Post by Admin/ Traveler on Apr 25, 2019 16:27:35 GMT
Trav here, I won't post the entire article, as it's pretty 'sciency', but it does have some important information, so I won't post the entire article, but the parts that seem relavent to those that are still searching for what they have and how they may have gotten the infection, it also serves for all of us to understand the prevalence. I have added extra spacing and some other things to help us all make it through the sciency bits a little easier with brain fog!
One thing to always keep in mind when reading these articles - they are talking ONLY about those people that actually can test positive for these infections - many of us can't and no studies are being done on why.
___________________________________________________________________________________________________________________________________________________________________
Human Bartonellosis: An Underappreciated Public Health Problem?
Mercedes A. Cheslock and Monica E. Embers
Division of Immunology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, LA 70433, USA
Received: 24 March 2019 / Accepted: 16 April 2019 / Published: 19 April 2019
Abstract: Bartonella spp. bacteria can be found around the globe and are the causative agents of multiple human diseases. The most well-known infection is called cat-scratch disease, which causes mild lymphadenopathy and fever.
As our knowledge of these bacteria grows, new presentations of the disease have been recognized, with serious manifestations. Not only has more severe disease been associated with these bacteria but also Bartonella species have been discovered in a wide range of mammals, and the pathogens’ DNA can be found in multiple vectors.
This review will focus on some common mammalian reservoirs as well as the suspected vectors in relation to the disease transmission and prevalence. Understanding the complex interactions between these bacteria, their vectors, and their reservoirs, as well as the breadth of infection by Bartonella around the world will help to assess the impact of Bartonellosis on public health.
Several Bartonella spp. have been linked to emerging and reemerging human diseases. These fastidious, gram-negative bacteria cause the clinically complex disease known as Bartonellosis. Historically, the most common causative agents for human disease have been Bartonella bacilliformis, Bartonella quintana, and Bartonella henselae. These infections cause a variety of manifestations from mild symptoms such as fever, headache, and malaise to more severe symptoms such as hallucinations.
Bartonellosis is characterized by a prolonged intraerythrocytic bacteremia within a diverse array of reservoirs hosts.
Bartonella spp. have been isolated from numerous hosts including:
humans,
cats,
dogs,
rabbits,
rodents,
horses,
cattle,
and other wild animals.
The severity of the clinical manifestations is often correlated with the immune status of the patient, although other factors such as the species infecting the host, virulence factors, and bacterial load should be considered as components in disease severity. These features allow Bartonella spp. to persist in the blood of hosts as a chronic infection and to account for the range of clinical manifestations.
Known diseases caused by Bartonella infections include:
Carrion’s disease,
cat-scratch disease,
chronic lymphadenopathy,
trench fever,
chronic bacteraemia,
culture-negative endocarditis,
bacilliary angiomatosis,
bacilliary peliosis,
vasculitis, and
uveitis
Recently, Bartonella infections have been linked to more diverse manifestations such as:
hallucinations,
weight loss,
muscle fatigue,
partial paralysis,
pediatric acute-onset neuropsychiatric syndrome (PANS),
and other neurological manifestations
A few case studies have also documented Bartonella in tumors, particularly vasoproliferative and those of mammary tissue.
The potential involvement of this pathogen in breast tumorigenesis is both disconcerting and warrants significantly more research.
Bartonella spp. are zoonotic pathogens transmitted from mammals to humans through a variety of insect vectors including:
the sand fly,
cat fleas,
and human body louse
New evidence suggests that ticks, red ants, and spiders can also transmit Bartonella. Bed bugs have been implicated in the transmission cycle of B. quintana and have been artificially infected.
B. quintana was found in bed bug feces for up to 18 days postinfection.
The diversity of newly discovered Bartonella species, the large number and ecologically diverse animal reservoir hosts, and the large spectrum of arthropod vectors that can transmit these bacteria among animals and humans are major causes for public health concern.
------------------------------------------------------------------------------------------------
Trav here again - I'm skipping a lot of content about transmission in the animals listed, but I want to get to the human issues
------------------------------------------------------------------------------------------------
5. Bartonella as a Coinfection in Humans
Equivalent to the debate on whether ticks transmit Bartonella, there has been more evidence gathered to support coinfection of Bartonella with other vector-borne pathogens. Most evidence has occurred through serological surveys conducted in an effort to estimate the incidence of human coinfection. Several studies have also focused on the detection of pathogens within questing ticks.
Although it is difficult to determine whether these coinfections occurred with one vector or transmission event or over the course of multiple events, one aspect is clear: A coinfection with these pathogens leads to difficulty clearing either infection and the antibiotic treatment should differ for individuals infected with multiple pathogens.
