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Table 1.  

Variable No. patients† B. henselae, n = 338 B. quintana, n = 54 Other Bartonella spp.,‡ n = 28
Age, y, median (range) 415 32 (1–79) 52 (9–76) 30 (1–77)
   <18 NA 122/335 (36) 2/52 (4) 10/28 (36)
   18–65 NA 182/335 (54) 43/52 (83) 11/28 (39)
   ≥65 NA 31/335 (9) 7/52 (13) 7/28 (25)
Sex 397 NA NA NA
   M NA 187/321 (58) 41/50 (82) 17/26 (65)
   F NA 134/321 (42) 9/50 (18) 9/26 (35)
Specimen origin§ 361 NA NA NA
   Texas 48 38/48 (79) 4/48 (8) 6/48 (13)
   Washington 46 34/46 (74) 8/46 (17) 4/46 (9)
   Ohio 40 36/40 (90) 0/40 (0) 4/40 (10)
   California 40 22/40 (55) 16/40 (40) 2/40 (5)
   Michigan 30 27/30 (90) 3/30 (10) 0/30 (0)
   Florida 27 26/27 (96) 0/27 (0) 1/27 (4)
   Oregon 21 17/21 (80) 2/21 (10) 2/21 (10)
   Pennsylvania 11 10/11 (91) 0/11 (0) 1/11 (9)
   Other¶ NA 78/98 (80) 15/98 (15) 5/98 (5)

Table 1. Demographic characteristics and specimen origin for patients who had Bartonella spp. detected by PCR in study of Bartonella spp. infections identified by molecular methods, United States*

*Values are no./total no. (%) unless otherwise indicated. NA, not applicable.
†Total number of patients for each indicated variable.
‡Includes B. vinsonii (n = 2), B. clarridgeiae (n = 4), B. washoensis (n = 1), and Bartonella sp. not otherwise specified (n = 21).
§Restricted to states with ≥10 patients who were infected with an identified Bartonella spp. to preserve anonymity.
¶Alaska (n = 4), Alabama (n = 5), Arkansas (n = 5), Colorado (n = 5), Connecticut (n = 3), District of Columbia (n = 2), Georgia (n = 5), Hawaii (n = 2), Iowa (n = 3), Idaho (n = 1), Illinois (n = 3), Indiana (n = 6), Kentucky (n = 2), Louisiana (n = 1), Massachusetts (n = 5), Maine (n = 1), Montana (n = 5), Mississippi (n = 1), North Carolina (n = 8), Nebraska (n = 5), New Hampshire (n = 2), New Jersey (n = 1), New York (n = 3), Oklahoma (n = 1), South Carolina (n = 3), Tennessee (n = 5), Utah (n = 1), Virginia (n = 5), and Wisconsin (n = 5).

Table 2.  

No. (%) specimens
Variable p value† Cardiac, n = 140 Lymph node, n = 122 Other,* n = 158
Age, y <0.0001

<18, n = 134

5 (4) 52 (39) 77 (57)  

18–65, n = 236

106 (45) 66 (27) 64 (27)  

≥65, n = 45

27 (60) 3 (7) 15 (33)  
Sex <0.0001

M, n = 245)

107 (44) 61 (25) 77 (31)  

F, n = 152)

24 (16) 57 (38) 71 (47)  

Table 2. Categorical age and sex of infected persons grouped by specimen type in study of Bartonella spp. infections identified by molecular methods, United States

*Abscess (n = 38), tissue (n = 32), neck/face/arm (n = 25), liver (n = 15), leg/hip (n = 14), breast/chest wall (n = 6), skin (n = 5), lung (n = 4), aorta (n = 2), vascular (n = 2), body fluid NOS (n = 4), bone (n = 4), spleen (n = 4), synovial fluid (n = 2), and dura mater (n = 1).
†By χ2 test.

CME / ABIM MOC

Bartonella spp. Infections Identified by Molecular Methods

  • Authors: David W. McCormick, MD, MPH; Sara L. Rassoulian-Barrett, MS; Daniel R. Hoogestraat, BS, MB(ASCP); Stephen J. Salipante, MD, PhD; Dhruba SenGupta, PhD; Elizabeth A. Dietrich, PhD; Brad T. Cookson, MD, PhD; Grace E. Marx, MD, MPH; Joshua A. Lieberman, MD, PhD
  • CME / ABIM MOC Released: 2/23/2023
  • Valid for credit through: 2/23/2024, 11:59 PM EST
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for infectious disease clinicians, internists, intensivists, cardiologists, laboratory specialists, and other clinicians who treat and manage patients with Bartonella spp. Infection.

The goal of this activity is for learners to be better able to describe the demographic, clinical, and microbiologic characteristics of patients with Bartonellosis diagnosed by both broad-range and organism-specific molecular assays (ie, polymerase chain reaction) targeting bacterial 16S rDNA hypervariable V1-V2 regions only or in parallel with Bartonella-specific ribC, at a large clinical reference laboratory.

