Bartonellosis - Causes, symptoms and treatment. MF.
Bartonellosis( bartonellosis - English) combines a group of human diseases caused by Gram-negative aerobic, facultatively intracellular bacteria that need to grow in the heme or the products of erythrocyte cleavage.
For human pathogens 5 independent species of Bartonella of varying degrees of virulence.
In nature, bartonelles circulate among mouse-like rodents, rats, representatives of the cat family( cats, cougars) and dogs, causing them to have a persistent infection with asymptomatic flow and prolonged many-month bacteremia. People have a variety of symptomatic acute( Volynian or trench fever, Carryon's disease, syn. - fever Oroya), subacute( cat scratch disease) and chronic( bacillary angiomatosis, Peruvian wart, purple hepatitis, endocarditis, prolonged febrile state with bacteremia).
Chronologically, diseases caused by Bartonella were known much earlier than the discovery and isolation of the pathogens themselves.
Species of Bartonella( before 1993 - Rochalimaea spp., Etc.) are microscopically represented by short sticks, 0.3-0.5 • 1.0-3.0 mm in size. In sections from infected tissues can be curved, pleomorphic, grouped into compact clusters( clusters).Rounded forms reach 1.5 mm in diameter. They are colored according to Romanovsky-Giemsa;in biopsy specimens from tissues - dye using silver by Warthing Starry;perceive also acridine orange dye, which is used in immunochemical studies. For B. bacilliformis, there are 1-4 flagella located on one of the poles of the cell, and therefore it is mobile;One monopole flagellum was observed for B. henselae;or just drank. Bacteria have a clearly structured three-layered membrane;The latter contains up to 12 proteins with a molecular weight from 174 to 28 kDa. The size of the genome is relatively small, within the limits of 1700-2174 in p;the ratio of guanine and cytosine is 38.5-41.0 mole%.Reproduction of Bartonella occurs by simple transverse division.
The prevalence of Bartonella has not been adequately studied. The endemicity of the causative agent of the Carrion-B. bacilliformis disease was uncontestedly established. It is distributed only in the North-West of South America in the mountainous areas of the Andes, protected from the Pacific winds, at altitudes of 600-2500 meters above sea level, geographically tied to Peru, partly to Colombia and Ecuador. The life cycle of the Bartonella data is related to the South American variety of mosquitoes of Flebotomus, namely, Lutzomia noguchi, L. verrucarum and others, as well as local mice-like rodents.
The most common, apparently, are the causative agents of cat scratch disease( English) and trench fever, carriers of which are, respectively, cat fleas and lice human lice. The latter are almost ubiquitous insects, their involvement in the transarticle of Bartonella Quintana and Henseli in the human body has been proven and, obviously, the barthenelles caused by these two kinds of microorganisms are spread all over the globe within the permanent habitats of people. In particular, a high( up to 68.1%) bacteremia among cats and kittens associated with B. henselae in some US states, as well as in Germany, especially among animals( up to 89%) among those families in which children or owners themselvescats suffered a cat scratch disease.
A wide search for bartonella in the natural rodent population in various countries( USA, Bolivia, Paraguay, British Columbia( Canada), Poland, and others) revealed a high prevalence of Bartonella in the natural population of rodents, felids and dogs( coyotes).
Concerning the most pathogenic for human B. bacilliformis and B. quintana it is assumed that a significant reservoir of these pathogens is a person, since asymptomatic and mild forms of infection are observed, accompanied by long bacterial transport. The natural reservoir for B. elizabethae also appears to be small wild mammals.
