toisiaan.
- Hirvikärpäsen elämänkierto on hyvin poikkeuksellinen. Laji ei muni lainkaan, vaan toukka syntyy naaraasta. Jos naaras kantaa jotain bakteeria, se leviää toukkaan ja samaan tapaan ihmiseen. Hirvikärpäsen elämänkierto on samanlainen kuin tsetsekärpäsellä, eikä muita samanlaisia tunneta, Heliövaara valaisee.
Kärpästä on liki mahdoton torjua
Kärpänen puree ihmistä luullessaan tätä hirveksi. Ihmisen veri ei kuitenkaan sovi hirvikärpäsen ravinnoksi, joten se ei jää loisimaan pitkäksi aikaa toisin kuin hirviin ja metsäpeuroihin.
- Viime vuonna ammuttiin yksi hirvi tutkittavaksi. Löysimme siitä 10 000 hirvikärpästä, Heliövaara kertoo.
Metsässä liikkuville sienestäjille ja marjastajille hirvikärpänen on ikävä riesa, mutta metsätöitä tekevät kärsivät ötökästä eniten.
Hirvikärpänen on ihmiselle vaivalloinen sikäli, että sen torjuminen on lähes mahdotonta, eikä sen puremiin ole lääkkeitä. Sitkeä eläin kestää hyönteismyrkyt ja saattaa viihtyä ihmisen hiuksissa parikin päivää: se ei hätkähdä edes saunomista.
Kansanterveyslaitoksen infektologian erikoistutkijan Henrikki Brummer-Korvenkontion ja Tampereen yliopiston ihotautien professorin Timo Reunalan mukaan ainoa keino välttää hirvikärpäsiä on pukeutua vaaleaan, hyvin peittävään vaatetukseen, johon kuuluu tiivis huppu tai harsohattu.
Metsäalan ammattilaiset ovat tosin tästä eripuraisia. Ainoa täysin varma keino välttää purema näyttää olevan se, ettei liiku hirvikärpäsalueilla.
Hirvikärpäset viihtyvät tiheissä metsiköissä. Avoimilla alueilla niitä ei juuri ole, sillä hirvikärpänen ei kykene lentämään pitkiä matkoja.
Rauhoittava ihovoide voi helpottaa
Jos purema alkaa vaivata, Reunala ja Brummer-Korvenkontio neuvovat, että antibakteerista ainetta sisältävä hydrokortisonivoide ja antihistamiinitabletit saattavat lievittää kutinaa hieman.
Voimakkaimmissa reaktioissa ja näppylöiden märkiessä tarvitaan käynti lääkärissä. Tällöin käytössä ovat voimakkaammat kortisonivoiteet ja mahdollisesti myös sisäinen antibioottilääkitys.
Helsingin yliopiston ja Metsäkeskuksen kyselyn mukaan hirvikärpästen yleistyminen vaikuttaa jo metsässä liikkujien käyttäytymiseen. Kyselyyn vastanneista varsinkin naiset kertoivat suojautuvansa usein.
Osa vastaajista kertoi välttävänsä hirvikärpäsalueita ja osa jopa vähentäneensä metsässä liikkumista.
Lajista tiedetään hyvin vähän
Hirvikärpäsistä ei ole kovin paljon tietoa, sillä niitä ei ole tutkittu juuri lainkaan. Suomessa hirvikärpänen on melko tuore tuttavuus - ensimmäinen havainto tehtiin 1960-luvulla Kaakkois-Suomessa. 2000-luvulla hirvikärpästen lukumäärä on kasvanut, ja ne ovat levinneet Pohjois-Suomen poroihin. Hirvikärpästen määrää ei tosin tiedä kukaan, sillä sitä ei mitata.
Hirvikärpäsiä on myös Ruotsissa. 1990-luvulla Ruotsia kuohuttivat tapaukset, joissa suunnistajia kuoli yhtäkkiä metsään. Heillä todettiin hirvikärpäsenkin kantamaa Bartonella-bakteeria.
