Conjuntivitis granulomatosa en 2 pacientes jóvenes / Granulomatous conjunctivitis in two young patients

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Effect of different drugs and drug combinations on killing stationary phase and biofilms recovered cells of Bartonella henselae in vitro.

BACKGROUND: Bartonella henselae is a Gram-negative bacterium transmitted to humans by a scratch from cat in the presence of ectoparasites. Humans infected with B. henselae can result in various clinical diseases including local lymphadenopathy and more serious systemic disease such as persistent bacteremia and endocarditis. The current treatment of persistent B. henselae infections is not very effective and remains a challenge. To find more effective treatments for persistent and biofilm Bartonella infections, in this study, we evaluated a panel of drugs and drug combinations based on the current treatment and also promising hits identified from a recent drug screen against stationary phase and biofilm recovered cells of B. henselae. RESULTS: We evaluated 14 antibiotics and 25 antibiotic combinations for activity against stationary phase B. henselae (all antibiotics were at 5 µg/ml) and found that ciprofloxacin, gentamicin, and nitrofurantoin were the most active agents, while clofazimine and miconazole had poor activity. Drug combinations azithromycin/ciprofloxacin, azithromycin/methylene blue, rifampin/ciprofloxacin, and rifampin/methylene blue could rapidly kill stationary phase B. henselae with no detectable CFU after 1-day exposure. Methylene blue and rifampin were the most active agents against the biofilm B. henselae after 6 days of drug exposure. Antibiotic combinations (azithromycin/ciprofloxacin, azithromycin/methylene blue, rifampin/ciprofloxacin, rifampin/methylene blue) completely eradicated the biofilm B. henselae after treatment for 6 days. CONCLUSIONS: These findings may facilitate development of more effective treatment of persistent Bartonella infections in the future.

Bartonella henselae infection presenting with a picture of adult-onset Still's disease.

We report a patient with a clinical picture of suggestive for adult-onset Still's Disease (ASOD) due to Bartonella infection. A 42-year-old immunocompetent man was admitted with fever, rash, arthralgia and sore throat. As his clinical picture suggested ASOD except unusual skin manifestation, we treated him on steroid and ibuprofen. His fever and constitutional symptoms responded immediately within 24hrs of commencing therapy, yet rash and leukocytosis remained. Meanwhile, Bartonella infection was proved by culture of bone marrow. Minocyclin treatment started combined with hydroxychloroquine sulfate and the patient discharged with overall improvement.

Intra-nodal injection of gentamicin for the treatment of suppurated cat scratch disease's lymphadenitis.

PURPOSE: Cat scratch disease (CSD)'s lymphadenitis may have a protracted course with painful suppuration necessitating several needle aspirations or surgical drainage. The objective of this study was to evaluate the benefit of an intra-nodal injection of gentamicin add-on oral azithromycin treatment on the outcome of suppurated CSD's lymphadenitis. METHODS: We performed a retrospective monocentric study including 51 consecutive patients diagnosed between Jan 2009 and Mar 2014 with suppurated CSD who had a positive PCR for Bartonella henselae DNA in pus collected from lymph node by needle aspiration, and who were treated with azithromycin. RESULTS: Among them, 26/51 patients (51%) received oral azithromycin only, of whom 8 patients (31%) were cured and 18 patients (69%) had complications, while 25/51 patients (49%) received an intra-nodal injection of gentamicin add-on oral azithromycin, of whom 16 patients (64 %) were cured and 9 patients (36%) had complications. In univariate analysis, the combined treatment was the only variable related to cure without complications (64 versus 31%, p = 0.01), but this difference did not remain statistically significant in multivariate analysis (OR = 3.84, 95% CI: 0.95-15.56, p = 0.06). CONCLUSIONS: Intra-nodal injection of gentamicin add-on oral azithromycin treatment might improve the outcome of patients with suppurated CSD's lymphadenitis, deserving further randomized studies.

The Bartonella henselae SitABCD transporter is required for confronting oxidative stress during cell and flea invasion.