Upon completion of this activity, participants will:

  • Assess the microbiologic characteristics of identified Bartonellosis cases, based on a series of broad-range and organism-specific molecular assays at a large clinical reference laboratory
  • Evaluate demographic and clinical characteristics of patients with Bartonellosis, based on a series of broad-range and organism-specific molecular assays at a large clinical reference laboratory
  • Determine the clinical implications of the demographic, clinical, and microbiologic characteristics of patients with Bartonellosis, based on a series of broad-range and organism-specific molecular assays at a large clinical reference laboratory


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • David W. McCormick, MD, MPH

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Sara L. Rassoulian-Barrett, MS

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Daniel R. Hoogestraat, BS, MB(ASCP)

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Stephen J. Salipante, MD, PhD

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Dhruba SenGupta, PhD

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Elizabeth A. Dietrich, PhD

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Brad T. Cookson, MD, PhD

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Grace E. Marx, MD, MPH

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

  • Joshua A. Lieberman, MD, PhD

    Centers for Disease Control and Prevention
    Fort Collins, Colorado

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

Editor

  • Susan Zunino, PhD

    Copyeditor Emerging Infectious Diseases

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


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    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC

Bartonella spp. Infections Identified by Molecular Methods

Authors: David W. McCormick, MD, MPH; Sara L. Rassoulian-Barrett, MS; Daniel R. Hoogestraat, BS, MB(ASCP); Stephen J. Salipante, MD, PhD; Dhruba SenGupta, PhD; Elizabeth A. Dietrich, PhD; Brad T. Cookson, MD, PhD; Grace E. Marx, MD, MPH; Joshua A. Lieberman, MD, PhDFaculty and Disclosures

CME / ABIM MOC Released: 2/23/2023

Valid for credit through: 2/23/2024, 11:59 PM EST

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Abstract and Introduction

Abstract

Molecular methods can enable rapid identification of Bartonella spp. infections, which are difficult to diagnose by using culture or serology. We analyzed clinical test results of PCR that targeted bacterial 16S rRNA hypervariable V1–V2 regions only or in parallel with PCR of Bartonella-specific ribC gene. We identified 430 clinical specimens infected with Bartonella spp. from 420 patients in the United States. Median patient age was 37 (range 1–79) years; 62% were male. We identified B. henselae in 77%, B. quintana in 13%, B. clarridgeiae in 1%, B. vinsonii in 1%, and B. washoensis in 1% of specimens. Eighty-three percent of specimens with B. quintana were cardiac specimens; 34% of specimens with B. henselae were lymph nodes. We detected novel or uncommon Bartonella spp. in 9 patients. Molecular diagnostic testing can identify Bartonella spp. infections, including uncommon and undescribed species, and might be particularly useful for patients who have culture-negative endocarditis or lymphadenitis.

Introduction

Bartonella spp. are fastidious, gram-negative intracellular bacteria that are transmitted to humans by insect vectors. The genus includes 12 species associated with human infection: B. henselae, B. quintana, B. bacilliformis, B. elizabethae, B. vinsonii, B. koehlerae, B. clarridgieae, B. alsatica, B. doshiae, B. grahamii, B. rattimassiliensis, and B. tribocorum[1,2]. Bartonellosis cases are not nationally notifiable in the United States, limiting knowledge of disease epidemiology.

In the United States, B. henselae is the most common pathogenic Bartonella spp.; ≈12,500 cases of infection and 500 hospitalizations occur annually[3]. The most common clinical manifestation of B. henselae infection is cat-scratch disease (lymphadenopathy and fever after a cat scratch or bite), although infection can also cause hepatic lesions, ocular disease, osteomyelitis, and endocarditis[4,5]. B. quintana infection is uncommon and incidence is unknown. Clinically, B. quintana infection can manifest as acute febrile illness or subacute endocarditis. B. quintana is transmitted by body lice and causes the most frequently reported vector-borne disease among persons experiencing homelessness (PEH); seroprevalence in the PEH population is 5%–15%[6–8]. Manifestations of other Bartonella spp. infections are sporadically described in case reports, often as culture-negative endocarditis.

Serology is the diagnostic tool most frequently used to identify Bartonella spp. infections. However, serologic diagnosis is complicated by lack of species-specific results, differences in use and interpretation of serologic assays among laboratories, and cross-reactivity with other pathogens, including Chlamydia spp. and Coxiella burnettii[9–15], which can lead to misdiagnosis and insufficient treatment. Bacterial cultures of blood or tissue can establish the diagnosis, but sensitivity of cultures is low because of the fastidious nature of Bartonella spp. and might result in underdiagnosis of infection. Combining enrichment culture techniques with molecular methods might increase detection of Bartonella spp. in blood or other clinical specimens[16].

Molecular detection of bacterial pathogens has emerged as an important clinical tool that can increase diagnostic yield compared with culture alone, particularly for detection of fastidious organisms[17]. Bartonella spp. have been detected by using broad-range PCR-based assays that target conserved binding sites flanking regions of the rRNA gene and have species-specific variations[18] or by using organism-specific gene targets, such as gltA[19] and ribC[20]. We describe the demographic, clinical, and microbiologic characteristics of patients with bartonellosis diagnosed by both broad-range and organism-specific molecular assays at a large clinical reference laboratory in Washington, USA.