BARTONELLOSIS

Dr. Ciro Maguia

PROFESOR PRINCIPAL
UNIVERSIDAD PERUANA CAYETANO
HEREDIA.
Archivo descargado de la web de Apuntes Mdicos del Per

Alpha-Proteobacteria
Ehrlichia chaffeensis
Rickettsia rickettsii
Rickettsia prowazekii
Rickettsia typhi
Afipia felis
Afipia clevelandensis
Agrobacterium tumefaciens
Brucella abortus
Bartonella henselae
Bartonella elizabethae
Bartonella vinsonii
Bartonella quintana
Bartonella bacilliformis ( hasta 1995)
Evolutionary Distance

Bartonella
Bartonella bacilliformis; alpha-2Proteobacteria
Motil, aerobia, pleomrfica, flagelo
unipolar
Intracelular: eritrocitos, celulas del
endotelio vascular
Otros patgenos humanos B. henselae; B.
Quintana,etc.
Patgenos de plantas: Agrobacterium
tumefaciens, Rhizobium meliloti

Bartonellosis
Bartonella spp are becoming recognized
as widespread organisms in many
species of animals. For example 98% of
deer killed on roads in the northwest,
93% of mule deer in the east, and 89% of
beef cattle and 17% of dairy cattle in
oregon carry bartonella spp.
11-99 NEWSLETTER(2000)

Prevalence of B. Henselae and

B clarridgeiae in Stray
Cats.(Francia)
De 94 gatos, 53% cultivo + Bartonella
( B Henselae, B clarridgeaie(16%))

Journal of Clinical Microbiology June

1977

Nuevas Bartonellas
Detection and identification of Two
Bartonella henselae Variants in Domestic
Cat in Germany.
Estudian 100 gatos : B henselae( 13%)
Cultivos + > en gatos jvenes, hembras
J of Clinical Microbiology 1997.

Nuevas Bartonellas 2001

Infection with Bartonella Weissi and

Detection of Nanobacterium Antigens in
a North Carolina Beef Herd.

E Breitschwerdt , et al DCSFARM,
College of Vetgerinary MedicineNorth
Carolina State University

BARTONELLOSIS:2002
Actualmente la Bartonellosis incluye a 18
especies que afectan a seres humanos y
animales.
Existen adems otras Bartonella sp. que
se encuentran en muchos animales (
Alces, venados, carnero, vaca, toro,
coyote, perro, gato, len americano, sapo,
cuy, etc.)
Por ello se lo considera dentro de las
nuevas enfermedades emergentes en el
mundo.

Bartonellas humanos -animales

Especie
ao
Hospedero
vector
B bacillifor. 1905 Humano
Lutzomyia
B talpae
1911 Topo
B quintana 1917 Humano
piojo
B peromysci 1942 Ciervo,raton
B vinsonii sup
Roedor campaol
vinsonii 1946

Bartonellas humanos-animales

B henselae 1992 gato pulga del gato

B elizabethae 1993 rata
Humano(incidental)
B grahammi 1995 raton campaol
B taylorii
1995 raton campaol
B doshiae
1995 raton campaol
B vinsonii sup
Berkhoffi
1996 perro

Bartonella humanos-animales

B clarridgeiae 1996
Humano incidental
B tribocarum 1998
B alsatica
1999
B khoelerae
1999
B vinsonii sup
Arupensis
1999
incidental.
B weissi
2000

Gato
rata
Conejo
Gato
Vacunos, humanos
Vacunas, gato

Bartonella Schoenbuchii sp.

Nov aislated : blood of wild roe
beer
Aislo de cinco wild roe deer( capreolus
capreolus) Western Europe.
Aisla 4 cepas de Bartonella . Estas cepas
poseen flagelos unipolares similar a B
bacilliformis y Bartonella claridgeae.
Dr C Dehio Dr Lanz, et al
Suiza. International Journal of systematic
and Evolutionary Microbiology vol 51,
2001

Bartonella birtlessi sp.

nov
Isolated

from small mammals(

Apodemus spp.)
Dr Bermond D, Heller R, et Hospital
Strasbourg France.
International Journal of Systematic and
Evol Microbiology vol50,1973-1979,
2000

Nuevas Bartonellas 2002

Bartonella

weiss
Bartonella washoensis
Bartonella Schoenbuchii
Bartonella birtlessi

A prospective Study of CSD in

LIMA-PERU.