In a Peruvian retrospective study, 35% of patients with Carrion’s disease had coinfections with B. bacilliformis, including:
Salmonella spp.,
Shigella dysenteriae,
Staphlococcus aureus,
Enterobacter spp.,
Toxoplasma spp.,
Histoplasma spp.,
Pneumocystis carinii, and
Plasmodium vivax malaria.
Although most patients responded to antibiotic treatments, 4 patients with coinfections died.
Another study in Peru found that 37.5% of Bartonellosis patients in an outbreak were infected with B. bacilliformis and Mycobacterium spp. While not necessarily co-transmitted, these infectious complications can exacerbate disease. These data help to demonstrate the importance of monitoring coinfections with pathogens such as Bartonella.
One serological survey conducted among the homeless in Columbia found 13.1% of enrolled individuals had IgG to both Bartonella spp. and Rickettsia typhi.
Lice collected from these homeless individuals were also screened, and 28% of louse pools were positive for Bartonella spp., while none were positive for Rickettsia spp., implicating other factors in this particular coinfection among the homeless in Bogotá.
From a collection of questing ticks surveyed in Germany, 15/104 nymphs were found to be coinfected with Bartonella spp. and Rickettsia spp.
A study of volunteer blood donors in Namibia identified a high rate of exposure to Coxiella burnetii, Spotted Fever Group and Typhus Group Rickettsiae, and Bartonella henselae. While B. henselae exposure (2.9%) was the rarest of the those tested, over 20% of donors had been exposed to two or more pathogens, which was positively correlated with occupations involving animals.
Although there is no direct evidence, these pathogens were transmitted at one time, and flea and tick vectors transmit the pathogens; Coxiella burnetii, which causes Q fever in humans, in particular, could produce more serious complications as a coinfection.
In 2012, a survey of 39 farmers, 119 foresters, and 32 healthy blood donors (controls) was conducted to investigate an exposure to tick-borne pathogens and coinfections including:
Borrelia burgdorferi,
Anaplasma phagocytophilum,
Bartonella spp., and
Babesia microti.
The sera obtained indicated that 23.1% of foresters, 27.7% of farmers, and 37.5% of control groups had antibodies to Bartonella.
A coinfection risk was directly linked to occupational exposure, and the highest rates of coinfection were with Bartonella and B. burgdorferi with 9.2% of forestry workers and 7.7% of farmers coinfected. The other coinfections observed were Bartonella spp. and A. phagocytophilum (1.7% forestry workers) and Bartonella spp. and B. microti (0.8% forestry workers). A small percentage (1.3%) of forestry workers even experienced triple infections with Borrelia burgdorferi, Bartonella spp., and A. phagocytophilum, and one individual had a quadruple infection with all pathogens investigated. These data support Bartonella coinfections in humans with multiple pathogens transmitted by a variety of vectors.
In 2006, a study conducted in New Jersey found that out of 168 questing Ixodes scapularis ticks collected, 6.55% were infected with Bartonella henselae and 1.19% were coinfected with B. henselae and Borrelia burgdorferi. Interestingly, there were 3 reported cases of individuals coinfected with B. henselae and B. burgdorferi in New Jersey in 2001.
I. scapularis ticks were obtained from one of the patient’s household and tested positive for B. henselae and Borrelia burgdorferi DNA using PCR. These patients all had neuroborreliosis, and after a treatment with antibiotics, their symptoms did not improve. However, once diagnosed as coinfected and placed on a more potent antibiotic regimen, the symptoms improved. There is no direct evidence that the patients described acquired the infections simultaneously. Nevertheless, patients treated for Lyme disease should be examined for existing coinfections prior to antibiotic therapy. An initial discovery of coinfection could lead to an improved patient outcome.
In Europe, I. ricinus ticks transmit many diseases. Studies have been conducted whereby questing ticks were collected and serological data was analyzed in regions to determine the risk for coinfections with Borrelia.
In France in 2011, a survey showed that, with a 32% I. ricinus rate of infection with B. burgdorferi, only about 0.1% demonstrated a coinfection with Bartonella, which was identified to be B. birtlesii.
In other parts of Europe, such as Germany, as much as 6.9% of the I. ricinus ticks were found to be infected with Bartonella and 25% of those ticks were coinfected with Borrelia burgdorferi.
A survey in Poland, on the other hand, found roughly 1.6% of I. ricinus ticks collected to be coinfected with Bartonella henselae and Borrelia burgdorferi. Most recently, a serological analysis of more than 400 Lyme patient samples revealed that most patients possess antibodies to multiple tick-transmitted pathogens. Depending on the Lyme disease patient category, between 15–33% were also seropositive for Bartonella henselae. These data support the possibility of a coinfection through a vector such as ticks. However, the occurrence of infections could have been either simultaneous or consecutive.