Bartonella henselae is a zoonotic pathogen that possesses a flea-cat-flea transmission cycle and causes cat scratch disease in humans via cat scratches and bites. In order to establish infection, B. henselae must overcome oxidative stress damage produced by the mammalian host and arthropod vector. B. henselae encodes for putative Fe²âº and Mn²âº transporter SitABCD. In B. henselae, SitAB knockdown increases sensitivity to hydrogen peroxide. We consistently show that SitAB knockdown decreases the ability of B. henselae to survive in both human endothelial cells and cat fleas, thus demonstrating that the SitABCD transporter plays an important role during the B. henselae infection cycle.

Surgical wound infection by Streptococcus pneumoniae after a cat-scratch disease.

Streptococcus pneumoniae (pneumococcus) is mostly known as an agent of meningitis and pneumonia. We present what is believed to be a previously unreported case of pneumococcal disease, involving an inguinal wound. A 10-year-old male patient underwent surgical removal of a cat-scratch disease-related enlarged groin lymph node; infection of the wound was soon observed, with multidrug-resistant S pneumoniae growing from the lesion discharge. This communication expands the spectrum of skin ulcer-infecting pathogens; in fact, although pneumococcus has been known to mostly affect central nervous system and airways, we observed a surgical wound infection by this organism.

Susceptibility of Polish Bartonella henselae strains.

Due to the fastidious nature of B. henselae and the limited number of available isolates worldwide, there are few data on its in vitro susceptibility to antibiotics. We determined the minimal inhibitory concentrations (MIC) of ten antimicrobial agents against 11 feline isolates of B. henselae by Etest method. The lowest MICs were obtained for rifampicin < or = 0.002 mg/L. MICs of all isolates were < 0.016 mg/L for ampicilin, amoxicillin/clavulanic acid, tetracycline and ranged from 0.016 to 0.032 mg/L for azithromycin. The MICs for two tested fluoroquinolones: ciprofloxacin and levofloxacin ranged from 0.016 to 0.125 mg/L. The highest MICs were obtained for gentamicin ranging from 0.025 to 2.0 mg/L. Sulphonamide resistance genes sul 1, sul 2, sul 3 were not found in any of the tested isolates. Etest methodology seems to be a reliable method for determination of B. henselae susceptibility, however standardization is strongly desired.

Heme degrading protein HemS is involved in oxidative stress response of Bartonella henselae.

Bartonellae are hemotropic bacteria, agents of emerging zoonoses. These bacteria are heme auxotroph Alphaproteobacteria which must import heme for supporting their growth, as they cannot synthesize it. Therefore, Bartonella genome encodes for a complete heme uptake system allowing the transportation of this compound across the outer membrane, the periplasm and the inner membranes. Heme has been proposed to be used as an iron source for Bartonella since these bacteria do not synthesize a complete system required for iron Fe³âº uptake. Similarly to other bacteria which use heme as an iron source, Bartonellae must transport this compound into the cytoplasm and degrade it to allow the release of iron from the tetrapyrrole ring. For Bartonella, the gene cluster devoted to the synthesis of the complete heme uptake system also contains a gene encoding for a polypeptide that shares homologies with heme trafficking or degrading enzymes. Using complementation of an E. coli mutant strain impaired in heme degradation, we demonstrated that HemS from Bartonella henselae expressed in E. coli allows the release of iron from heme. Purified HemS from B. henselae binds heme and can degrade it in the presence of a suitable electron donor, ascorbate or NADPH-cytochrome P450 reductase. Knocking down the expression of HemS in B. henselae reduces its ability to face H2O2 induced oxidative stress.

Hemin binding protein C is found in outer membrane vesicles and protects Bartonella henselae against toxic concentrations of hemin.