1998-1999 43 pacientes, 12 de los cuales se

confirmo diagnostico, la media de 10 aos,
todos los pacientes tuvieron contacto con gatos.
Sintomas: Fiebre, Malestar, Linfoadenopatia.
12 + IFI 1/50- 1/800 B henselae y B
Clarridgeiae. Dos biosias + CSD. No cultivos +.
Dr Huarcaya, Dr Maguia. Diagnostico 2001.

BARTONELLOSIS: 2002
Al ser humano causan enfermedad:
B. bacilliformis (E. Carrin), B. quintana
(Fiebre trincheras, angiomatosis bacilar,
endocarditis, etc.)
B. henselae (Araazo del gato,
endocarditis, FOO, angiomatosis, etc.)
B. clarridgeae (AG), B. grahamii
(neuroretinits), B. elizabethae
(endocarditis).
B. vinsonii, B. washoensis (carditis)

Nuevas Bartonellas :B quintana

Vector : PIOJO
ENFERMEDADES
1.- Fiebre de trincheras(Gueera, piojos, vagos)
2.- Angiomatosis bacilar(Sida, piojos)
3.- Endocarditis( alcoholismo, piojos, vagos)
4.- Linfoadenopata crnica
5.-Bacteremia, 6.- Masa abdominal
7.- Hemorragia Gintestinal,
8.- Alteraciones neurolgicas.

BARTONELLOSIS:Patrones
clinicos e Immunidad
1.- Immunocomprometidos : A Bacilar
2.- Immunocompetente: Araazo del gato

Enfermedad de Carrin
3.- Immunocompetente o
Immunodeprimido : Bacteremia
recurrente, Endocarditis

CUTANEOUS BARTONELLOSIS

10

Fiebre Trincheras( Trench fever)

ORGANISM:

DISEASE:

Unknown

DIAGNOSIS:

Human body louse

RESERVOIR:

Relapsing bouts of fever

Bacteremia

VECTOR

B. quintana

Epidemiologic and clinical culture

TREATMENT:

CAF, TETRAC(?)

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Enfermedades: BARTONELLA
QUINTANA
Fiebre

Trincheras.
Bacillary Angiomatosis
Bacillary Peliosis Hepatis
Bacteremia/Fever
Endocarditis

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ANGIOMATOSIS BACILAR
ORGANISMOS:
B. henselae
B. quintana
VECTOR:
Gato y/o pulga gato (?)
RESERVORIO: Pulga Gato (B.
henselae)
Desconocido

para B. Quintana

ANGIOMATOSIS BACILAR

Enfermedad:

DIAGNOSTICO:

Lesion vascular prolferativa de piel y otros

organos viscerales.
Historia clinico epidemiologica, serologia,
patologia, cultivo, PCR

TRATAMIENTO: Erithromicina,
claritromicina, azithomicina, doxiciclina,
tetraciclina

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CUTANEOUS BARTONELLOSIS
Bacillary Angiomatosis (B. henselae and B. quintana)

Bartonella henselae
Domestic Cats

Ctenocephalides
Fleas
Cat Scratch

Humans Bacteremia &

Subacute Bacterial
Endocarditis

Immunocompetent Humans
Cat Scratch Disease
Domestic Cats
Bacteremia

Immunocompromised
Humans
Bacillary Angiomatosis

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Bartonella Henselae

Vector: Pulgas
Enfermedad del araazo del gato(gatos),
Angiomatosis bacilar (sida,gatos),
Endocarditis( Valvulopata,gatos) Bacteremia,
Peliosis Bacilar(sida, gatos), Neuritis ptica,
Meningitis asptica, Granuloma pulmonar,
Parlisis facial, Paroniquia.
Osteomielitis, Hepatitis granulomatosa

Araazo del gato (CAT SCRATCH

DISEASE)

ORGANISM:
-Bartonella henselae
-B. Clarridgeae
DISEASE:
-Cutaneous papule
-Pustule, proximal
-Lymphadenopathy
-With granuloma formation

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CAT SCRATCH DISEASE

CSD : LABORATORIO

CULTIVO : B. HENSELAE (1-2%) DIFICIL

PCR (+++)
IFI: 84% SENSIBILIDAD,
96% ESPECIFICIDAD
PATOLOGIA:

Hiperplasia linfoidea, GRANULOMAS, Necrosis

Central
Whartin Starry (+)

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VISCERAL GRANULOMAS AND

PERICARDIAL EFFUSSION: B. henselae
Liver biopsy showed a necrotising
granulomatous hepatitis
Serology (+) B. henselae
Treated with clarithromycin and
recovered
Bakker, et al.
AFD Interne Geneeskunde

