1. Cat Scratch Disease Bartonella henselae

2. 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

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

4. Common infection strategy of the bartonellae
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.

5. תכונות אלימות:
פילי המשמשים להצמדות לתאי מטרה.

6. 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

7. המחלה בחתולים בד"כ נשא בריא ואסימפטומטי.
בקטראמיה – מס' חודשים – שנים (מחזורית)
שכיחות גבוהה יותר בגורים (< שנה )
לחתולים עם FeLV ) לטנטי או פרוגרסיבי) יש סיכון גדול יותר לחלות ב BH

8. הדבקה ניסויית של חתולי SPF
לרוב לא נצפו סימנים קליניים.
קשרי לימפה מוגדלים באופן מופשט, follicular hyperplasia
חום, חוסר תיאבון,
שיבושי רביה.
שינויים פתולוגיים:
טחול וקשרי למפה מוגדלים,
דלקת של שריר הלב,
דלקת כליה פיו-גרנולומטוטית

9. המחלה בחתולים המחלה בחתולים היא מחזורית ופרססטנטית.
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

10. Seroprevalance in cats
מס' ניכר של חתולים בעולם נחשף ל-B. henselae
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)

11. ©2003, Neal R. Chamberlain, Ph.D., All rights reserved
התבטות באדם
©2003, Neal R. Chamberlain, Ph.D., All rights reserved

12. פתוגנזה Cat contact Resolution in weeks to months Dissemination
(scratch, bite,
? cat flea bite)
1 - 3 weeks
Dissemination
in immuno-
compromised
hosts

13. Cat scratch disease and other zoonotic Bartonella infections Bruno B
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
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.

14. 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

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

16. פתוגנזה:
נפיחות של קשרי לימפה מקומיים (lymphoid hyperplasia, microabcesses, granuloma, suppuration ) עם רגישות יתרה.
umed.med.utah.edu/MS2/derm
© Copyright 2003, eMedicine.com, Inc

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

18. 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.

19. כלבים
תוארו מקרים בודדים של הדבקה ב B.henseleבכלבים בעיקר 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.

20. CONCLUSIONS AND CLINICAL RELEVANCE:
Clinicopathologic findings in dogs seroreactive to Bartonella henselae antigens.
Goodman RA, Breitschwerdt EB.
Am J Vet Res Dec;66(12): 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.

21. 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

22. 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.
*****************May be zoonotic*******************

23. 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 Aug;42(8):3462-8

24. 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. 

25. איבחון:
סרולוגיה (FA ) (תגובות הצלבה)
כנראה קשר סרולוגי (הצלבה) עם B. quintana הגורם ל bacilliary angiomatosis בבני אדם אימונוסופרסיביים
תרבית דם: 2-6 שבועות
IFA: מראה חשיפה
ELISA: מראה חשיפה
PCR מרקמות או דם

26. טיפול או חיסון
Doxycycline, amoxicillin, enrofloxacin, and rifampin (4-6 weeks) may reduce the level of bacteremia in the infected cat or dog.
The ability of any antibiotic or antibiotic combination to completely clear B. henselae from the blood stream has not been established.
Given the duration of treatment necessary to clear the bacteremia and the concern for development of antimicrobial resistance, treatment is recommended only for pets that have clinical symptoms.

27. גורמי סיכון: ילדים: 80%-90% מהמקרים הם מתחת לגיל 21. חתולים בקטראמיים
חתולים צעירים
חתולים החיים גם בחוץ
פרעושים
משחק עם חתולים המלווה בשריטות או נשיכות

28. מניעה:

29. מניעה: הדברת פרעושים שטיפה יסודית וחיטוי של כל שריטה או נשיכה
ניטור וטיפול בחתול בקטראמי ומעקב לתקופה ארוכה
אנשים אימונוסופרסיביים :
אימוץ חתול סרולוגית שלילי בלבד?
חתול סרולוגית חיובי מעל שנה?
- declawingאינו מונע את הסיכון