In summary, the prevalence of Bartonella appears to be very broad, as these pathogens can utilize multiple vectors and cam infect a diverse range of hosts. Given the complex clinical manifestations and difficulty in effective treatments, the impact of these bacteria on human health may be more significant than is currently appreciated. These factors warrant further research on Bartonella prevalence, risks for infection, and pathobiology in mammalian hosts.
One thing to always keep in mind when reading these articles - they are talking ONLY about those people that actually can test positive for these infections - many of us can't and no studies are being done on why.
___________________________________________________________________________________________________________________________________________________________________
Human Bartonellosis: An Underappreciated Public Health Problem?
Mercedes A. Cheslock and Monica E. Embers
Division of Immunology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, LA 70433, USA
Received: 24 March 2019 / Accepted: 16 April 2019 / Published: 19 April 2019
Abstract: Bartonella spp. bacteria can be found around the globe and are the causative agents of multiple human diseases. The most well-known infection is called cat-scratch disease, which causes mild lymphadenopathy and fever.
As our knowledge of these bacteria grows, new presentations of the disease have been recognized, with serious manifestations. Not only has more severe disease been associated with these bacteria but also Bartonella species have been discovered in a wide range of mammals, and the pathogens’ DNA can be found in multiple vectors.
This review will focus on some common mammalian reservoirs as well as the suspected vectors in relation to the disease transmission and prevalence. Understanding the complex interactions between these bacteria, their vectors, and their reservoirs, as well as the breadth of infection by Bartonella around the world will help to assess the impact of Bartonellosis on public health.
Several Bartonella spp. have been linked to emerging and reemerging human diseases. These fastidious, gram-negative bacteria cause the clinically complex disease known as Bartonellosis. Historically, the most common causative agents for human disease have been Bartonella bacilliformis, Bartonella quintana, and Bartonella henselae. These infections cause a variety of manifestations from mild symptoms such as fever, headache, and malaise to more severe symptoms such as hallucinations.
Bartonellosis is characterized by a prolonged intraerythrocytic bacteremia within a diverse array of reservoirs hosts.
Bartonella spp. have been isolated from numerous hosts including:
humans,
cats,
dogs,
rabbits,
rodents,
horses,
cattle,
and other wild animals.
The severity of the clinical manifestations is often correlated with the immune status of the patient, although other factors such as the species infecting the host, virulence factors, and bacterial load should be considered as components in disease severity. These features allow Bartonella spp. to persist in the blood of hosts as a chronic infection and to account for the range of clinical manifestations.
Known diseases caused by Bartonella infections include:
Carrion’s disease,
cat-scratch disease,
chronic lymphadenopathy,
trench fever,
chronic bacteraemia,
culture-negative endocarditis,
bacilliary angiomatosis,
bacilliary peliosis,
vasculitis, and
uveitis
Recently, Bartonella infections have been linked to more diverse manifestations such as:
hallucinations,
weight loss,
muscle fatigue,
partial paralysis,
pediatric acute-onset neuropsychiatric syndrome (PANS),
and other neurological manifestations
A few case studies have also documented Bartonella in tumors, particularly vasoproliferative and those of mammary tissue.
The potential involvement of this pathogen in breast tumorigenesis is both disconcerting and warrants significantly more research.
Bartonella spp. are zoonotic pathogens transmitted from mammals to humans through a variety of insect vectors including:
the sand fly,
cat fleas,
and human body louse
New evidence suggests that ticks, red ants, and spiders can also transmit Bartonella. Bed bugs have been implicated in the transmission cycle of B. quintana and have been artificially infected.
B. quintana was found in bed bug feces for up to 18 days postinfection.
The diversity of newly discovered Bartonella species, the large number and ecologically diverse animal reservoir hosts, and the large spectrum of arthropod vectors that can transmit these bacteria among animals and humans are major causes for public health concern.
------------------------------------------------------------------------------------------------
Trav here again - I'm skipping a lot of content about transmission in the animals listed, but I want to get to the human issues
------------------------------------------------------------------------------------------------
5. Bartonella as a Coinfection in Humans
Equivalent to the debate on whether ticks transmit Bartonella, there has been more evidence gathered to support coinfection of Bartonella with other vector-borne pathogens. Most evidence has occurred through serological surveys conducted in an effort to estimate the incidence of human coinfection. Several studies have also focused on the detection of pathogens within questing ticks.
Although it is difficult to determine whether these coinfections occurred with one vector or transmission event or over the course of multiple events, one aspect is clear: A coinfection with these pathogens leads to difficulty clearing either infection and the antibiotic treatment should differ for individuals infected with multiple pathogens.
In a Peruvian retrospective study, 35% of patients with Carrion’s disease had coinfections with B. bacilliformis, including:
Salmonella spp.,
Shigella dysenteriae,
Staphlococcus aureus,
Enterobacter spp.,
Toxoplasma spp.,
Histoplasma spp.,
Pneumocystis carinii, and
Plasmodium vivax malaria.