There is no mandatory registration of Bartonelles. It is known that during the First World War an epidemic of trench fever in the theater of military operations in Europe broke out, affecting at least 1 million soldiers. During the Second World War, it revived in an epidemic form, but on a much smaller scale. Over 80 thousand people were ill( Liu Wei Tung, 1984).With the end of World War II, outbreaks of trench fever stopped. About the age of the infection associated with B. quintana, reports appeared in the early 1990s, when the causative agent was identified as the cause of opportunistic infection in HIV-infected individuals. Serological and molecular genetic studies in various countries, including Russia [Rydkina E. et al., 1999] revealed a latent circulation of the pathogen among the population and its presence in the population of lice. In the population of Ukraine, specific antibodies to bartonella quintana were detected in all age groups in the range of 1.48-2.48%, in France - in 0.6% of the examined patients, and endocarditis caused by this species of bartonella were confirmed in 76.4% of the grouppatients with unidentified etiology of suffering( 1995-1998 gg.).
The epidemic of trench fever is associated with human lice in case of epidemic typhus;it is caused by mechanical rubbing of infected feces into the combs of the skin. In the feces of lice of Bartonella quintana retain their viability for an exceptionally long time - up to 1312 days [Balashov B. C., Dayter AB, 1973].The natural reservoir of Bartonella Quintana has not been established to date, the only source of infection is a person. In lice, unlike typhoid rickettsiosis, bartonellosis is asymptomatic, the microorganism persists for life( up to 30-45 days), transvarial transmission is absent. In humans, in addition to an acute febrile illness, a prolonged( up to 2-5 years) latent asymptomatic carriage or in combination with chronic lymphadenopathy and endocarditis may be possible.
Fleas Cfenocephalides felis, as well as clothing lice, in contrast to ticks, throughout their life cycle, feed many times and are illegible with regard to their feeder. As a consequence, they alternately sticking to cats or rodents, in their environment are easily infected with bartonella. In their body, Bartonella Henseli persists for more than a year without affecting behavior and lifestyle. In search of food insects attack and the person.
The true number of patients with bartonellosis, caused by Bartonella Henseli, remains unclear. But it is known that in the USA, for example, in the early 1990s the rickettsiosis, the spotted fever of the Rocky Mountains, the most common in this country, was recorded at a level exceeding 1,000 cases per year, while the incidence of cat scratch disease was estimated at 22,000 cases, of which2000 - were hospitalized [Zangwill et al., 1993].
Diseases of people with acute form of Carrion disease, known as the fever of Oroya, are associated with the bites of several species of mosquitoes. With a mosquito bite, the bartonella, along with the saliva of the insect, directly penetrate into the bloodstream, attack and penetrate into the erythrocytes and spread by the hematogenous way, followed by the colonization of the endothelial cells of the vascular system, lymph nodes, spleen and other organs. At the same time, up to 90% of red blood cells are hemolysed, which causes a sharp anemia and a clinical picture of the disease.
Symptoms of Bartonellosis
Pathogenicity factors of Bartonella have not been studied in practice. It is well established that the introduction of bartonelles into erythrocytes occurs with the participation of a flagellum, by means of which the bartonella, in particular the causative agent of the Carrion disease, attach to the surface of the erythrocyte and then penetrate into it.
At the entrance gate of the pathogen, there are usually no specific traces associated with the microorganism, excluding the disease of cat scratching. In the latter case, in addition to a scratch from the claw of an animal or a trace from a bite of the latter, often a primary affect is formed, which can be inflated( attachment of the secondary flora) and leave a minor scar later. The spread of microorganisms from the entrance gateway occurs by lymphogenous and hematogenous pathways, which leads to generalization of the infection with the corresponding clinic of acute or chronic form of the disease.
The main "targets" in the body of warm-blooded animals sensitive to Bartonella are erythrocytes and endothelial cells of the cardiovascular system. For Bartonella quintana and bacillifor-mis, their tropism is also revealed to the hematopoietic tissue of the bone marrow. In the places where the Bartonella is attached to sensitive cells, clusters( clusters) of microorganisms are formed and an inflammatory reaction occurs with the proliferation of endothelial cells and adjacent tissues. The most vulnerable part of the human vascular system in its microcirculatory bed is usually affected, with some of the endothelial cells being necrotic. As a result, either angiomatosis or lymphadenopathy develops, or a combination of both with the destruction of bone marrow cells and erythrocytes. Around the sites with "swollen"( "epithelioid") endothelial cells, neutrophils and eosinophils are grouped. The location of the latter corresponds, as a rule, to the accumulations of bacilli in the perivascular space. Bacteria can be found in erythrocytes, vascular endothelial cells, spleen, lymph nodes, liver, bone marrow, skin.
