Cat Scratch Disease Findings from CDC study

csd-incidence-per-cdc-2016

An important new study on Cat Scratch Disease (CSD) was recently published by researchers at the U.S. Centers for Disease Control (CDC) in the journal Emerging Infectious Disease. CSD is an acute infection with the bacteria Bartonella henselae and characterized by acute fever and persistent swollen lymph nodes. Based on an analysis of 9 years of private health insurance claims data for people under the age of 65, key findings include:

  • CSD appears to be a bigger concern for immunocompetent adults and for females compared to men than previously recognized.
  • Average annual incidence of CSD is 4.7 per 100,000 persons <65 years of age in the US, with an estimated total of 12,500 patients receiving a CSD diagnosis each year in the United States.
  • Given the limitations of the MarketScan insurance claims database (a convenience sample excluding claims from persons >65 years of age, military personnel, uninsured persons, or Medicaid/Medicare enrollees), the actual incidence of CSD may be much higher.

Evidence Beyond CSD

CSD and other types of Bartonellosis are not notifiable conditions. As a result, information on the epidemiology of Bartonella-related disease is extremely limited. Importantly, current research from teams around the globe have published important evidence further challenging traditional understandings of CSD and other Bartonella spp infections. Notable emerging evidence includes:

Fortunately, innovations in diagnostic approaches for confirmation of Bartonella spp infection in patient samples are driving research and discovery into the medical importance of these elusive bacteria and supporting efforts to raise awareness about the occupational risks and potential prevalence of Bartonella spp infection.

As always, PREVENTION IS KEY. For the prevention of CSD, CDC researchers recommend “comprehensive flea control for cats can help reduce the risk for human infection. Risk may also be reduced by washing hands after contact with cats, to remove potentially infectious flea feces that could enter breaks in the skin. Furthermore, because cats that hunt outdoors are at substantially greater risk for B. henselae bacteremia, limiting hunting activity of cats may reduce risk for human infection.”

To limit occupational exposure, we recommend that veterinarians and other animal workers use personal protective devices. We also urge pet owners and animals workers to use appropriate flea and tick control practices to ensure the health and safety of the animals and the people who care for them.

To learn more about the latest research and emerging clinical picture related to Bartonella spp infection, please see our FREE medical education webinar, Understanding Bartonella.

Further Reading:

Bartonellosis: One Health Perspectives for an Emerging Infectious Disease

Detection of Bartonella species in the blood of veterinarians and veterinary technicians: a newly recognized occupational hazard?

Risk Factors for Bartonella species Infection in Blood Donors from Southeast Brazil

In Pursuit of a Stealth Pathogen: Laboratory Diagnosis of Bartonellosis

 

What is Bartonellosis?

Bartonellosis is an infectious disease caused by bacteria in the genus Bartonella. Bartonellosis causes similar disease manifestations in cats, dogs, horses, humans and potentially other wild and domestic animals. Popularly known as the key agents causing Cat Scratch Disease (Bartonella henselae) or Trench Fever (Bartonella quintana), Bartonella species (spp.) are very difficult to detect in patient blood, cerebrospinal fluid, joint fluid or tissue samples. Consequently, little has been known until recently about the pathogenesis of this disease.  Bartonella (with currently 37 named species and 17 Candidatus spp.) were essentially rediscovered in the 1990’s as a cause of vasoproliferative tumors, endocarditis and fever of unknown origin in immunosuppressed or immunocompromised (HIV) patients.  Recent medical findings suggest that, while potentially life-threatening to immunosuppressed patients, Bartonellosis is associated with chronic illness in immunocompetent patients. Animal and human Bartonellosis has been documented in many regions throughout the world.

How do people get Bartonellosis?

Bartonella spp. may be transmitted by contact with flea and louse feces, ticks or biting flies, or by the scratch or bite of an infected animal, most often a flea-infested cat.  Bartonella spp. DNA have been found in several arthropod vectors in the United States, including cat fleas (Ctenocephalides felis) and ticks (Ixodes scapularis, Ixodes pacificus). Suspected transmission of Bartonella spp. following the bite or scratch of wild animals, such as groundhogs, squirrels, and coyotes has also been documented.

Research suggests that people who live and work with animals, especially veterinary workers, have the highest risk of Bartonella infection.

Where do most cases of Bartonellosis occur?

Bartonella infections in humans and animals have been documented throughout the United States and in countries in all major regions of the world.  Geographic evidence suggests that prevalence of Bartonella spp. in arthropod vectors (fleas, ticks, lice, biting flies, etc.) is higher in warmer climates.

What are the symptoms of Bartonellosis?

