Bartonella - Causes, Symptoms and Treatment .MF .
Bartonella (bartonellosis -. English) brings together a group of human diseases caused by Gram-negative aerobic, facultative intracellular bacteria require for their growth in hemin or cleavage products of erythrocytes.
for human pathogenic species of Bartonella 5 independent of varying degrees of virulence.
In Bartonella nature circulate among rodents, rats, representatives of the cat family (cats, cougars) and dogs, causing them persistent infection with asymptomatic bacteraemia and lasting many months.In humans, causing a variety of on symptoms of acute (Volyn or trench fever, Karrionv disease syn -. Fever Oroya), subacute (cat scratch disease) and chronic (bacillary angiomatosis, the Peruvian wart, a purple hepatitis, endocarditis, prolonged fever with bacteremia) disease.
Chronologically diseases caused Bartonellas were known long before the discovery and isolation of pathogens themselves.
Types Bartonellas (until 1993 -.. Rochalimaea spp, etc.) are mainly represented by microscopically short s
prevalence of Bartonella poorly understood.Indisputable installed endemic pathogen Carrion - V. bacilliformis.It is distributed only in the North-West of South America in the Andes protected from Pacific winds at altitudes of 600-2500 m above sea level and geographically linked to Peru, part of Colombia and Ecuador.The life cycle of the data associated with Bartonella South American moskitovflebotomusov kind, namely, Lutzomia noguchi, L. verrucarumi others, as well as local rodents.
most common, apparently, is the causative agent of cat scratch disease (cat scratch disease -. English) and trench fever, carriers which are, respectively, cat fleas and lice person.The latter are almost ubiquitous insects, their involvement in transimissii Bartonella quintana and henselae in a human body is proved and obviously bartenellezy caused by these two types of micro-organisms spread across the globe within places of permanent human habitation.In particular, set the high (up 68.1%), bacteremia among cats and kittens, bound with B. henselae in some states of the USA, as well as in Germany, especially among the animals (up to 89%) of those families in which children or owners themselvescats moved cat-scratch disease.
wide search Bartonellas in a natural population of rodents in different countries (USA, Bolivia, Paraguay, British Columbia (Canada), Poland and others) revealed a high prevalence of Bartonella in the natural population of rodents, the representatives of the cat (cougar) and dog (coyotes).
Regarding the most pathogenic for human B. bacilliformisi B. quintana it is assumed that a significant reservoir of pathogens data is the person registered as asymptomatic and mild forms of infection, accompanied by lengthy bacteriocarrier.The natural reservoir for B. elizabethae also apparently are small wild mammals.
mandatory registration bartonelloses does not exist.It is known that during the First World War trench fever epidemic broke out in the theater of operations in Europe, which affected at least 1 million soldiers.During the Second World War it was revived in the epidemic form, but in a much smaller scale.Ill with about 80 thousand. Man [Liu Wei Tung, 1984].With the end of the Second World War, trench fever outbreak ceased.About the age of infection associated with B. quintana, reports appeared in the early 1990s, when the causative agent was identified as the cause of opportunistic infection in HIV-infected individuals.Serological and molecular genetic studies in different countries, including in Russia [Rydkina E. et al., 1999] found hidden pathogen circulating in the population and its presence in a population of lice.The population of Ukraine specific antibodies to Bartonella quintana found in all age groups in the range of 1,48-2,48%, in France - at 0.6% of the patients, and endocarditis caused by this type of Bartonella, confirmed at 76.4% in the grouppatients with pain of unknown etiology (1995-1998 gg.).
epidemic of trench fever associated with the human body louse at an epidemic typhus;it is caused by mechanical rubbing the infected feces into the skin scratches.In the feces of lice Bartonella quintana keep their zhiznensposobnost extremely long - up to 1312 days [Balashov B. C., Daiter AB, 1973].The natural reservoir of Bartonella quintana has not yet been set, the only source of infection is considered to be a person.At lice, unlike typhus ricketsiosis, Bartonella are asymptomatic, the microorganism remains for life (30-45 days), transovarial transmission is absent.In humans, in addition to flowing acute febrile illness, possible long-term (2-5 years) the latent asymptomatic carriage or in combination with chronically proceeding lymphadenopathy and an endocarditis.Fleas
Cfenocephalides felis, as well as body lice, unlike pincers, during their life cycle eat repeatedly and illegible concerning their prokormitelya.As a result, they turn prisasyvayas cats or rodents in their environment easily infected Bartonellas.In their organism Bartonella henselae remain more than a year without affecting the behavior and lifestyle.In search of food and insect attack on the person.