Bartonella species are gram-negative, emerging bacterial pathogens found in two distinct environments. In the gut of the obligately hematophagous arthropod vector, bartonellae are exposed to concentrations of heme that are toxic to other bacteria. In the bloodstream of the mammalian host, access to heme and iron is severely restricted. Bartonellae have unusually high requirements for heme, which is their only utilizable source of iron. Although heme is essential for Bartonella survival, little is known about genes involved in heme acquisition and detoxification. We developed a strategy for high-efficiency transposon mutagenesis to screen for genes in B. henselae heme binding and uptake pathways. We identified a B. henselae transposon mutant that constitutively expresses the hemin binding protein C (hbpC) gene. In the wild-type strain, transcription of B. henselae hbpC was upregulated at arthropod temperature (28°C), compared to mammalian temperature (37°C). In the mutant strain, temperature-dependent regulation was absent. We demonstrated that HbpC binds hemin and localizes to the B. henselae outer membrane and outer membrane vesicles. Overexpression of hbpC in B. henselae increased resistance to heme toxicity, implicating HbpC in protection of B. henselae from the toxic levels of heme present in the gut of the arthropod vector. Experimental inoculation of cats with B. henselae strains demonstrated that both constitutive expression and deletion of hbpC affect the ability of B. henselae to infect the cat host. Modulation of hbpC expression appears to be a strategy employed by B. henselae to survive in the arthropod vector and the mammalian host.

Occlusive vasculitis and optic disk neovascularization associated with neuroretinitis.

PURPOSE: To report a case of neuroretinitis associated with ischemic nasal branch retinal vein occlusion, periphlebitis, and neovascularization of the optic disk. METHODS: Case report. RESULTS: A 32-year-old man presented with a typical image of neuroretinitis, retinal hemorrhages and sheathing of the retinal veins in the nasal retina. His left hand had been bitten by a kitten 8 weeks before. Serology for Bartonella henselae was negative. On the 6th week of follow-up, optic disk neovascularization developed, which required retinal photocoagulation. Photocoagulation was performed again at the 12th and 18th week revision since further new vessels had developed. At the 32nd week of follow-up neovascularization had regressed. CONCLUSIONS: Neuroretinitis may be associated with severe complications such as retinal vascular occlusions and optic disk neovascularization.

The Bartonella henselae VirB/Bep system interferes with vascular endothelial growth factor (VEGF) signalling in human vascular endothelial cells.

The vasculotropic pathogen Bartonella henselae (Bh) intimately interacts with human endothelial cells (ECs) and subverts multiple cellular functions. Here we report that Bh specifically interferes with vascular endothelial growth factor (VEGF) signalling in ECs. Bh infection abrogated VEGF-induced proliferation and wound closure of EC monolayers as well as the capillary-like sprouting of EC spheroids. On the molecular level, Bh infection did not alter VEGF receptor 2 (VEGFR2) expression or cell surface localization, but impeded VEGF-stimulated phosphorylation of VEGFR2 at tyrosine(1175) . Consistently, we observed that Bh infection diminished downstream events of the tyrosine(1175) -dependent VEGFR2-signalling pathway leading to EC proliferation, i.e. phospholipase-Cγ activation, cytosolic calcium fluxes and mitogen-activated protein kinase ERK1/2 phosphorylation. Pervanadate treatment neutralized the inhibitory activity of Bh on VEGF signalling, suggesting that Bh infection may activate a phosphatase that alleviates VEGFR2 phosphorylation. Inhibition of VEGFR2 signalling by Bh infection was strictly dependent on a functional VirB type IV secretion system and thereby translocated Bep effector proteins. The data presented in this study underscore the role of the VirB/Bep system as important factor controlling EC proliferation in response to Bh infection; not only as previously reported by counter-acting an intrinsic bacterial mitogenic stimulus, but also by restricting the exogenous angiogenic stimulation by Bh-induced VEGF.

Antimicrobial susceptibility by Etest of Bartonella henselae isolated from cats and human in Japan.

Bartonella henselae, a small fastidious Gram-negative bacillus, is the causative agent of cat-scratch disease (CSD). Because of difficulty in isolating the organism, there has been no report on its antibiotic susceptibility in Japan. We determined the minimal inhibitory concentrations (MICs) of eight antimicrobial agents against 32 isolates of B. henselae (31 from cats and one from a human in Japan) by the Etest method. MICs of all 32 isolates were <0.016 µg/ml for minocycline and ranged from ≤0.016 to 0.064 µg/ml for erythromycin, clarithromycin, azithromycin, ceftriaxone, and amoxicillin. MICs ranges of ciprofloxacin and gentamicin were from 0.064 to 0.25 µg/ml and from 0.5 to 3 µg/ml, respectively. All isolated strains showed high susceptibility to minocycline and macrolides antibiotics, which are currently used in the primary treatment of CSD in Japan. Although in vitro result of B. henselae susceptibility testing may not necessarily correlate with clinical response, these data are relevant in the choice of drugs for CSD treatment.

Comparative activity of pradofloxacin, enrofloxacin, and azithromycin against Bartonella henselae isolates collected from cats and a human.

Using Bartonella henselae isolates from cats and a human, the activity of pradofloxacin was compared with those of enrofloxacin and azithromycin. By Etest and disc diffusion assay, pradofloxacin showed greater antimicrobial activity than did other antibiotics. We conclude that pradofloxacin may prove useful for the treatment of B. henselae infections.

Detrimental effects of Bartonella henselae are counteracted by L-arginine and nitric oxide in human endothelial progenitor cells.

The recruitment of circulating endothelial progenitor cells (EPCs) might have a beneficial effect on the clinical course of several diseases. Endothelial damage and detachment of endothelial cells are known to occur in infection, tissue ischemia, and sepsis. These detrimental effects in EPCs are unknown. Here we elucidated whether human EPCs internalize Bartonella henselae constituting a circulating niche of the pathogen. B. henselae invades EPCs as shown by gentamicin protection assays and transmission electron microscopy (TEM). Dil-Ac-LDL/lectin double immunostaining and fluorescence-activated cell sorting (FACS) analysis of EPCs revealed EPC bioactivity after infection with B. henselae. Nitric oxide (NO) and its precursor l-arginine (l-arg) exert a plethora of beneficial effects on vascular function and modulation of immune response. Therefore, we tested also the hypothesis that l-arg (1-30 mM) would affect the infection of B. henselae or tumor necrosis factor (TNF) in EPCs. Our data provide evidence that l-arg counteracts detrimental effects induced by TNF or Bartonella infections via NO (confirmed by DETA-NO and L-NMMA experiments) and by modulation of p38 kinase phosphorylation. Microarray analysis indicated several genes involved in immune response were differentially expressed in Bartonella-infected EPCs, whereas these genes returned in steady state when cells were exposed to sustained doses of l-arg. This mechanism may have broad therapeutic applications in tissue ischemia, angiogenesis, immune response, and sepsis.

Heterogeneity of susceptibility to fluoroquinolones in Bartonella isolates from Australia reveals a natural mutation in gyrA.

OBJECTIVES: Bartonella sp. are intracellular bacteria associated with an increasing number of clinical manifestations but with few published data on in vitro susceptibility testing of antibiotics. Our objective was to evaluate in vitro antibiotic susceptibilities of 20 new Bartonella isolates from animals in Australia. METHODS: MICs were determined using Etest assay on Columbia agar supplemented with 5% horse blood. The presence of mutations in the quinolone-resistance-determining region (QRDR) of gyrA was searched for after PCR amplification and DNA sequencing using specific oligonucleotide primers. RESULTS: Bartonella isolates from Australia were susceptible to rifampicin, tetracyclines, beta-lactam and macrolide compounds but were resistant to vancomycin. We found heterogeneity of susceptibility for fluoroquinolones with ciprofloxacin being more effective (MICs from 0.06 to 0.5 mg/L) than ofloxacin (MICs from 0.5 to 4 mg/L). This heterogeneity was linked to a natural mutation Ser-83-->Ala (Escherichia coli numbering) in the QRDR. Surprisingly, this mutation was also present in the QRDR of Bartonella henselae, Bartonella quintana and Bartonella bacilliformis. CONCLUSIONS: Etest is a sensitive and reliable assay for evaluation of antibiotic susceptibility in the genus Bartonella. The higher sensitivity of this method allowed us to detect heterogeneity of susceptibility among fluoroquinolones that was associated with natural mutation in the QRDR of the DNA gyrase. Because a high level of resistance to fluoroquinolones due to a second mutation may be obtained easily in vitro, we believe that fluoroquinolone compounds should be avoided for the treatment of any Bartonella-related diseases.

Familial occurrence of cat-scratch disease, with varying clinical expression.

Cat-scratch disease, primarily caused by Bartonella henselae, typically presents with regional adenopathy, and the role of antibiotics in the treatment is debatable. We present a report of B. henselae infection transmitted by the same kitten to 4 different individuals, each with different clinical characteristics, treatment, and evolution.