www.borelioza-forum.pl

tosho 02.01.08, 16:27
z notatek z konferencji:
http://www.betterhealthguy.com/images/s ... me2007.pdf

Treatment of BLO is:
• Levaquin is the drug of choice. 500mg daily with proton pump inhibitor. Tendon
damage primary side effect.
• Cell-wall drugs used for Lyme are ineffective though may be synergistic with
Levaquin. Remember bartonella is usually intracellular and cell-wall drugs do
not reach the intracellular spaces.
• Erythromycins are totally ineffective. These may even inhibit the Levaquin
therapy. Biaxin and Zithromax also ineffective.
• Rifampin and Flagyl may be alternative treatments.
• Response to doxycyclines are varied but generally poor.
• Combination therapies may be required.
• Treatment should last 1-3 (or more) months

Pol J Microbiol. 2007;56(1):33-8.
Presence of Bartonella spp. in various human populations.
Chmielewski T, Podsiadly E, Tylewska-Wierzbanowska S.
National Institute of Hygiene, Warsaw, Poland.

Bartonella spp. bacteria are significant human pathogens and the agents of
bacterial zoonosis acquired from an animal companion. The aim of the study was
to determine the seroprevalence of two of the most common Bartonella species
B. henselae and B. quintana in various human populations. The studied groups
included: alcoholics, intravenous drug users, veterinarians, cats' owners.
Blood samples were collected and cultured on chocolate agar plates and in
mouse fibroblasts L-929 cell line culture. The levels of Bartonella henselae
IgM and IgG antibodies were determined by indirect immunofluorescence assay.
Specific B. henselae IgG were detected in 48.3% of homeless alcoholics, in
45.0% veterinarians and in 53.3% cats' owners. The differences in the
prevalence of B. henselae antibodies between the studied groups and a control
group were statistically supported. No homeless intravenous drug users had
specific B. henselae and B. quintana antibodies. High titers of B. quintana
IgG antibodies were detected in two homeless alcoholics. Bartonella spp. was
cultured on chocolate blood agar plates from blood samples from 2 alcoholics.
The isolates were identified as B. henselae by PCR amplification of the
riboflavin synthase gene (ribC). The results prove that B. henselae and B.
quintana, emerging human pathogens, are present and widely distributed in
Poland in such specific risk groups as: alcoholics, veterinarians and cats'
owners.

Braz J Infect Dis. 2006 Dec;10(6):411-5.

Bartonellosis: suggestive case reports in adult and pediatric patients and
therapeutic issues.

Manfredi R, Sabbatani S.

Department of Clinical and Experimental Medicine, Division of Infectious
Diseases, University of Bologna Alma Mater Studiorum, S. Orsola Hospital,
Bologna, Italy.

Cat-scratch disease warrants extensive investigation, from an
epidemiological, a diagnostic, but especially a therapeutic point of view. Two
suggestive episodes of Bartonella henselae-caused cat-scratch disease are
reported, and discussed in the light of the most recent literature evidence. The
first case occurred in a 60-year-old man, thus suggesting that it is important
to maintain an elevated level of suspicion for this disease in adults as well.
Both episodes were characterized by a very prolonged and complicated disease
course (with the involvement of three lymph node sets in the first case), a need
for lymph-node drainage, and apparently negligible activity of many
antimicrobial courses, with a very slow local cure. While specific culture and
molecular biology techniques proved negative (probably due to late availability
of appropriate clinical specimens), indirect immunofluorescence antibody assay
was positive since the first weeks of disease, and elevated levels were also
fond many months after disease onset. When clinicians face patients with
prominent swelling of lymph nodes draining from the upper limbs, cat-scratch
disease may be suspected on the grounds of epidemiological and clinical
features, with a limited systemic involvement contrasting with a prominent local
disease. The significance of specific antibody temporal kinetics in the subacute
disease course is still unknown. Although biomolecular assays are now available,
the time elapsed from disease onset to clinical diagnosis usually hampers
diagnosis, while the roles of surgical debridement and of the unpredictable
activity of antimicrobial chemotherapy warrant careul investigation.

nfection. 2007 Apr;35(2):107-9.