- Mutta bakteerin ja kuolemantapausten välinen yhteys on yhä epäselvä, Kari Heliövaara rauhoittelee.
Hän kuitenkin luonnehtii hirvikärpästä terveysriskiksi, koska laji tunnetaan niin huonosti.
- Sitäkään ei tiedetä, miksi sen puremasta tulee paukamia. (HäSa)
Kari Heliövaara, metsäeläintieteen professori
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Lyme borreliosis and Bartonella
By Barbara L. Fitzmaurice, R. N.
We are not textbook diseases anymore!
Co-infection with multiple vector-borne organisms may occur in animals and in humans. We now realize it is very possible to be infected with bacterial, rickettsial, parasitic, viral, and protozoal organisms following the attachment of a single tick. Borrelia burgdorferi, a spirochetal bacteria, other strains of Borrelia species, and additional infectious organisms such as the protozoa, Babesia spp.(1 (babesiosis), Francisella tularensis (tularemia), Rickettsia rickettsii (Rocky Mountain spotted fever)(1) and ehrlichiosis (an intracellular bacteria causing human monocytic ehrlichiosis (HME) and human granulocytic ehrlichiosis (HGE)), mycoplasma (parasitic bacteria), and Powassan-like virus also are spread by ticks.(2) More recently, bartonella, an intracellular organism transmitted via the tick, has also been found to infect humans.(3)(4)(5)
The organisms in the genus bartonella have emerged in importance as opportunistic pathogenic infections in humans. Seven species, with a possibility of an eighth, exist in the genus bartonella and are known to cause illness in humans: Bartonella bacilliformis, B. elizabethae, B. henselae, B. quintana, B. washoensis, B. vinsonii subsp. Berkhoffii, B. vinsonii subsp. Arupensis. (Table 1) A widening spectrum in the bartonella species and subspecies of organisms causes infections in mammals as well. Birds, which carry lice and ticks, no doubt play a major role in transporting and disseminating these infected vectors, resulting in widespread disease. Numerous animals, both domestic and wild, act as reservoirs for the bartonella species. With the apparent ability of insects also to act as bartonella reservoirs, a much higher prevalence of this infectious disease is becoming evident.
Another possibility is that many of the infectious diseases mentioned above could have the potential to be sexually transmitted. Research into transmission of some of the above diseases through other vectors, such as the mosquito,(6) flea, sand fly, and louse, as well as via blood transfusions,((9(10) mother to fetus transmission,(13)(14), and transmission through breast-feeding, has been documented. A few early studies looked at direct contact as a mode of transmission of spirochetes. (15) (19) It is possible that bartonella infections or the other pathogenic organisms found in Lyme disease patients may also be transmitted between species by other mechanisms than those known or suspected. (6) (12) Clearly, the growth in the numbers of ticks in the United States and worldwide is alarming. (11) Increasing tick populations, along with other vectors capable of transmitting Lyme disease and other infectious illnesses to humans, has reached a level that no prudent public or private healthcare professional should ignore.
The bartonella species are not free-living organisms and require a reservoir host that is transferred by vectors such as body lice, flies, and ticks. Fleas have been found infected with Bartonella henselae in both dogs and cats, indicating that Bartonella henselae may be transmitted to humans and pets via the flea vector. (15) (16) While researchers still dispute this, there is a growing number of reports of patients proving positive for bartonella infection having no history of contact with cats. Scratches from a cat and exposure to the saliva were thought to be the only means of transmission of bartonella infection for a very long period. It has since been established that fleas carry the organism in their midgut, and bartonella has also been found in the feces of fleas.(16) (21)(39) Other small and large animals that carry fleas and ticks may undoubtedly act as hosts as well. (Table 1)
Table 1 - The genus bartonella with species and subspecies listed. As research is ongoing, undoubtedly more strains will be discovered and more information will be forthcoming on the specific illnesses these organisms are capable of causing in humans.
