This post was submitted by Dr, Schaller at http://www.personalconsult.com and relates the growing attention to Bartonella thanks to brilliant veterinary researchers like Dr. Edward Breitschwerdt, DVM, DACVIM.
Bartonella species, their animal hosts, potential vectors, and sequelae of infection are being identified at a snowballing rate. From a handful of recognized species to more than forty identified, and many more suspected, a new diagnostic test may help DVMs and MDs come together to better understand these infections in their patients and the way they interact with chronic Lyme disease and other co-infections.
FOUR QUOTES OF INTEREST:
*Antibody testing for Bartonella species is proving to be very insensitive.
*The genus Bartonella is also unusual because it appears that no other infectious agent is transmitted by more vectors.
*Patient response to treatment is frequently incomplete.
*Clearly some of us now are much more concerned about the genus Bartonella than anyone is at the National Institutes of Health (NIH) or Centers for Disease Control and Prevention (CDC).
Veterinarians and physicians should talk to each other more frequently than we have in the past. Of all known organisms, 61% are zoonotic and of the emerging pathogens, the vast majority is zoonotic organisms. In recent years, the genus Bartonella has been the major focus of our vector-borne research efforts.
BARTONELLA SPECIES COMPLEXITIES
The organism that causes cat scratch disease in people was identified as a Bartonella species in 1992.
As researchers have continued to study these bacteria, we’ve learned that the intraerythrocytic component of the infection with a Bartonella species has been somewhat overemphasized. Bartonella species are endotheliotropic bacteria that use a specialized invasion process to enter endothelial cells and can move about the body by infecting macrophages, with localization in a variety of tissues. Researchers have learned that Bartonella species are the first bacteria identified to have an ability to invade CD3+ progenitor cells in bone marrow. This may be why we find Bartonella organisms in cats in only a low percentage (3%) of their erythrocytes.
The genus Bartonella is also unusual because it appears that no other infectious agent is transmitted by more vectors. We now know that sand flies, human body lice, cat fleas, rodent fleas, and probably many other flea species are capable of transmitting certain Bartonella species. And cattle, deer, elk, and sheep all have their own Bartonella species that appear to be transmitted by biting flies or keds (wingless flies)
AN UNDER-RECOGNIZED ZOONOSIS
In my opinion, physicians and veterinarians need to come together regarding bartonellosis, because it appears to be an important and under-recognized zoonosis diagnostic test sensitivity for documenting infection with this genus of bacteria is extremely poor, and based upon recent experience in our laboratory, patient response to treatment is frequently incomplete.
What’s important for physicians and veterinarians to recognize is that some of these Bartonella species are found in cats, dogs, rats, ground squirrels, and rabbits. In 1992, two Bartonella species were known to exist, and in 2009, over 26 named or candidate’s species exist. [RECENTLY A GENE RESEARCHER AND MD SAID OVER 40 SPECIES OF BARTONELLA, AND ALSO BABESIA, EXIST IN PUBLIC GENETIC DATA BASES IF ONE ACTUALLY KNOWS HOW TO LOOK].
ANIMAL RESERVOIR HOSTS
Bartonella species are present in a multitude of animal species. One of the most recently identified Bartonella species, Bartonella australis, was found in kangaroos. Unexpectedly, 82% of beef cattle in North Carolina have Bartonella bovis in their blood. My laboratory can isolate a Bartonella species from one or two out of three feral cats in North Carolina, and other laboratories around the world have documented similar levels of bacteremia in flea-infested cats.
Another important point for physicians and veterinarians to consider is that many of their patients and clients have pocket pets, some of which tend to scratch and bite. Unfortunately, numerous Bartonella species have been identified in the blood of various rodent species. For example, the overall prevalence was 26% in the population of wild and captive animals brought to Japan to be sold as pocket pets. The human medical literature in the United States reveals case reports of previously healthy people with no evidence of louse exposure and a history of cat exposure who presented to their physicians for evaluation of lymphadenopathy or seizures and were found to be infected with Bartonella quintana. [QUINTANA IS BRUTAL AND IS ONE REASON NAPOLEANaEAAAÂS ARMY WAS DESTROYED RETURNING FROM RUSSIA BASED ON DNA IN DENTAL PULP IN MASS SOLDIER GRAVES. ONE BELIEF MANY PHYSICIANS HOLD IS THAT THE USA AND ALL OF N. AMERICA HAS NO QUINTANA]. More recently, our laboratory isolated B. quintana from cats and from a woman who was bitten by one of those cats. In reviewing the human literature, as it relates to B. quintana, it told me, as a veterinary internist, what I should be looking for in my canine patients if I suspect that this organism is causing disease. And vice versa: I would suggest that physicians review data and observations that veterinarians are generating in regard to this genus of bacteria, because clearly some of us now are much more concerned about the genus Bartonella than anyone is at the National Institutes of Health (NIH) or Centers for Disease Control and Prevention (CDC).