Histologically, the tissues and organs of patients in the acute stage of the Carrion disease( fever Oroya) are anemic, central necrosis around the hepatic veins is revealed with infiltration of affected areas by microphages and polymorphonuclear leukocytes;in the pulp of the spleen - foci of necrosis;lymph nodes - proliferation of endothelium and pigment deposits;in the bone marrow - proliferation, macrophagocytosis.
Peruvian wart expressed proliferative processes of the endothelium of lymphatic and blood vessels, neoplasms of small blood vessels with the appearance of angioendothelioma and secondary proliferation of connective tissue. In heart valves affected by Bartonella in patients with clinically manifested endocarditis, numerous vegetations from fibrin and platelets are formed, perforations are observed on valve flaps, and in the tissues of remote valves there is a mass of extracellularly located microorganisms and superficial inflammatory infiltrates.
Weakening of the immune system due to dysfunction and discoordination of the endothelial cell system, circulatory disorders and hypoxia of organs and tissues cause the emergence and growth of general toxic symptoms( fever, chills, hypotension, nausea, vomiting, weakening of cardiac activity).In patients with fever Oroya dominate the phenomenon of anemia. The latter is due to the intensive and rapid involvement of red blood cells in the infectious process, reaching 40-50 and even 90% of the total circulating mass, followed by their destruction.
The gradual appearance in the blood of patients with protective antibodies stops the infectious process, the patients gradually recover with the formation of immunity of different duration, depending on the kind of Bartonella. In chronic forms of bartonellosis, developing most often streets with immune deficiency, long-term bacteremia is established, despite intensive multi-month therapy with antibiotics. The latter is explained by the intracellular localization of part of the pathogen population in inflammatory infiltrates.
The epidemiological significance of Bartonellosis associated with C. clar-ridgeiae and B. elizflbethae is unknown. To date, isolated cases of endocarditis caused by these Bartonella in the territories( the USA, Sweden), significantly removed from each other, are known.
Disease kochashih scratches -( a synonym - lymphoreticulosis benign).Known in France and the US, at least since 1932, in Russia - since 1955 [Maretskaya MF, 1955].The disease is characterized by unilateral lymphadenitis, regional to the entrance gate of the pathogen, and benign outcome of the disease. Etiology - B. henselae. Named after D. Hensel, who isolated the pathogen after persistent( more than 6,000 sowings) cultivation attempts.
The disease is obviously more widespread than is known by now;probably within the habitats of humans and related cats. Infection of a person occurs through contact, through damage to the skin or conjunctiva of the eye.
The location of the entrance gate determines the subsequent involvement of regional lymph nodes draining the site of skin damage.
Symptoms and course. The incubation period lasts from 3 to 20 days( usually 7-14 days).According to clinical manifestations, typical forms( about 90%), manifested in the appearance of primary affect and regional lymphadenitis, and atypical forms, which include: a) eye forms;b) defeat of the central nervous system;c) defeat of other organs;d) Cat-scratch disease in HIV-infected people. The disease can occur both in acute form and in chronic. It is also different in the severity of the disease.
A typical disease begins, as a rule, gradually with the appearance of primary affect. On the site of the already scratched or bitten cat by that time, a small papule with a rim of skin hyperemia appears, then it turns into a vesicle or pustule, then into a small sore. Sometimes the abscess dries up without the formation of an ulcer. Primary affect is more often localized on the hands, less often on the face, neck, lower limbs. The general condition remains satisfactory.15-30 days after infection, regional lymphadenitis is noted - the most constant and characteristic symptom of the disease. Sometimes this is almost the only symptom. A rise in body temperature( from 38.3 to 4GS) is observed in only 30% of patients. Fever is accompanied by other signs of general intoxication( general weakness, headache, anorexia, etc.).The average duration of fever is about a week, although in some patients it can last up to a month or more. Weakness and other signs of intoxication last an average of 1-2 weeks.