Bartonella bacilliformis (also called Bartonellesis)
Flies in South America
Oroyo fever (acute hemolytic anemia), Carrion?s disease (chronic ? verruga peruana) (3)(15)(20)
B. Elizabethae
Tick and Rodent Endocarditis (26)
B. henselae (11 strains)*
Fleas, ticks, animals
Cat scratch disease, endocarditis, (3)(19) bacillary angiomatosis (24)
B. quintana (7 strains)*
Body louse, tick
Trench fever, endocarditis, (3)(23) bacillary angiomatosis (46)
B. clarridgeiae
Fleas, cats. Isolated from a patient
Found in cat scratch disease. Found in a patient with endocarditis
B. alsatica sp. nov.
Isolated from the blood of wild rabbits
Unknown if disease in humans
B. birtlesii
Isolated from small mammals
Unknown if disease in humans
B. bovis
Isolated from European & American ruminants
Unknown if disease in humans
B. capreoli
Isolated from European ruminants
Unknown if disease in humans
B. doshiae
Isolated from the blood of animals and man
Unknown if disease in humans
B. grahamii (5 strains)*
Isolated from the blood of animals
Neuroretinitis(54)
B. koehlerae
Isolated from the blood of animals
Unknown if disease in humans
B. peromysci
Isolated from the blood of animals
Unknown if disease in humans
B. schoenbuchii sp. nov.
Isolated from the blood of wild roe deer
(45)
B. talpae
Isolated from the blood of animals
Unknown if disease in humans
B. taylorii (6 strains)*
Isolated from the blood of animals
Unknown if disease in humans
B. tribocorum
Isolated from the blood of animals
Unknown if disease in humans
B. vinsonii subsp. arupensis
Isolated from the blood of animals and man
Valvular disease, heart, fever, and neurological signs(3)
B. vinsonii subsp. berkhoffii
Isolated from the blood of the canine, rodents, and ticks
Endocarditis(3)(19)(26)
B. vinsonii subsp. vinsonii
Isolated from the blood of animals, transmission via tick
Unknown if disease in humans
B. washoensis
Rodents, I. pacificus ticks
Myocarditis (3)
(1) (26) (27) (37) (43)*
Relationship of Bartonella Species
Similar protein profiles have been established and a dendrogram (comparison of relationships based on immunoreactive bands) demonstrated that the Bartonella species can be divided into three groups:
· Bartonella bacilliformis is distinct from the other bartonella species
· Bartonella grahamii, Bartonella taylorii, Bartonella doshiae, and Bartonella Vinsonii are related and form a cluster
· Bartonella henselae, Bartonella quintana, Bartonella elizabethae and Bartonella clarridgeiae also form a cluster
. (Bartonella henselae is related closely to Bartonella quintana, Bartonella clarridgeiae is closely related to Bartonella henselae, and Bartonella elizabethae is closely related to Bartonella quintana and Bartonella henselae)
ITS, or intergenic spacer sequencing, may be an effective method for the further sub-typing and identification of the Bartonella spp. For instance, B. henselae has further been found to have 11 strains of the organism.(43)(56)
Western blotting appears to be an effective method to identify the phenotype of the bartonella group down to the species.(43)
· Bartonella bacilliformes: Oroyo fever, or Carrion?s disease, is transmitted from the sand fly in South America and can cause severe progressive anemia and high fevers with muscle, tendon, and joint pain. Skin eruptions or internal lesions that bleed profusely may be present, and the result can be fatal. The organism attaches to red blood cells and destroys them. If disseminated into the brain, neurological problems may develop causing seizures, paralysis, and death. In 1926 research by H. Noguchi, the tick Dermacentor andersoni was experimentally infected with Bartonella bacilliformis, which then transmitted the organism to a non-human primate.(20)
The term ?bartonellosis? has been used to describe the frequently fatal syndrome caused by B. bacilliformis. It has only been reported in South America, although with the emergence and increase in illness due to vector-borne disease worldwide, it may someday have no boundaries. One treatment and another consideration worth noting is that chloramphenicol is effective against Salmonella, and this organism has been found as a secondary infection along with B. bacilliformis.(25)
