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Abstract
Bartonellae are short, pleomorphic, hemotropic, facultative intracellular Gram negative rods within the oc2 subgroup of the class proteobacteria.
Bartonellae are arthropod-borne bacterial pathogens that typically cause persistent infection of erythrocytes and endothelial cells in their mammalian hosts. In human infection, bartonellae can trigger massive proliferation of endothelial cells, leading to vascular tumour formation.
The genus Bartonella comprises several important human pathogens that cause a wide range of clinical manifestation: B. henselae causes cat scratch disease, bacillary angiomatosis and peliosis, fever of unknown origin and endocarditis. B. quintana, the causative agent of trench fever in World War I, has reemerged in recent years as a cause of urban trench fever (relapsing fever, headache and body pain), bacillary angiomatosis and endocarditis, especially in homeless people. B. bacilliformis causes Carrion’s disease in South America. This biphasic disease consists of acute phase, called Oroya fever, which is characterized by intra-erythrocytic bacteremia that results in an often-fatal hemolytic anaemia, and chronic phase, called verruga peruana, manifests in vascular tumours. Other Bartonella species have recently been implicated as human pathogens. B. clarridgeiae is possibly another agent of CSD, B. elizabethae and vinsonii may cause endocarditis and B. grahamii may cause neuroretinitis.
Typically CSD presents as regional lymphadenopathy preceded by an erythematous papule at the inoculation site in most of patient. About 2 weeks after scratch, regional lymphadenopathy develops, which lasts two to three months and resolve spontaneously. In some cases there is prolonged morbidity with persistent fever and suppuration of lymphnodes. Other complications include Parinaud’s oculoglandular syndrome, hepatic and splenic abscess, encephalopathy and arthralgia.
Bacillary angiomatosis is vascular proliferative disease that occur particularly in immunocompromised patients with Bartonella infections. BA can involve almost any organ system, but cutaneous lesions are most common and can resemble lesions of Kaposi’s sarcoma. Subcutaneous lesions mimicking tumours, osteolytic lesions, visceral lesions (peliosis hepatis) and CNS lesions also occur.
Laboratory diagnosis of Bartonella infections depends on detection of Bartonella itself by microscopic examination, immunohistologic testing, culture and polymerase chain reaction to detect Bartonella DNA.