Elbow, armpit, cervical lymph nodes are more often affected. In some patients( about 5%) generalized lymphadenopathy develops. The size of enlarged lymph nodes is often in the range of 3 to 5 cm, although in some patients they reach 8-10 cm. The nodes that are painful on palpation are not soldered to surrounding tissues. In half of the patients, the affected lymph nodes are suppressed with the formation of a thick yellowish-greenish pus which, when sown, can not be isolated from the usual nutrient media of the bacterial microflora. The duration of adenopathy from 2 weeks to one year( an average of about 3 months).In many patients, there is an increase in the liver and spleen, which persists for about 2 weeks. In some patients( in 5%) there is an exanthema( rubella-like, papular, according to the type of erythema nodosum), which disappears after 1-2 weeks. A typical clinical form accounts for about 90% of all cases of disease.
Eye forms of the disease are observed in 4-7% of patients. In their manifestations, these forms resemble oculoglandular syndrome Parino( conjunctivitis Parino).Develops, probably, as a result of hit on a conjunctiva of a saliva of the infected cat. As a rule, one eye is affected. The conjunctiva is sharply hyperemic, edematous, against this background there is one or several nodules that can ulcerate. Significantly increases the lymph node located in front of the earlobe( reaching a size of 5 cm or more), the lymph node is often inflated, the duration of lymphadenopathy reaches 3-4 months. After suppuration and fistula formation, scar scarring changes remain. Sometimes not only the parotid but also the submandibular lymph nodes are enlarged. For the acute period of the disease is characterized by severe fever and signs of general intoxication. Inflammatory changes in the conjunctiva persist for 1-2 weeks, and the total duration of glazoglandulyarnoy form of the cat scratch disease ranges from 1 to 28 weeks.
Changes in the nervous system are noted in 1-3% of patients. They are manifested in the form of encephalopathy, meningitis, radiculitis, polyneuritis, myelitis with paraplegia. Neurological symptoms are accompanied by a high fever. They appear in 1-6 weeks after the appearance of lymphadenopathy. When a neurological examination reveals diffuse and focal changes. There may be a short-term disorder of consciousness. Cases of coma are described. Thus, the lesions of the nervous system develop against the background of classical clinical manifestations of cat scratch disease( with severe course of the disease).They can be considered complications of the disease.
Other complications may also occur: thrombocytopenic purpura, primary atypical pneumonia, splenic abscess, myocarditis.
Diagnosis and differential diagnosis. Diagnosis of classic forms of cat scratch disease does not present great difficulties. Important is contact with the cat( in 95% of patients), the presence of primary affect and the appearance of regional lymphadenitis( usually 2 weeks) in the absence of the reaction of other lymph nodes. The diagnosis can be supported by a microbiological study of blood sowing on blood agar, histological examination of the papule biopsy or lymph node with staining of the sections using silver and microscopic search for bacterial accumulations, as well as molecular genetic investigation of the pathogen from the patient's biopsy.
Differentiate from dermal-bubonic form of tularemia, tuberculosis of lymph nodes, lymphogranulomatosis, bacterial lymphadenitis.
Prognosis favorable, fatal outcomes and recurrent disease are not described.
Treatment. The disease ends with spontaneous cure. Aspiration of pus with 20 ml of syringe is recommended for suppuration of the lymph node. Antibiotics are not effective. Prospective use of a new antibiotic ketolide from the group of macrolides.