· Trench fever due to Bartonella quinata (formerly Rickettsia, Rochalimaea) can be contracted after exposure to the body louse and may cause prolonged or recurrent fevers. Transmission commonly occurs when infected lice feces are rubbed into an open area on the skin or in the eyes. The organism can persist in humans for months after recovery and relapses have been reported as many as ten years later. This illness was seen in military personnel during World War I and World War II. The incubation period is 14-30 days, but problems may appear sooner. Onset is sudden, with fever, weakness, dizziness, and headache. There may be severe back and leg pains, bone pain, and an enlarged spleen. Fever may reach 40.5° C (105° F) and persist for five to six days. Fever has been reported to reoccur at intervals. Rash is possible. The liver and the spleen may enlarge, and recently endocarditis, an infection involving the heart, has been documented.(19)(22)(25) Recommendations for treatment are chloramphenicol and the tetracyclines, although currently there have been no studies to prove that this disease can be overcome completely.(1(19)(24)
· Bacillary angiomatosis (BA), due specifically to B. henselae and B. quintana, was the name used when first recognized in immunocompromised AIDS patients. These patients either developed nodules under the skin or vascular lesions, meaning bartonella infection had entered the blood vessels or lymph system. The nodules included papular, nodular, or polypoid lesions. (23) BA may also occur as a septicemia, infection that has disseminated into the blood, which if left untreated may lead to death. A patient with BA may have an increase in lesions, rashes, abscesses, chills, fever, sweats, lack of appetite, nausea, and vomiting as well as weight loss. BA is now reported to be an illness found in immunocompetent patients as well (32)
· B. elizabethae can cause endocarditis. B. vinsonii has been reported recently to be another cause of human endocarditis. Two Bartonella species, B. henselae and B. clarridgeiae, have been isolated from the blood of cats. B. henselae DNA has been amplified from fleas isolated from bacteremic cats. Transmission of B. henselae by the cat flea, or Ctenocephalides felis, has been demonstrated. Recently, B. clarridgeiae was isolated from the blood of a cat. It was present in the bloodstream of a healthy cat involved in a human case of cat-scratch disease (CSD) caused by B. henselae. It is not known whether B. clarridgeiae can be transmitted to man via cat or whether it actually does induce disease in humans.(26)(27) However, it is highly suspect since B. clarridgeiae antibodies recently have been found in a chest wall abscess.(35)
· Bartonella henselae, or cat -scratch disease (CSD), originally named Rochalimaea henselae in 1992, was renamed Bartonella henselae after the entire genus of Rochalimaea was merged with the genus of Bartonella in 1993. This organism is a gram-negative rod-like bacillus. Cat-scratch disease was described in 1950, but not until some 43 years later was a primary pathogen found. In the 1990s, it was determined that this infectious agent could be widespread in humans after AIDS patients were observed exhibiting symptoms that affected virtually every organ system in the body, including the brain, heart, lymph, bone, bone marrow, muscle, soft tissue, liver, and spleen. (20)(21)(25) The same organism has been identified as a cause of encephalitis following dissemination of Bartonella henselae into the central nervous system.
CSD can be transmitted by kittens and cats and, most likely, by fleas and ticks. This illness is closely related to Bacillary angiomatosis, which has mainly been seen in AIDS and other immunocompromised patients.(20)(27) It should be noted that the saliva of the cat might also contain the organism. Therefore, if an open area on the body is exposed to the Bartonella organism, transmission can also occur in that fashion.