true number ill bartonelllezom caused by Bartonella henselae, remains unclear.But we know that in the US, for example, in the early 1990s, the most common in this country rickettsial disease - Rocky Mountain spotted fever - was recorded at a level exceeding 1000 cases annually, whereas the incidence of cat scratch disease was evaluated in 22 000 cases, of which2000 - hospitalized [Zangwill et al, 1993.].
diseases people acute form of the disease Carrion, known as Oroya fever, is associated with several types of bites of mosquitoes.When a mosquito bites a Bartonella together with a saliva of the insect to penetrate directly into the bloodstream, attack and penetrate into erythrocytes and extend hematogenous by with the subsequent settling of the cells of the endothelium of the vascular system, lymph nodes, and other organs slezenki.Thus up to 90% of hemolyzed red blood cells, resulting in anemia and sharp clinical picture.
pathogenicity factors Bartonellas virtually unknown.Well established that introduction Bartonellas to erythrocytes is mediated by flagella by which Bartonella, in particular pathogen Carrion, attached to the erythrocyte surface, and then introduced into it.
In place of the entrance gate of the pathogen is usually no specific traces associated with a microorganism does not remain, except cat-scratch disease.In the latter case, in addition to scratches from the claws of an animal bite or a trace of the latter, often shaped primary affect that can fester (connection of the secondary flora) and leave in a subsequent slight scar.The spread of microorganisms from the site entrance gate there is lymphatic and hematogenous routes, which leads to a generalization of infection with the relevant clinic for acute or chronic form of the disease.
main "targets" in the body responsive to warm-blooded animals are Bartonella erythrocytes and endothelial cells of the cardiovascular system.For Bartonella quintana and batsillifor mis-identified as their tropism for hematopoietic bone marrow tissue.In places of attachment Bartonellas to sensitive cells formed clusters (clusters) of microorganisms and inflammatory reaction occurs with the growth of the cells of the endothelium and surrounding tissues.Usually it affects the most vulnerable part of the human vascular system in its microvasculature, with some necrotic endothelial cells.As a result, developing a angiomatosis or lymphadenopathy, or a combination thereof with the simultaneous defeat of bone marrow cells and red blood cells.Around the areas with the "swollen" ( "epithelioid-E"), endothelial cells are grouped neutrophils and eosinophils.It corresponds to the last location, usually in clusters bacilli perivascular space.Bacteria may be detected in erythrocytes, vascular endothelial cells, spleen, lymph nodes, liver, bone marrow, skin.
Histologically, tissues and organs of patients in the acute stage of the disease Carrion (Oroya fever) are anemic, revealed central necrosis around the hepatic veins with infiltration lesions microphages and polymorphonuclear leukocytes;in the pulp of the spleen - foci of necrosis;lymph nodes - the proliferation of endothelial and pigment deposition;in the bone marrow - proliferation, makrofagotsitoz.
When Peruvian wart expressed proliferative processes endothelium of lymphatic and blood vessels, tumors of small blood vessels with the emergence angioendoteliom and secondary growth of connective tissue.The valves of the heart affected Bartonellas in patients with manifest endocarditis, numerous vegetation formed of fibrin and platelets on the wings observed valve perforation, and in the tissues of remote valves - the mass of microorganisms extracellularly located and superficial inflammatory infiltrates.
weakening of immune protection due to dysfunction and incoordination of system activity of endothelial cells in blood circulation disorders and hypoxia of organs and tissues and cause the appearance of the growth of general toxic symptoms (fever, chills, hypotension, nausea, vomiting, weakening of cardiac activity).Patients Oroya fever is dominated by the phenomenon of anemia.This is caused by intense and rapid process involving in infectious erythrocytes reaching 40-50 and even 90% of the circulating mass from their subsequent destruction.
gradual appearance in the blood of patients with protective antibodies infectious process stops, patients gradually recover to form immune varying lengths, depending on the type of Bartonella.In chronic forms bartonelloses, developing most of the streets with the immune deficiency established long-term bacteremia, despite many months of intensive antibiotic therapy.This is explained by the intracellular localization of the pathogen populations in the inflammatory infiltrates.