SIMILARITIES OF DISEASE EXPRESSION IN PEOPLE AND ANIMALS
Bartonella species can induce a number of what I think are fairly well established pathologies in either dogs or people. So we’re seeing that what’s occurring in people is also occurring in dogs – for example, about 80% of people and about 80% of dogs have endocarditis selectively involving the aortic valve. And based on the veterinary literature, physicians may want to put bartonellosis on their differential lists for children with unexplained nose bleeding. [AFTER READING MUCH OF THE WORLD LITERATURE I WOULD SAY BARTONELLA DOES NOT CAUSE THREE MEDICIAL TROUBLES, BUT TOP PAPERS REPORT 20 PROBLEMS WITH EVERY ORGAN, AND PERHAPS 40 WITH THE BRAIN.
We need better detection of bartonella species infections.
After the first isolation of B. vinsonii ssp. berkhoffii, we had difficulty isolating Bartonella species in other dogs by using culture or by detecting Bartonella DNA in patient samples by PCR testing, even though we could detect antibodies by using an immunofluorescent antibody assay. In our laboratory, we had discussed that these bacteria seem to be happier in insects than they do in dogs, so we decided to develop an optimized insect cell culture media to enhance the growth of Bartonella species.
My laboratory has found that 50% of dogs and people infected with B. henselae or B. vinsonii subsp. berkhoffii do not have detectable antibodies to any of the six different Bartonella species antigens used in our testing [PERHAPS BECAUSE AS OUR BOOK EXPLAINS THE IMMUNE SYSTEM MAKING ANTIBODIES IS REDUCED BY BARTONELLA].
So antibody testing for Bartonella species is proving to be very insensitive. [MEANING 99.9% OF PHYSICIAN TESTING IS WORTHLESS].
We now know that some people and some dogs can be coinfected with more than one Bartonella species, [I HAVE SEEN NO ONE DISCUSS THIS SERIOUSLY BEFORE] as is the case in cats that may be simultaneously infected with three Mycoplasma species. Our special testing allowed us detect B. quintana from a woman who bitten by a cat.
Our new lab approach shows the first DNA evidence of human infection with candidatus Bartonella melophagi, and CDC investigators used this approach to make the first isolates of Bartonella tamiae from febrile human patients. [THIS VETERANIAN RESEARCHER GETS INVOLVED VERY SERIOUSLY WITH TWO PEOPLE AND IN PERHAPS 18 MONTHS FINDS NEW SPECIES IN HUMANS FOR WHICH NO TEST IS AVAILABLE].
BARTONELLA SPECIES INFECTION AND ONE MEDICINE
There are several more examples in the literature that describe people with unexplained and chronic illnesses, who are identified as having positive Bartonella species test results. What I have described today doesn’t prove causation of illness, but I think we have justification to worry about disease causation. Bartonella species infection is truly a problem in comparative medicine and a place where One Medicine applies.
Veterinarians and physicians need to work closely to find solutions for the benefit of our respective patients. Although we still have much to learn about these bacteria, we now have a better way of detecting them in patient samples; therefore, we need to find out what they’re doing in our patients and how often they’re doing it.
MY FATHER’S ILLNESS AND BARTONELLA SPECIES
About two years ago, my 86-year-old father, who lived in a rural farm community and had developed gradual, progressive joint pain, was tested for Lyme disease, and the results were negative. He subsequently developed memory loss that was thought to be possible Alzheimer’s disease. He then fell twice a few weeks apart, and a third time he fell, his hip fractured. He had many postoperative complications, and during his stay in a rehabilitation hospital he developed seizures.
At this point I became intimately involved in his medical evaluations, and because I direct the Intracellular Pathogens Research Laboratory at NCSU, I was given his aseptically obtained blood and CSF samples for testing. The results of PCR tests for Anaplasma, Ehrlichia, and Rickettsia species were negative. We ultimately identified what appears to be a new Bartonella species, most closely related to “Candidatus Bartonella volans”,AAÂ in his blood, as well as B. henselae and B. vinsonii ssp. berkhoffii.
Most of this post was taken from information published by Edward B. Breitschwerdt, DVM, DACVIM. For more information and sources: