Infective Endocarditis Due to Bartonella Quintana in a Patient with Biological Aortic Prosthesis.

BACKGROUND: Bartonella quintana is a facultative intracellular bacterium and the causative agent of trench fever. The disease was reported during the World Wars in pre-antibiotic era and is associated with louse infestation and poor hygiene conditions. Bartonella bacteraemia may result in endocarditis mostly in people with existing heart valve abnormalities. CASE REPORT: We report a case of endocarditis caused by B. quintana in a 77-year-old woman with previous valvulopathy. This active endocarditis case was characterized by aortic root involvement 5 years after surgical aortic valve replacement. Although the initial serological tests had induced to a presumptive diagnosis of Q fever, B. quintana infection was confirmed by PCR and sequencing. Detection of Bartonella DNA in valvular and abscess specimens was determinant to confirm Bartonella infection in the absence of other associated risk factors. CONCLUSIONS: Bartonella infection should be considered in patients with pre-existing valvular disease and with a blood culture-negative endocarditis.

Adhesins of Bartonella spp.

Adhesion to host cells represents the first step in the infection process and one of the decisive features in the pathogenicity of Bartonella spp. B. henselae and B. quintana are considered to be the most important human pathogenic species, responsible for cat scratch disease, bacillary angiomatosis, trench fever and other diseases. The ability to cause vasculoproliferative disorders and intraerythrocytic bacteraemia are unique features of the genus Bartonella. Consequently, the interaction with endothelial cells and erythrocytes is a focus in Bartonella research. The genus harbours a variety of trimeric autotransporter adhesins (TAAs) such as the Bartonella adhesin A (BadA) of B. henselae and the variably expressed outer-membrane proteins (Vomps) of B. quintana, which display remarkable variations in length and modular construction. These adhesins mediate many of the biologically-important properties of Bartonella spp. such as adherence to endothelial cells and extracellular matrix proteins and induction of angiogenic gene programming. There is also significant evidence that the laterally acquired Trw-conjugation systems of Bartonella spp. mediate host-specific adherence to erythrocytes. Other potential adhesins are the filamentous haemagglutinins and several outer membrane proteins. The exact molecular functions of these adhesins and their interplay with other pathogenicity factors (e.g., the VirB/D4 type 4 secretion system) need to be analysed in detail to understand how these pathogens adapt to their mammalian hosts.

Bartolenosis, causa de angiomatosis esplénica / Bartonellosis, cause of splenic angiomatosis

En esta ocasión se trata de un paciente de 61 años de edad, del sexo masculino, de la raza negra, residente en Habana del Este. Ingresó para estudio de un dolor abdominal. Presentó antecedentes de hipertensión arterial. Cumplió misión internacionalista en Angola del 1985 al 86, donde tuvo un mono como mascota, su vivienda esta en buen estado, no tenía gatos ni perros y su higiene personal era adecuada

Bartolenosis, causa de angiomatosis esplénica / Bartonellosis, cause of splenic angiomatosis

En esta ocasión se trata de un paciente de 61 años de edad, del sexo masculino, de la raza negra, residente en Habana del Este. Ingresó para estudio de un dolor abdominal. Presentó antecedentes de hipertensión arterial. Cumplió misión internacionalista en Angola del 1985 al 86, donde tuvo un mono como mascota, su vivienda esta en buen estado, no tenía gatos ni perros y su higiene personal era adecuada

Las pediculosis humanas o ¿cómo actuar ante los piojos? / Pediculosis humanus or how to treat lice infestations

Se divulgan y mencionan aspectos relevantes de las pediculosis humanas, citando a las especies de piojos implicadas, su localización en las zonas pilosas del ser humano y sus ropas, describiendo las lesiones más frecuentes que producen, el adecuado manejo de las infestaciones así como su tratamiento. Las pediculosis no suponen un evento reciente, probablemente el piojo que encontramos en la actualidad parasitando al hombre sea muy similar al que nos infestó antaño (AU)

Bacillary angiomatosis by Bartonella quintana in an HIV-infected patient.

Bacillary angiomatosis and bacillary peliosis are opportunistic infections caused by Bartonella henselae and Bartonella quintana, which occur in patients with late-stage infection. We report a case of bacillary angiomatosis in an HIV-infected patient with skin, bone, and probably liver involvement, The identification of the agent (B quintana ) was done by polymerase chain reaction in the skin specimen. The patient had complete regression of all lesions after a 6-month regimen of oral erythromycin.

Bartonella (Rochalimaea) quintana infection in a seronegative hemodialyzed patient.

Bartonella quintana is a reemerging pathogen responsible for trench fever, endocarditis, bacteremia, and bacillary angiomatosis. We previously reported the first case of a patient with B. quintana-induced chronic adenomegaly, and here we present a report on a second patient. A hemodialyzed patient with Sjögren's syndrome presented with mediastinal adenomegalies and secondary pancytopenia. All diagnostic investigations remained negative, except that a Bartonella-like microorganism was isolated from a bone marrow biopsy. The isolate was identified as B. quintana by a specific mouse polyclonal antibody and by determination of a partial gltA (citrate synthase-encoding) gene and 16S rRNA gene sequences. DNA of the pathogen was also detected in the adenomegaly and in the serum of the patient by PCR amplification of the gltA gene. Anti-B. quintana antibodies were never detected in the patient's serum throughout the 12-month follow-up but were detected in the serum of the patient's cat. The patient's outcome was favorable after treatment with gentamicin. Chronic adenomegaly in seronegative patients is a new clinical entity due to B. quintana.

Trench fever in Belfast, and the nature of the 'relapsing fevers' in the United Kingdom in the nineteenth century.

Some evidence is assembled to suggest that trench fever, an infection with a strain of Rochalimaea, if not quintana, then vinsonii, was present in Belfast in the first half of the nineteenth century in endemic and epidemic form. It may have amounted at times to one half or more of 'fever'. This may account for the comparatively low mortality in some years from 'fever'. The phrase 'relapsing fever' in the nineteenth and twentieth century medical literature of the United Kingdom should not be taken necessarily to mean infection with Borrelia recurrentis. Much or most may have been infection with Rochalimaea, quintana or vinsonii. The newly discovered Irish vole should be examined to see if it carries a Rickettsia or Rochalimaea infection.

A passive hemagglutination test for diagnosis of trench fever due to Rochalimaea quintana.

A passive hemagglutination test devised for diagnosis of trench fever was easily performed and highly sensitive and specific. Tanned sheep erythrocytes were sensitized with soluble antigen from Rochalimaea quintana. The test detected antibody in six of seven cases of primary infection and in four cases of late, relapsed trench fever. Titers of antibody ranged from 1:20 to 1:640. Although both IgM and IgG antibody to R. quintana were detected by passive hemagglutination, IgG appeared to be the major reactive antibody. Antigens involved in the reaction were two types of proteins, one inactivated at 50 C and 60 C and the other at 80 C and 100 C. Of 322 control samples of sera that were tested, only one reacted positively; thus, the test had a specificity of greater than 99%. The single positive reaction was in serum from a patient with Q fever. This finding suggests that, in an area where Q fever is endemic, this disease must be ruled out in the interpretation of a positive passive hemagglutination test. Sera should be tested routinely against tanned, unsensitized erythrocytes, since an occassional sample of serum may agglutinate unsensitized cells. Because of its sensitivity and specificity, as well as its simplicity of performance, the passive hemagglutination test shows promise as a useful procedure for serologic identification of both acute and past infection with R. quintana.