Earlier papers discussed the idea that immunocompromised individuals would be the most susceptible population at risk for contracting cat-scratch fever if exposed to the organism Bartonella. First recognized in AIDS patients and later in individuals with chronic illnesses such as cancer, it has most recently been detected in patients with chronic infections including Lyme disease. This population of patients most likely would have more complications in fighting this infection. Still some physicians continue to insist that infection with a Bartonella species is a self-limiting illness in an otherwise healthy individual.
After a superficial scratch from cat or kitten, a raised lesion or papule may form near the point of injury, reportedly, in about half of the CSD patients. The lesion becomes red and crusty. One to two weeks later, swollen painful lymph glands, along with fever, may appear. Conjunctivitis, meningitis, or pneumonia, all serious complications, may develop.(24)
Patients complain of fatigue, headache, sore throat, swollen and painful lymph glands and, sometimes, loss of appetite, with weight loss due to nausea and vomiting occurring in some individuals. Reddish, berry-like lesions on the skin can bleed very easily if the skin is injured. In other patients, no rashes or lesions develop. Infections occur in bone, liver, and brain. Abscesses may form. Endocarditis may develop in AIDS patients or the immunocompromised patient infected with Bartonella henselae and Bartonella quinata. As this pathogenic organism may not be well recognized, it could present as a very serious illness in the immunocompetent person as well.(33)(34)
Other symptoms include inflammation of the optic nerve and the retina, myelitis leading to paraplegia, and cerebral arteritis, an inflammation of an artery in the brain. Cranial or peripheral nerve involvement may be present. Facial palsy or peripheral facial nerve paralysis, known as Bell?s palsy, has been commonly reported in patients with Lyme disease and is also reported in Cat Scratch Disease.(22)(24)(36))(37)(3(49)
Cats can be infected with Bartonella henselae but remain without symptoms. With the latest findings that a flea or tick may carry the disease and transmit it to humans, potential infection with this disease should not be overlooked. This is an important fact for all clinicians to take into account. Families that have pets or may have contact with small animals that carry lice and ticks need to take action to eliminate these parasites from their pets.
Testing and Diagnosing
?For many years, CSD has been clinically diagnosed when three of the following four criteria are met in a patient: 1) history of traumatic cat contact; 2) positive skin-test response to CSD skin-test antigen; 3) characteristic lymph node lesions; and 4) negative laboratory investigation for unexplained lymphadenopathy.? (32) Quoted from Russell Regnery, Ph.D., and Jordan Tappero, M.D., 1995
Blood serology has commonly been used to look for the antibodies to both Bartonella henselae and Bartonella quintana. It was not until fairly recently that testing for antibodies in other species was undertaken. Bartonella henselae can be cultured from lymph nodes or the papule area of a scratch. Positive antibody titers can help confirm the diagnosis, but may or may not be present. CT scans may be normal or EEG?s may show some slowing, but the all-important medical history and physical exam are essential in determining the diagnosis of cat-scratch disease. An antibody titer test may be ordered to see if the person is producing antibodies to Bartonella henselae. A polymerase chain reaction test (PCR) can be performed but it still may not reflect with absolute certainty an infection with the Bartonella organism unless histology and serology testing is also done. Using special techniques, the bacteria can sometimes be seen in a biopsy specimen from the affected body part.