Bartonella spp. induce chronic intravascular and intracellular infection resulting in a wide range of symptoms that can include pathology involving multiple organ systems.  The early clinical presentation of Bartonellosis is often nonspecific with symptoms that resemble many other infectious and non-infectious diseases. Three important components of the initial clinical presentation are fever, swollen lymph nodes, and at risk exposure to arthropod vectors or bacteremic animals. None of these symptoms may be present in patients seeking medical care for chronic Bartonellosis.

Symptoms that vary in number and severity among patients may include:

  • fever
  • fatigue
  • headache
  • malaise
  • swollen lymph nodes
  • skin rash or markings
  • joint aches and swelling
  • cardiovascular signs
  • neurovascular inflammation
  • abnormal sleep patterns
  • memory loss
  • skin lesions
  • vasoproliferative tumors

Bartonellosis is associated with complex disease processes in both people and animals.  It is possible to be chronically-infected with Bartonella and not have disease symptoms.  The extent to which persistent infection in outwardly healthy individuals ultimately contributes to organ system pathology is unknown. Bartonellosis can range from severe life-threatening illnesses (myocarditis, endocarditis, vasculitis) to chronic intermittent and often relapsing symptoms listed above. It is possible that some individuals may become infected and not develop disease. It is not known if this is because some immune systems clear the Bartonella infection or because the infection is well tolerated.

How is Bartonellosis diagnosed?

A diagnosis of Bartonellosis is based on a combination of symptoms, physical examination findings, and specialized confirmatory laboratory tests. Detection of Bartonella is extremely challenging, as these bacteria are immune-evasive and infect at exceedingly low levels of detection. IFA serology tests are available for the detection of antibodies, but only for a few Bartonella spp. Although highly insensitive, IFA serology tests can provide evidence of exposure, but do not confirm infection. The most effective means of detecting active infection involves the combination of culture and PCR detection methods–referred to as enrichment PCR or ePCR.

Evolving evidence suggests that early detection and confirmation of Bartonella spp. infection is important for providing the best patient care.

How is Bartonellosis treated?

A number of different antibiotics have been used to treat Bartonella infection. Treatment recommendations vary on a case-by-case basis.

How can Bartonellosis be prevented?

  • Avoid contact with feral animals, especially cats and rodents.
  • Wear protective clothing when working or playing outdoors and when interacting with animals.
  • Routinely use pest control measures for fleas, lice and ticks in your home and on your pets.
  • Remove fleas, lice, and ticks promptly and properly and avoid scratching arthropod feces into wounds.
  • Clean bites and scratches promptly using soap and water.
  • See your doctor if you experience persistent flu-like symptoms and other adverse reactions following potential Bartonella spp exposure. Early detection is key.

Further Reading

Bartonellosis: One Health Perspectives for an Emerging Infectious Disease.  Breitschwerdt EB. ILAR J (2014) 55 (1): 46-58. http://ilarjournal.oxfordjournals.org/content/55/1/46.full

Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Maggi RG, Mozayeni BR, Pultorak EL, Hegarty BC, Bradley JM, Correa M, Breitschwerdt EB. Emerg Infect Dis. 2012 May;18(5):783-91.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358077/ 

Neurological Manifestations of Bartonellosis in Immunocompetent Patients: A Composite of Reports from 2005–2012. Breitschwerdt EB, Sontakke S, and Hopkins S. Journal of Neuroparasitology 2012;Vol 3:1-15. http://www.ashdin.com/journals/jnp/235640.pdf 

Bartonella, a common cause of endocarditis: a report on 106 cases and review.  E. S., Nabet C, Lepidi H, Fournier PE, Raoult D. J Clin Microbiol. 2015 Mar;53(3):824-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390654/ 

Severe Weather Advisory – Jan 21, 2016

The National Weather Service has issued a severe winter weather advisory for NC and much of the eastern United States.  While we expect to be open tomorrow, Friday, Jan 22nd, we are advising our clients to NOT ship samples to Galaxy Diagnostics Thursday to avoid delivery delays.

Please refrigerate and hold your samples for overnight shipment on Monday.

Check here for updates:

http://www.wral.com/weather/

http://www.fedex.com/us/servicealerts/

Happy Holidays!! 2015 saw a lot of progress!

Cute tabby kitten inside of Christmas present on white background

Cute tabby kitten inside of Christmas present on white background

Our lab will be closed Thu, Dec 24 and Fri, Dec 25, 2015 and Fri, Jan 1, 2016.  Please store any samples collected Wed, Dec 23 or Thu, Dec 31 in the refrigerator for shipment the following Monday.