epidemiological significance bartonelloses associated with clar-ridgeiae B. and B. elizflbethae unknown.Hitherto known isolated cases of endocarditis caused by these Bartonellas the territories (USA, Sweden), a considerable distance from each other.
clinical picture and diagnostics bartonelloses.Bartonelloses clinical picture in humans are extremely diverse - from the local lung disorders lymph and blood circulation (cat scratch disease, lymphadenopathy, bacillary angiomatoe skin) to the more serious acute, often recurrent (trench fever) or duration of the current painful suffering (bacillary angiomatosis with necrotic,purple or splenitis hepatitis, chronic septic bacteremia, endocarditis).The most malignant form of acute flows Carrion's disease known as Oroya fever, in which the mortality rate reached 40 before, and in some outbreaks - 90%.Diseases caused Bartonellas:
»Carrion's disease in acute (Oroya fever) and chronic (Peruvian wart) forms;
»bacillary angiomatosis of the skin;
»rohalimiyny (bartonellezny) bacteremic syndrome;
»bacillary peliozny hepatitis (splenpt);
»vnekozhnaya disseminated infection (synonym - chronic lymphadenopathy).
be fatal acute forms bartonelloses except Oroya fever, are very rare.Long-term and often recurrent course some of them, especially in HIV-infected patients, resulting in significant labor losses and may result in unfavorable, despite intensive antibiotic therapy.
cat scratch disease
disease kochashih scratches - (synonym - limforetikulez benign).Known in France and the United States, at least since 1932, in Russia - since 1955 [Marecki MF, 1955].For the disease characterized by unilateral lymphadenitis, regional to the site of the entrance gate to the originator, and a benign outcome.
Etiology - B. henselae.Named in honor of D. Hensel, select the pathogen after persistent (more than 6000 seeding) cultivation attempts.
disease apparently is more widespread than it is known to the present time;probably within the human habitat and related cats.Human infection occurs by contact, through the skin or conjunctiva.
localization entrance gate determines the subsequent involvement of regional lymph nodes draining the site of skin damage.
Symptoms and flow.The incubation period lasts from 3 to 20 days (usually 7-14 days).According to the clinical manifestations can be identified common form (about 90%), manifested in the appearance of primary affect and a regional lymphadenitis, and atypical forms, which include: a) eye shape;b) the central nervous system;c) the failure of other organs;g) cat scratch disease in HIV-infected.The disease can occur both in acute and chronic.Also differ according to the severity of disease.
typical disease usually begins gradually with the appearance of primary affect.On the site already healed by the time a cat scratch or bite appears a small papule with rim flushing of the skin, and then it turns into a vesicle or pustule, further into the small ulcers.Sometimes the abscess dries without ulceration.The primary affect is often localized on the hands, at least on the face, neck, lower extremities.The general condition is satisfactory.After 15-30 days after infection marked regional lymphadenitis - the most constant and characteristic symptom of the disease.Sometimes, it's almost the only symptom.Increased body temperature (38.3 to 4w) says only 30% of patients.Fever accompanied by other signs of intoxication (general weakness, headache, anorexia, etc.).The average duration of fever for about a week, although in some patients it may take up to a month or more.Weakness and other symptoms of intoxication lasts an average of 1-2 weeks.
Most affected elbow, axillary, cervical lymph nodes.Some patients (about 5%) developed generalized lymphadenopathy.Dimensions of enlarged lymph nodes more often between 3 to 5 cm, although some patients they get 8-10 cm. Nodes painful to palpation, not soldered to surrounding tissues.Half of the patients affected lymph nodes abscess to form a thick yellowish-green pus, which when sown in the usual nutrient media can not distinguish bacterial microflora.Duration adenopathy from 2 weeks to one year (at about 3 months).Many patients have an enlarged liver and spleen, which persists for about 2 weeks.Some patients (5%), rash appears (krasnuhopodobnaya, papular, by type of erythema nodosum), which disappears in 1-2 weeks.In a typical clinical form accounts for about 90% of all diseases.
ocular form of the disease occur in 4-7% of patients.According to its manifestations these forms resemble okuloglandulyarny Parinaud syndrome (conjunctivitis Parinaud).Develops, probably as a result of contact with the conjunctiva saliva of infected cats.Amazed, usually one eye.