Program SCRATCH Program SCRATCH

Cat Scratch Disease
Bartonella henselae


Bartonella
• Bartonella henselae
• Bartonella quintana
trench fever or 5-day fever

• Bartonella bacilliformis
deadly pathogen but endemic only in the high valleys of
the Andes and apparently restricted to infecting humans

• B. clarridgeiae
• Bartonella vinsonii subsp. berkhoffii
• Bartonella koehlerae


:‫תכונות‬

.‫ גרם שלילי‬,‫ פלאומורפי‬,‫ עדין‬,‫• מתג‬
‫• צמיחה איטית )עד חודש( על קרקע‬
CO2 5% ‫מזון מעושר ב‬

Presence of B. henselae) arrow) within naturally infected cat erythrocytes, as seen by
confocal microscopy. V. Jacomo,1 P. J. Kelly,2 and D. Raoult1* Natural History of Bartonella
Infections (an Exception to Koch’s Postulate) CVI, 2002


Common infection strategy of the bartonellae. The drawing illustrates the general concept of
reservoir host infections with Bartonella. Following transmission by an arthropod vector (a), the

bartonellae colonize the primary niche, which probably involves entry into migratory cells (b) and
transport to the vascular endothelium (c), where the bacteria persist intracellularly. From the
primary niche, the bacteria are seeded into the bloodstream (d), where they invade erythrocytes
and reinfect the primary niche. After limited replication inside the red blood cell (e), they persist
in the intraerythrocytic niche (f) competent for transmission by a bloodsucking arthropod (g).
A. Harms and C. Dehio, Clin Microbiol Rev. Jan 2012; 25(1): 42–78.


‫תכונות אלימות‪:‬‬
‫• פילי המשמשים להצמדות לתאי מטרה‪.‬‬


‫פתוגנזה‪:‬‬
‫•‬
‫•‬
‫‪‬‬
‫‪‬‬
‫‪‬‬

‫גורם לפרוליפרציה של תאי אנדותל בכלי דם קטנים‪.‬‬
‫בבני אדם גדל בתוך תאים אפיתליאלים‪.‬‬
‫בחתול – גדל בתוך אריטרוציטים ותאי אנדותל‪ ,‬מצב‬
‫אשר מקנה עמידות בפני מע' החיסון של המאכסן‬
‫יכולת העברה ע"י וקטור פרוק רגליים‪.‬‬
‫עבודה ניסויית הראתה הדבקת חתולים ע"י החדרה תוך‬
‫עורית של צואת פרושים‬


‫המחלה בחתולים‬
‫•‬

‫•‬
‫•‬
‫•‬

‫בד"כ נשא בריא ואסימפטומטי‪.‬‬
‫בקטראמיה – מס' חודשים – שנים )מחזורית(‬
‫שכיחות גבוהה יותר בגורים )> שנה (‬
‫לחתולים עם ‪ ( FeLV‬לטנטי או פרוגרסיבי( יש סיכון‬
‫גדול יותר לחלות ב ‪BH‬‬


‫הדבקה ניסויית של חתולי ‪SPF‬‬
‫•לרוב לא נצפו סימנים קליניים‪.‬‬
‫•קשרי לימפה מוגדלים באופן מופשט‪follicular ,‬‬
‫‪hyperplasia‬‬

‫•חום‪ ,‬חוסר תיאבון‪,‬‬
‫• שיבושי רביה‪.‬‬
‫שינויים פתולוגיים‪:‬‬
‫•טחול וקשרי למפה מוגדלים‪,‬‬
‫•דלקת של שריר הלב‪,‬‬
‫•דלקת כליה פיו‪-‬גרנולומטוטית‬


‫המחלה בחתולים‬
Sick seropositive cats are more likely to have uveitis stomatitis, kidneys
and urinary tract diseases. (seroepidemiologic survey!!)
.‫• המחלה בחתולים היא מחזורית ופרססטנטית‬
‫• נמשך חודשים או שנים‬

Seroprevalance in cats
B. henselae-‫מס' ניכר של חתולים בעולם נחשף ל‬
•Hawaii: 47%, Japan:15%, S. Africa: 21%
USA:15-55%, (serology)
•Israel – 40% [45/114] (serology)
•25.1% (84/334) of general cat population
positive by molecular screening (Harrus 2014)