Amsterdam: 1997 Feb 22, 141(8):399-90

Araazo del gato (CSD)

VECTOR:Gato

Pulga del gato

RESERVORIO: Gato
DIAGNOSTICO:

Epidemiologia ,clinica, serologia

patologia, cultivo, IFI +++, PCR

TRATAMIENTO: No requiere

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Araazo del gato:CSD

ORGANISMOS:

Bartonella henselae
B. clarridgeiae
Afipia felis

Enfermedad:

papula

Pustula (10%), Linfoadenopatia

proximal. Con formacion de
granulomas

VISCERAL GRANULOMAS AND

PERICARDIAL EFFUSION: B. HENSELAE

55 year-old woman after a three week

period of upper abdominal pain, nausea
fever, headache and exertional dysphnea.
Echocardiography:
-Perycardial effusion
Abdominal CT-Scan

-Multiple Hypodense lesions, liver, spleen

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CSD : LIMA PERU 1999

SEROLOGY

IFI ( FRANCE)
BARTONELLA HENSELAE
: 1/50- 1/800 (+ )
BARTONELLA CLARRIDGIEAE:
: 1/50 - 1/800 ( +)
( Dr. Huarcaya, Dr Maguia, 1999)

B. CLARRIDGEIAE AND CSD

A

newly recognized zoonotic

pathogen causing innoculation
papules, fever and lymphadenopathy
(CSD) (first report)

Kordick,J. Clinic, Microbiol 1997 Jul:35(7):1811818

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Bartonella Elizabethae
Vector

Desconocido

Enfermedad:

Endocarditis (
Un caso reportado)

Bartonella Clarridgeiae
Vector

: desconocido
Enfermedad: Araazo del
gato( Gato)
Dos casos reportados.

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Bartonella VINSONNI
1.-Subsp vinsonii( Brener, 1993)
2.- Subsp berkhoffii.( Kordick ,1996)
isolated from Dogs.
3.- Subsp arupensis ( Welch et al 2000)
From a cattle rancher; identity with isolates
found in conjunction with Borrelia
burgdorferi and Babesia microti.
J. Clin. Microbiol ,1999, 37:2598-2601.

Bartonella Vinsonii
Vector : Desconocido ?
Garrapatas ?
Enfermedad : Endocarditis
Encelopata B V sup arupensis( Un caso
reportado)

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Bartonella Grahammi
Vector

Desconocido

Enfermedad:

Infeccin

intraocular

Australian and New Zealand

Journal of Opthalmology
27(2),153-156 , 1999
Conservative management of document
neuroretinitis in CSD associated with B
Henselae infection.
NEURORETINITIS MACULAR.
IFI +B Henselae 1/128. No terapia. Buena
resolucin.

22

J of Clinical Microbiology dec

1999:4034-4038
Demostration of B Grahamii DNA in
Ocular Fluids of a Patient with
Neuroretinitis( Netherlands)
Mujer 55 aos vih(-) neuroretinitis, fluido
intraocular PCR + (DNA) B Grahamiii.
Tx con doxiciclina 200 mg por da y RFP
600 mg x dia por 4 semanas.

Bartonella ALSATICA
Isolated from the blood of wild rabbits.
(Oryctlagus cuniculus)
Dr Heller, et al . Francia
INT Jou. Of Sys Bacteriology vol 49 283288, 1999.

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Bartonella TRIBOCARUM
Isolated from the blood of wild rats
( Rattus norvegicus)
Dr Heller, Riegel, etc
Francia.
Inter. Journ. of Systematic Bacter vol 48,
1333-1339, 1998.

BARTONELLA
KOEHLERAE

Sp. NOV. ISOLATED FROM CATS.

DROZ, ET. AL.

J. CLIN. MICROB. 1999
APR. 37 (4), 1117 -22

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Tratamiento nuevas
Bartonellas

Immunocompetente: CSD
CUESTIONABLE, CSD Atipico
Probable

Immunodeprimido : SI TRATAR CSD,

AB
,etc.

Pyogenic Granuloma vs.

Cutaneous Bartonellosis
Warthin-Starry negative for

Warthin Starry positive for bacilli

bacteria

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Pyogenic Granulomas vs.

Cutaneous Bartonellosis
At low power: vascular
component predominates

At low power vascular and

cellular components are equal

Single pattern divided by

septa

Single pattern with no septa

Mucin scant

Vessels bizarre shaped and

jagged edges

Vessels round and oval

Mucin in stroma

Pyogenic Granuloma vs.