Great progress in 2015!!

We saw significant advances in 2015 in Bartonella research findings and in awareness about the importance of Bartonellosis (Bartonella spp infection) in human and animal health.  To mention a few…

High Risk Populations:  People who live and work with animals are at high risk of Bartonella spp infection, especially those individuals with compromised immune function.  A recent Italian study reported a Bartonella henselae seroprevalence rate of 21% in patients awaiting a heart transplant (n=38), compared to zero positive titres in healthy controls (n=50).

Cardiovascular Disease:  As the leading cause of culture negative endocarditis, Bartonella cause an intravascular infection that can localize to heart tissue. Two important reviews were published this year examining the potential influence of Bartonella infection on cardiovascular function.  French researchers present a large case series study (n=106), remarking that Bartonella endocarditis reports are on the rise as a result of better awareness and better diagnostic tools.  In a second study, Italian researchers propose a likely disease mechanism,  arguing that “the discovery that Bartonella henselae can infect and damage EPCs” (endothelial progenitor cells), suggests that “this infection could impair the cardiovascular regenerative potential and increase the risk for cardiovascular disease.”

Neurovascular Disease: Bartonella has been linked to both motor and cognitive dysfunction in patients. A case report out of the University of North Carolina calls for a closer look at the role of Bartonella henselae infection (Cat Scratch Disease) in patients with seizures (status epilecticus), further suggesting immune-mediation factors which may play a role.

Oncology:  Bartonella can lead to the growth of vasoproliferative tumors in many areas of the body.  In a recent study, Polish researchers find that 25% of pediatric bartonellosis patient present with atypical CSD symptoms, including lesions that mimick the oncological process.  In spite of significant diagnostic challenges, they recommend that bartonellosis be ruled out as a possible explanation for atypical lesions appearing on the head, neck and upper extremities.

Upcoming Research:  Clinicians frequently report an association between skin striations and neuro-psychological symptoms in teenagers.  Dr. Marna Ericson at the University of Minnesota Medical School is developing a study to investigate the potential role of Bartonella in skin striae.  Please support this important research by making a donation to Dr Ericson’s lab.

For more frequent highlights on Bartonella research findings, follow us on Facebook, Twitter, or Linked In.

 

Unravelling the Bartonella Mystery

cover pageThe Better Health Guy (aka Scott Forsgren) recently published a well written article in the Townsend Letter on Bartonella spp infection (bartonellosis).  The article is called Unraveling the Mystery of Bartonellosis.  He included a list of the pathogenic species of Bartonella and a list of commonly reported symptoms from chronically ill patients who receive clinical diagnoses of Bartonella spp infection.

This article offers a good snapshot view of the clinical picture.  More research is needed to better define the role that these bacteria play in complex chronic disease.

Follow us on Facebook and Twitter to keep up with the emerging research linking Bartonella to hard-to-diagnose chronic symptoms.

Bartonella and Small Vessel Disease on People’s Pharmacy

Excellent podcast on People’s Pharmacy!! Dr Neil Spector discusses some practical aspects of Lyme Disease epidemiology, diagnosis, and treatment. Dr. Robert Mozayeni discusses potential links between Bartonella and Lyme Disease, as well as the diagnostic process for small vessel disease and chronic inflammation. Dr. Platts-Mills discusses alpha-gal antibody response following tick bites and meat consumption in regions endemic for Rocky Mountain Spotted Fever.

Podcast is available on iTunes or can be downloaded from the People’s Pharmacy website.

Thanks to Joe & Terry Graedon for the opportunity to share our research and clinical experience!

 

 

Free Webinar: Understanding Bartonella

Webinar recorded July 10, 2015

Bartonella infections are increasingly implicated in complex chronic disease syndromes, yet are extremely difficult to diagnose accurately. The purpose of this webinar is to raise awareness about Bartonella; its prevention, diagnosis and treatment. Medical, veterinary and public health professionals will benefit from attending this webinar.

Speakers include subject matter experts Edward Breitschwerdt, DVM and B. Robert Mozayeni, MD.  Please note that the content is highly technical and designed for an audience of medical, veterinary and public health professionals.

Learning objectives include the ability to:

  • Describe the epidemiology of Bartonella;
  • Identify populations most at risk for Bartonella infection; and
  • Explain the process for accurate and timely diagnosis of and treatment considerations for Bartonella

Our mission is to educate as many people as possible about the increasing medical importance of Bartonella.  As an advocate for One Health, please share this free webinar link with others who may be interested.

onehealth logo_final a jpg (1)

 

Many thanks to the One Health Commission for sponsoring our Bartonella webinar!