‫התבטות באדם‬

Neal R. Chamberlain, Ph.D., All rights reserved, 2003©


‫פתוגנזה‬
Resolution
in weeks to
months

1 - 3 weeks

Cat contact
(scratch, bite,
? cat flea bite)

Dissemination
in immunocompromised
hosts

Cat scratch disease and other zoonotic Bartonella infections
Bruno B. Chomel, DVM, PhD; Henri Jean Boulouis, DVM, MS; Edward B.
Breitschwerdt, DVM, DACVIM
JAVMA, Vol 224, No 8, April 2004 1270-1279
Cats—Because of the high prevalence of infection with B henselae in cats, it has
been difficult to associate infection with specific clinical signs. However, cats that
were experimentally infected with B henselae (mainly type-II feline isolates)
developed various clinical signs. Fever was one of the most commonly observed
clinical signs that usually developed within a few days of infection and persisted
for 2 days to a few weeks. Local inflammation (erythema and swelling) at the
site of inoculation and lymphadenopathy were also observed. Lethargy and
anorexia have also been reported in experimentally infected cats. As reported
for certain humans infected with B henselae, some cats also developed CNS
disorders. Additionally, reproductive disorders (eg, inability to become pregnant,
pregnancy achieved only after repeated breedings, and stillbirths) have been
observed in experimentally infected queens..
Variations in the pathogenicity of different strains of B henselae have been
suggested for differences in clinical signs observed in experimental conditions.
On the basis of serologic findings, naturally infected cats were more likely to
have lymphadenitis and gingivitis (especially those also infected with FIV) than
were Bartonella seronegative cats. A similar association between the presence
of antibodies against B henselae and stomatitis or urologic diseases in cats has
also been demonstrated. Bartonella henselae has also been implicated as a
potential cause of anterior uveitis in cats. Bartonella henselae-associated
endocarditis was recently confirmed via PCR assay in a cat from California.


Optic Neuritis Due to Bartonella henselae Infection, Arnd M. Herz, M.D.,
and J. Michael Lahey, M.D., N Engl J Med 2004; 350: January 8, 2004

‫פתוגנזה‪:‬‬
‫ביטוי קליני בבני אדם‪ :‬פפולה אדמדמה‬
‫במקום החדרת החיידק )שריטה‪ ,‬עקיצה‬
‫של פרוש?(‬


:‫פתוגנזה‬
lymphoid) ‫נפיחות של קשרי לימפה מקומיים‬
hyperplasia, microabcesses, granuloma,
.‫ ( עם רגישות יתרה‬suppuration

umed.med.utah.edu/MS2/derm
© Copyright 2003, eMedicine.com, Inc


‫בנוסף‪ ,‬טחול מוגדל‪ ,‬הרס עצם )‪lytic bone‬‬
‫‪ ( lesions‬דלקת ריאות ומעורבות מערכת‬
‫העצבים המרכזית‪.‬‬
‫די נפוץ גרנולומה של רירית העין‪.‬‬


Both B. quintana and B. henselae are further able to elicit bacillary
angiomatosis, i.e., the outgrowth of multiple vasoproliferative tumors, as a
common complication of infection, primarily but not exclusively in
immunocompromised individuals such as AIDS patients

.A. Harms and C. Dehio,

Clin Microbiol Rev. Jan 2012; 25(1): 42–78


‫כלבים‬

‫בכלבים בעיקר‬B.hensele ‫תוארו מקרים בודדים של הדבקה ב‬
.‫עם מעורבות של הכבד‬
 6y spayed G.Retriever female no history of prior illness.
weakness, abdominal distension. specimens from liver contained
DNA from B. henselae
 4y old spayed Basset Hound female
cs: recurrent fever, anorexia, weight loss.
histology: severe pyogranulomtous inflammation.
PCR from liver :B. henselae

‫תסמונות‬
Granulomatous hepatitis
Peliosis hepatis – vasculoproliferative disorder
characterized by cystic blood filled in the liver.