Still, it is possible to have routine laboratory cultures reported as ?negative.? Bartonella organisms from the many species and strains have not all been differentiated, and so the exact infecting species or strain may not be known in patients. Enhanced methodologies in the future may help answer these questions and decrease confusion. Coxiella or Chlamydia are two infections that are difficult to differentiate from bartonella even with testing. All can be a cause of endocarditis, but different antibiotics are used in treatment. Development of reliable tests to distinguish between these organisms is very much needed.(44)
Spinal fluid may also show an increase in protein, but minimal pleocytosis (a small increase in the number of lymphocytes in cerebral spinal fluid) may be observed. New testing methods that distinguish between B. henselae and closely related B. quintana cells might be more sensitive in PCR testing. The organism itself can be viewed in tissues.(43)(44) Other illnesses due to Bartonella henselae are bacillary angiomatosis (BA) and Parinaud?s oculoglandular syndrome (eye involvement with red, irritated eye). There may be excessive tears, similar to conjunctivitis. Sometimes swelling of the lymph glands occurs nearby, often in front of the ear. A fever and generalized illness may be present.(3)
Using indirect fluorescence assay (IFA), IgG antibody positive titers in the acute phase of B. henselae infection have been reported to be high after two weeks. IgG antibodies were lower after 25 weeks. IgM antibodies demonstrated less sensitivity using IFA serology testing.(45) PCR sensitivity and specificity from the lesions or nodes, may be even more accurate if fine needle aspiration is employed. (32) Bartonella henselae and Bartonella quinata can be tested in the blood of immunocompromised patients by obtaining blood cultures and using special stains that are allowed to grow for 21 days or longer. This may delay much needed treatment. In summary, this infection can be present in the immunocompetent patient and not easily identified by a lab test alone.
It cannot be stressed enough how often misdiagnoses of Bartonella infections have occurred due to atypical onset and non-recognition of the widespread symptoms. A case study revealed that a four-year-old girl died even though treated aggressively for fevers and seizure. At autopsy, the little girl?s brain revealed marked cerebral edema and multiple granulomatous lesions as well as meningitis and encephalitis. Testing using PCR and Southern Blot was positive for Bartonella DNA.(40)
The pathogenic course of a bartonella infection can be very difficult to distinguish from the signs and symptoms of many bacteria, viruses, fungi, and protozoan infections. Gaubitz et al., reported a young woman who had been diagnosed with systemic lupus erythematosus and treated with increasing doses of steroids, but yet did not respond. Scratches on her arms from her cat led to suspicion of cat-scratch disease, and the illness was ultimately confirmed with additional blood tests. Treatment with clarithromycin was given and a rapid, favorable response resulted.(29)
Brain involvement may not be recognized as due to an infectious organism. A careful history, including potential exposure to cats or other animals, fleas, ticks, or other vectors may determine if serological testing for one of the bartonella species is necessary. Whole families can develop CSD. Multiple cases of encephalitis may raise the question if differing virulence among the strains of Bartonella henselae is a possibility. If antibodies to Bartonella henselae are detected in CSF, the organism may have directly invaded the central nervous system.(4
Treatment
An acute bartonella infection may respond to antimicrobial treatment even in immunocompromised individuals. Doxycycline, erythromycin, and rifampin are recommended antibiotics. Penicillin, gentamicin, ceftriaxone, ciprofloxacin, and azithromycin have been used and patients have responded favorably. Treatment for two weeks in immunocompetent individuals and six weeks in immunocompromised people is generally recommended. Relapses, associated with bacteremia, have been reported in immunocompromised people despite treatment for six weeks. (50)
"Because Bartonella species are highly susceptible to aminoglycosides, the usual recommendation of penicillin or ampicillin plus an aminoglycoside to treat blood culture-negative endocarditis will effectively treat Bartonella endocarditis. In one patient (patient 19), however, B. henselae was isolated after the completion of a course of aminoglycoside therapy. Some researchers have reported that ciprofloxacin is more effective.? (3) Rauolt, et al, 1996
According to the same sources, treatment is not generally needed except in an immunocompromised population and when neurological or liver involvement develops. CSD might be suspected if it has been previously diagnosed, and the patient has persistent complaints of not feeling well. Recurrence is possible.
When a scratch or a bite from a kitten or cat or other furred creature has occurred, warm compresses to the scratch and papule area should be applied after first cleaning with an antiseptic, such as peroxide. If the area becomes swollen, irritated, and uncomfortable, a doctor should be called. Purulent drainage may indicate an infection. If lymph nodes become swollen and painful, needle aspiration should be considered, as well as testing for potential infectious agents.