Although most patients responded to antibiotic treatments, 4 patients with coinfections died.
Another study in Peru found that 37.5% of Bartonellosis patients in an outbreak were infected with B. bacilliformis and Mycobacterium spp. While not necessarily co-transmitted, these infectious complications can exacerbate disease. These data help to demonstrate the importance of monitoring coinfections with pathogens such as Bartonella.
One serological survey conducted among the homeless in Columbia found 13.1% of enrolled individuals had IgG to both Bartonella spp. and Rickettsia typhi.
Lice collected from these homeless individuals were also screened, and 28% of louse pools were positive for Bartonella spp., while none were positive for Rickettsia spp., implicating other factors in this particular coinfection among the homeless in Bogotá.
From a collection of questing ticks surveyed in Germany, 15/104 nymphs were found to be coinfected with Bartonella spp. and Rickettsia spp.
A study of volunteer blood donors in Namibia identified a high rate of exposure to Coxiella burnetii, Spotted Fever Group and Typhus Group Rickettsiae, and Bartonella henselae. While B. henselae exposure (2.9%) was the rarest of the those tested, over 20% of donors had been exposed to two or more pathogens, which was positively correlated with occupations involving animals.
Although there is no direct evidence, these pathogens were transmitted at one time, and flea and tick vectors transmit the pathogens; Coxiella burnetii, which causes Q fever in humans, in particular, could produce more serious complications as a coinfection.
In 2012, a survey of 39 farmers, 119 foresters, and 32 healthy blood donors (controls) was conducted to investigate an exposure to tick-borne pathogens and coinfections including:
Borrelia burgdorferi,
Anaplasma phagocytophilum,
Bartonella spp., and
Babesia microti.
The sera obtained indicated that 23.1% of foresters, 27.7% of farmers, and 37.5% of control groups had antibodies to Bartonella.
A coinfection risk was directly linked to occupational exposure, and the highest rates of coinfection were with Bartonella and B. burgdorferi with 9.2% of forestry workers and 7.7% of farmers coinfected. The other coinfections observed were Bartonella spp. and A. phagocytophilum (1.7% forestry workers) and Bartonella spp. and B. microti (0.8% forestry workers). A small percentage (1.3%) of forestry workers even experienced triple infections with Borrelia burgdorferi, Bartonella spp., and A. phagocytophilum, and one individual had a quadruple infection with all pathogens investigated. These data support Bartonella coinfections in humans with multiple pathogens transmitted by a variety of vectors.
In 2006, a study conducted in New Jersey found that out of 168 questing Ixodes scapularis ticks collected, 6.55% were infected with Bartonella henselae and 1.19% were coinfected with B. henselae and Borrelia burgdorferi. Interestingly, there were 3 reported cases of individuals coinfected with B. henselae and B. burgdorferi in New Jersey in 2001.
I. scapularis ticks were obtained from one of the patient’s household and tested positive for B. henselae and Borrelia burgdorferi DNA using PCR. These patients all had neuroborreliosis, and after a treatment with antibiotics, their symptoms did not improve. However, once diagnosed as coinfected and placed on a more potent antibiotic regimen, the symptoms improved. There is no direct evidence that the patients described acquired the infections simultaneously. Nevertheless, patients treated for Lyme disease should be examined for existing coinfections prior to antibiotic therapy. An initial discovery of coinfection could lead to an improved patient outcome.
In Europe, I. ricinus ticks transmit many diseases. Studies have been conducted whereby questing ticks were collected and serological data was analyzed in regions to determine the risk for coinfections with Borrelia.
In France in 2011, a survey showed that, with a 32% I. ricinus rate of infection with B. burgdorferi, only about 0.1% demonstrated a coinfection with Bartonella, which was identified to be B. birtlesii.
In other parts of Europe, such as Germany, as much as 6.9% of the I. ricinus ticks were found to be infected with Bartonella and 25% of those ticks were coinfected with Borrelia burgdorferi.
A survey in Poland, on the other hand, found roughly 1.6% of I. ricinus ticks collected to be coinfected with Bartonella henselae and Borrelia burgdorferi. Most recently, a serological analysis of more than 400 Lyme patient samples revealed that most patients possess antibodies to multiple tick-transmitted pathogens. Depending on the Lyme disease patient category, between 15–33% were also seropositive for Bartonella henselae. These data support the possibility of a coinfection through a vector such as ticks. However, the occurrence of infections could have been either simultaneous or consecutive.
In summary, the prevalence of Bartonella appears to be very broad, as these pathogens can utilize multiple vectors and cam infect a diverse range of hosts. Given the complex clinical manifestations and difficulty in effective treatments, the impact of these bacteria on human health may be more significant than is currently appreciated. These factors warrant further research on Bartonella prevalence, risks for infection, and pathobiology in mammalian hosts.