Clinicopathologic findings in dogs seroreactive to
Bartonella henselae antigens.
Goodman RA, Breitschwerdt EB.
Am J Vet Res. 2005 Dec;66(12):2060-4 Department of Clinical Sciences, College

of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA

OBJECTIVE: To assess the potential clinical relevance of seroreactivity to
Bartonella henselae antigens in dogs. ANIMALS: 40 dogs seroreactive to B

henselae and 45 dogs that did not seroreact to B henselae. PROCEDURE: A
case-control study was conducted. Clinical and clinicopathologic findings
were extracted from medical records of each dog.
RESULTS: Statistical differences were not detected between dogs seroreactive
or nonseroreactive to B henselae when analyzed on the basis of disease
category or results of hematologic, biochemical, urine, or cytologic analysis.

CONCLUSIONS AND CLINICAL RELEVANCE:
Significant associations were not detected between seroreactivity to B
henselae and various diseases.


Bartonella spp. in dogs
Bartonella vinsonii subsp. berkhoffii,
Bartonella henselae, and other Bartonella species.
•Bartonella infection is more likely to cause clinical symptoms in
dogs compared to cats.
•Low seroprevalence in worldwide dog populations suggests that
dogs are probably not a natural reservoir for B. vinsonii
berkhoffii.
•It is not yet known if dogs can transmit infection to humans.
•In addition to dogs and cats, numerous domestic and wild
animals, including bovine, canine, human, and rodent species can
serve as reservoir hosts for various Bartonella species
2013,Centers for Disease Control, National Center for Emerging and Zoonotic Infectious Diseases


Bartonella vinsonii
B.vinsonii is an emerging bacterial pathogen of dogs
• associated with endocarditis, lymphadenitis,

granulomatous lesions, epistaxis, immune-mediated
thrombocytopenia, neurologic dysfunction, and potentially
polyarthritis.
The organism appears to be tick-transmitted by Rhipicephalus
sanguineus and may be co-transmitted with Ehrlichia canis
or Babesia canis.
Concurrent infection with Bartonella may interfere with the
expected therapeutic elimination of E. canis with doxycycline.
Similarly to Ehrlichia canis, some healthy dogs can be
chronically infected.


Bartonella koehlerae
• Reported to cause endocarditis in humans and dogs
• Isolated from domestic cats, has been recovered as
well from a stray cat population in Israel.
• B. koehlerae was identified in the valvular tissue of an
endocarditis patient by DNA sequencing of the PCR
products of two Bartonella genes

.Bartonella koehlerae, a new cat-associated agent of culture-negative human endocarditis
Avidor B1, Graidy M, Efrat G, Leibowitz C, Shapira G, Schattner A, Zimhony O, Giladi M.
J Clin Microbiol. 2004 Aug;42(8):3462-8


Bartonella bovis
The vast majority of Bartonella bovis infections cause no signs of disease
in cattle. There are rare reports of bartonella bovis causing endocarditis,
which is inflammation in the tissue that lines the heart, including the heart
valves.

Cases of endocarditis in cattle are usually only diagnosed at slaughter or
during autopsy examination.
The interaction between this bacterium and other pathogens such as BVD
and bovine herpes virus remains to be investigated. It is plausible that
infection with bartonella may have subclinical effects on reproduction and
growth.
Blood-sucking insects, such as lice, biting flies and ticks, transmit this
bacterium between cattle.
The percentage of infected cattle seems to vary between locations. For
example, a 2008 study in North Carolina found that 82 percent of beef cattle
were positive for B. bovis. 


‫איבחון‪:‬‬
‫•‬

‫סרולוגיה )‪) ( FA‬תגובות הצלבה(‬

‫– כנראה קשר סרולוגי )הצלבה( עם ‪ B. quintana‬הגורם ל ‪bacilliary‬‬
‫‪ angiomatosis‬בבני אדם אימונוסופרסיביים‬
‫•‬
‫•‬
‫•‬
‫•‬

‫תרבית דם‪ 2-6 :‬שבועות‬
‫‪IFA‬מראה חשיפה ‪:‬‬
‫‪ELISA‬מראה חשיפה ‪:‬‬
‫‪PCR‬מרקמות או דם‬