Rifampin, ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole have demonstrated good results for CSD in a laboratory setting. Treatment failures, however, have been reported in some patients. In severe cases, gentamicin has shown some effectiveness.(25) Oral doses of erythromycin or doxycycline have been used over at least a three-month period with reported success. Infections involving the heart, liver or, in the case of severe disseminated infection, may require intravenous antibiotics, changed to orals after the infection is under some control. Combination antibiotics may be indicated.(25) There are reports on the varying duration of treatment, ranging from at least six weeks to six months or longer.
Because of the wide variations of antibiotics used against bartonella infections in both lab settings and actual patients, it is unclear which treatment is superior to another. Patient responses in objective and subjective outcomes have to guide the physician. Co-infections must be considered, because once an organism has invaded and produced an illness, a patient?s immune capabilities are at risk. There is no set protocol of treatment for many of the vector-borne diseases, especially if two or three are involved in a specific patients? illness. Treatment has to be individualized and followed closely by a doctor who is experienced in treating the full realm of vector-borne illnesses.
Summary
As more is learned about bartonella infections in patients already infected with Borrelia burgdorferi, the possibility exists that infection with this organism is one explanation for the chronicity of Lyme disease. The idea that short courses of antibiotics may cure the Lyme borreliosis infected victim when, in fact, various spirochetal strains are known to recur and persist, is illogical. With the added knowledge of co-infection, treatments must be individualized and no set protocol can be followed precisely. Being co-infected with a recurring or persistent bartonella infection, or even another infectious agent such as a Babesia spp., may help to explain prolonged illness in some of the Lyme borreliosis-infected population.(55)
We can no longer ignore some of the questions regarding bartonella infections and what role they may be playing in Lyme disease victims. There are many unknowns about bartonella infections as well as its various species and strains.
Does borreliosis play a role, due to the Borrelia spp. spirochetes and other vector-borne infections, in people diagnosed with chronic fatigue syndrome, fibromyalgia, or Gulf War Syndrome? Ticks, fleas, sand flies, and other insects, as well as household pets and the above mentioned illnesses and syndromes, may all be involved when the immune system becomes compromised and a person has had exposure to a pathogenic organism. Testing is not conclusive in many of the vector-borne diseases. Signs and symptoms can overlap or be misdiagnosed without thought being given to a chronic infection, let alone the full spectrum of infections.
A major problem exists - physicians in the United States and around the world do not adequately recognize the issue of the seriousness of tick-borne or other vector-borne illnesses. The vast majority of mainstream medical providers do not acknowledge that local ticks and other vectors that transmit pathogenic organisms can cause severe illness. The appropriate recognition of Lyme borreliosis and other opportunistic infections causing a host of continuing problems, manifested as chronic persistent disease, is essential for meaningful progress to be made.
Signs & Symptoms Involving Bartonella Infection
Scratches, bites from a cat or animal
Nausea, vomiting, weight loss
Rashes and/or lesion ? may or may not be present
Liver and/or spleen enlargement
Draining, purulent wound, may or may not be present
Headache
Respiratory difficulties, shortness of breath, cough
Heart ? chest pain, cough, irregular heart beat
Temperature ? may or may not be elevated
Memory loss
Generalized weakness. Limbs, whole body
Extreme fatigue
Pain ? muscle, tendons, joints
Hearing loss
Swollen lymph glands, may become tender, painful
Balance, equilibrium problems
Pain in limbs, disseminated throughout the body
Facial palsy
Difficulty with urination, bloody urine
Seizures
Retention of fluids, swelling in extremities
Vision problems, eye infections, red, runny
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SUOMEN LYME BORRELIOOSI ry
Borrelioosi on yleisin punkkien levittämä infektiosairaus Euroopassa ja Pohjois-Amerikassa. Tautia tavataan lähes kaikkialta maailmasta ja kaikista ikäryhmistä. Borreliabakteeri siirtyy ihmisen elimistöön esimerkiksi punkinpureman kautta.
ja missä ja miten se näkyisi jos näkyisi?