Cutaneous Bartonellosis
Blood vessels are crowded
Few histiocytes in stroma
No neutrophils unless
ulcerated. No dust
No violaceous granular
materia

Blood vessels are separated

by stroma
Many histiocytes in stroma
Neutrophils collections and
nuclear dust
Violaceious material present

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ENFERMEDAD DE CARRION
Una

de las pocas enfermedades

con dos fases clinicas totalmente
diferentes con diversos patrones
clinicos(18 sindromes).
Modelo til para enfermedades
tumorales.

Mecanismo de TransmisionReservorio( Estudio Caraz)

Reservorio animal (Bartonella spp no

baciliformis)

Perro
10%
Gato
0%
Cuyes
2%
Caballos, mulas, cerdos 0% (cultivo solo)
Animales de corral
0%
Roedores domsticos 2%
Roedores silvestres 31%
Sapos
100% (n=1)

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Reservorio Humano Resumen

Asintomticos
Seropositivos

(11%)
Convalescientes
(14%)
Fase verrucosa
(23%)

6/813 (0.7%)
8/75
3/21
17/74

CARRIONS DISEASE IN THE

NEW ERA.
Clinical infectious diseases
September 15, 2001

Dr Ciro MAGUIA, Dr Garca, Dr

Gotuzzo, Dr Spach, et al.
Estudio de 145 casos ( 68 agudos y 77
eruptivos)

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CARRIONS DISEASE
FACTORS ASSOCIATED WITH
LETALITY
Coma, delirium
Anasarca, respiratory distress
increased levels of GOT, GPT, AF
Hypoalbuminemia
Leukocytes > 20,000/mm3
Hyponatremia

Complicaciones CARDIOVASCULARES
Fala cardiaca 62.5%
Pericarditis efusiva 56.5%
Edema agudo pulmonar 40%
Taponamiento cardiaco 17.5%
Choque cardiovascular 15%
Myocarditis 2.5%

Franco, Maguia (1997)

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VERRUGA PERUANA
DIAGNOSTICO:
1.- CLINICA
2.- BIOPSIA, CULTIVOS.
3.- W BLOT (+++)
4.- MO, M ELECTRONICA
5.- PCR.
6.- Immunohistoquimica

SONICATED DIAGNOSTIC
IMMUNOBLOT FOR BARTONELLOSIS
94% SENSITIVE TO CHRONIC
BARTONELLOSIS AND 70%
SENSITIVE TO ACUTE
BARTONELLOSIS
MALLQUI V. SPEELMON EC,
MAGUIA C..
CLIN. DIAG. LAB. INMUNOLOG.
2000 JAN 7(1)

30

VERRUGA PERUANA
Diagnostico diferencial:
Hemangioma,
granuloma pigeno,
angiomatosis bacilar, tumores drmicos,
forma histiode de la lepra.
Sarkoma kaposi, molusco contagioso.
Melanoma, varicela, etc.

VERRUGA PERUANA
TRATAMIENTO:
RIFAMPICINA 21 DIAS
ERITROMICINA
CIPROFLOXACINA 10 dias
AZITROMICINA. 10 dias
Problema la Verruga recurrente

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ENFERMEDAD DE CARRION
Para la prevencin de la enfermedad se
requiere usar repelentes, no dormir en
reas rurales sin proteccin.
Usar mosqueteros
No hay profilaxis, ni vacunas

BARTONELLOSIS
Cats

are healthy carriers of B.

henselae and B. clarridgeiae, and
can be bacteremic for months to
years.
Chomel, Bull-Acad-Natl Med 1997
(18)181(3):441-50

32

DEMOSTRATION OF BARTONELLA
GRAHAMMI DNA IN OCULAR
FLUIDS OF A PATIENT WITH
NEURORETINITIS
J. OF. CLINICAL MICROBIOLOGY
DEC 1999 P. 4034-4038
VOL.37 N 12

REFERENCES

Maguia C. Tesis Doctoral Medicina (UPCH) 1993

Llanos-Cuentas A., Maguina Vargas C., Warrel D.A.
Bartonellosis, Internal Medicine Oxford University
1996. Third Edition
Maguia C., Gotuzzo E. Verruga Peruana o
Enfermedad de Carrin. Libro Pediatra Menenghello
Chile Quinta Edicin 1996.
Maguia Ciro, Gotuzzo E. Bartonellosis New and Old.
Infectious Disease Clinics of North America Vol 14 (1)
March 2000.
Walker, Guerra, Maguia C. Bartonellosis. Tropical
Infectious diseases, Textbook 1999
Maguia C, 2001, Clinical infectious Diseases.

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