PROCAARE: Epidemiology of bacillary angiomatosis-peliosis

[procaare@usa.healthnet.org]

Reference: Koehler, J.E., Sanchez, M.A., Garrido, C.S., Whitfeld, M.J.,
Chen, F.M., Berger, T.G., Rodriguez-Barradas, M.C., LeBoit, P.E., Tappero,
J.W. (1997).  Molecular epidemiology of Bartonella infections in patients
with bacillary angiomatosis-peliosis.  New Engl. J. Med. 337: 1876-83.

This case-control study enrolled 49 patients with Bartonella infection,
confirmed histologically or microbiologically; 45 of the 49 were
HIV-positive.  26 were infected with B. henselae and 23 with B. quintana.
96 controls, matched for HIV status and hospital/clinic location (the San
Fransisco Bay area in California) were also enrolled.  

B. quintana infection was strongly associated with subcutaneous tissue and
lytic bone lesions, while B. henselae was significantly associated with
lymph node, liver, and spleen infection.  Both were equally associated
with cutaneous bacillary angiomatosis.  Patients with Bartonella infection
were significantly less likely to have taken macrolide antibiotics in the
six month reference period; trimethoprim-sulfamethoxazole, ciprofloxacin,
dapsone, penicillins and cephalosporins had no protective effect.
Patients with bartonellosis were also significantly more likely to have
anorexia, weight loss and recurrent fevers than were controls (frequencies
of malaise, nausea, vomiting, rash, headache and joint pain were similar).
B. henselae infection, but not B. quintana infection, was significantly
associated with diarrhea.

Individuals infected with B. henselae were more likely to have contact
with cats or fleas than controls (p<0.004), and molecular subtyping was
employed to document transmission from pet cats to patients.  Patients
with B. quintana infection were more likely to have low income (p=0.003),
to be homeless (p=0.004) and to have exposure to lice (p=0.03).  Patients
with bartonellosis of either kind were more likely than controls to have
low hematocrit.  Elevations in serum alkaline phosphatase were
significantly associated only with B. henselae. 

B. henselae colonies had a rough appearance and were deeply embedded in
chocolate agar, while B. quintana colonies were smooth and non-pitting.
B. henselae grew preferentially on heart infusion agar supplemented with
5% rabbit blood, while B. quintana grew optimally on chocolate agar.  In
general, Bartonella isolates from humans required at least 8 days of
culture for detection.

KEYWORDS: CLINICAL SCIENCE, EPIDEMIOLOGY, OPPORTUNISTIC INFECTION,
BARTONELLA, BARTONELLA HENSELAE, BARTONELLA QUINTANA, CAT SCRATCH DISEASE,
MICROBIOLOGY

From: Albert Shaw <ashaw@usa.healthnet.org>
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