Chronic Vasculitis and Polyneuropathy due to Infection with Bartonella henselae.

Stockmeyer B, Schoerner C, Frangou P, Moriabadi T, Heuss D, Harrer T.

Dept. of Medicine III, University Hospital Erlangen, Krankenhausstr. 12,
91054, Erlangen, Germany, Thomas.Harrer@med3.imed.uni-erlangen.de.

Bartonella henselae, the causative agent of cat scratch disease and
bacillary angiomatosis, is associated with an expanding spectrum of diseases.
Here, we report on a 40-year-old patient suffering from chronic recurrent
painful ulcers of the toes, distal axonal sensomotor polyneuropathy and
Raynaud's phenomenon. Biopsy of the sural nerve demonstrated an axonal
neuropathy with a neurogenic muscular atrophy. Treatment with high dose
corticosteroids had no beneficial effect. A biopsy taken from a recurring ulcer
7 years after the beginning of the disease revealed superficial ulcerated
hyperkeratosis with subepithelial proliferation of small vessels compatible with
a diagnosis of verruca peruana, however, without detection of microorganism.
Serologic analysis revealed an elevated IFT titer of 1:1,024 against B.
henselae. Treatment with erythromycin induced healing of the ulcer, remission of
the vasculitis and the polyneuropathy, and a decline of the IFT titer. This case
illustrates that B. henselae infection should be considered in patients with
vasculitis and polyneuropathic syndromes.

Praca sugeruje, ze testy typu Elisa sa do kitu dla diagnozy
Bartonelli i ze byc moze pacjenci beda mieli wiecej szczescia w diagnozie jezeli
uzyc PCR. W kazdym razie ujemny test Elisa na Bart nie wyklucza tej choroby.


Clin Microbiol Infect. 2007 Mar 22;
Serological testing for Bartonella henselae infections in The Netherlands:
clinical evaluation of immunofluorescence assay and ELISA.
* Vermeulen MJ, * Herremans M, * Verbakel H, * Bergmans AM, * Roord JJ, * van
Dijken PJ, * Peeters MF.

Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.

Cat-scratch disease (CSD), caused by Bartonella henselae infection, can mimic
malignancy and can manifest atypically. Reliable serological testing is
therefore of great clinical importance. The diagnostic performance of
immunofluorescence assay (IFA) and ELISA was evaluated in a group of Dutch
patients with proven CSD (clinical diagnosis confirmed by PCR). Sera of 51 CSD
patients and 56 controls (patients with similar symptoms, but who were B.
henselae PCR-negative and had an alternative confirmed diagnosis) were tested
for anti-B. henselae IgM and IgG by IFA and ELISA.

A commercially available IFA test for IgM had a sensitivity of 6%. In-house
assays for IgM showed specificities of 93% (IFA) and 91% (ELISA), but with low
sensitivities (53% and 65%, respectively). With a specificity of 82% (IFA) and
91% (ELISA), in-house IgG testing showed a significantly higher sensitivity in
IFA (67%) than in ELISA (28%, p less than0.01). Sensitivity was higher for
genotype I (38-75%) than for genotype II (7-67%) infections, but this was only
statistically significant for IgG ELISA (p less than0.05).

In conclusion, detection of IgM against B. henselae by in-house ELISA and IFA
was highly specific for the diagnosis of CSD. The high seroprevalence in healthy
individuals limits the clinical value of IgG detection for diagnosing CSD. Given
the low sensitivity of the serological assays, negative serology does not rule
out CSD and warrants further investigation, including PCR. Adding locally
isolated (e.g., genotype II) B. henselae strains to future tests might improve
the sensitivity.