Clinical picture and diagnosis of Bartonellosis. The clinical picture of bartonellosis in humans is extremely diverse - from mild local disorders of lymph and blood circulation( cat scratch disease, lymphadenopathy, bacillary angiomatous skin) to more severe acute, often recurrent( trench fever) or long-term painful suffering( bacillary angiomatosis with necroticisation,purple hepatitis or splenitis, chronic septic bacteremia, endocarditis).The most malignant is the acute form of Carrion's disease, known as the Oroya fever, in which mortality previously reached 40, and in some outbreaks it reached 90%.Diseases caused by Bartonella:
»trench fever;
"cat scratch disease;
»Carrion's disease in acute( fever Oroya) and chronic( Peruvian wart) forms;
»bacillary angiomatosis of the skin;
»rohalimia( Bartonella) syndrome with bacteremia;
»bacillary peliotic hepatitis( splen);
»endocarditis;
»is an external disseminated infection( a synonym for chronic lymphadenopathy).
Deaths in acute forms of Bartonellosis, except for the Oroya fever, are very rare. Prolonged and often recurrent course of some of them, especially in HIV-infected patients, leads to significant work losses and can end in the face of adverse, despite intensive antibiotic therapy.
CATHEDRAL SURGERY
SURGERY OR TRANSFER Fever
Synonyms: five-day fever, Volyn fever, Moldavian-Valahan fever, tibial fever, rickettsiosis of Weigel-Mosig, etc.
Etiology - B. quintana( before 1993 - Rochalimaea quintana).There is no systematic information on morbidity, although the latent circulation of the pathogen in the population is evident, as evidenced by the facts of its identification in patients with chronic forms of lesions, in particular, endocarditis. The natural reservoir of the
pathogen was not detected. It is believed that such is a person, since relapse of the disease is observed even after 10 years after the disease. Infection of people occurs transmissivnym and the way with the participation of lice through scratching. In the absence of a carrier, the disease is non-contagious.
Symptoms and course. The incubation period is 10-14 days. Usually the onset is acute, with a rise in temperature to 39.0-39.5 ° C with subsequent preservation at this level to 1-3 days. After a gradual return of the temperature to the norm, after 3-7 days, a new increase in the temperature with an exacerbation of the disease follows. Develop a general malaise, headache, pain in the field of eyeballs, in the muscles, lower back, joints, bones of the body and extremities, especially the tibia. At 20-80% of patients develops a mildly pronounced rosetole rash. Sometimes there is anemia, especially with prolonged disease.
Repeated attacks of fever are accompanied by the resumption of the same painful symptoms and signs of illness as during the first attack, but they are less pronounced.
The prognosis of the disease is favorable, since the deaths are not described. Patients lose their ability to work up to 1.5-2 months. If the process is chronicized, specific endocarditis with valve damage or bacillary angiomatosis, as well as other chronic forms of bartonellosis, is formed in the long term.
The diagnosis is based on a characteristic clinical picture and epidemiological data, confirmed by the serological detection of specific antibodies in the blood, either by isolating the culture of the pathogen, or by molecular genetic testing in PCR, with the amplification of the resulting DNA fragments.
Treatment is performed with tetracycline or fluoroquinolone preparations.
CARRION DISEASE
Endemic to a limited region in the North-West of South America, a disease of Bartonella etiology. Pathogen - B. bacil-liformis, first described by A.N.Barton in 1905. As a separate nazoform has gained fame since 1871 due to significant outbreaks in Peru, when up to 7000 workers engaged in the construction of the railway in the Lima-Oroya section fell ill and died.
In the clinical course of the disease, two forms are distinguished:
1) acute, leaking with high temperature, significant anemia and lethality to 90%, known as Oroya fever;
2) dermal form developing 1-2 months after the acute phase of the disease with the formation of a rash and multiple papules on the skin and mucous membranes of the body;This option was awarded a warty( Verrux) or Peruvian wart nomination.
The identity of the two forms of the disease was proved by the student of the Faculty of Medicine of the University of Lima, D. Carrion, in 1885 in the experience of self-contamination for two decades before the announcement of A. Barton. Outside the natural focus, the disease has not been identified. The disease in natural conditions is caused by the attack of mosquito-phlebotomus, which confirms the transmissible transmission pathway of the pathogen.
In the absence of a carrier, the disease is non-contagious. The natural reservoir of the pathogen is the mice-like rodents. The incubation period is within 17-21 days.
Symptoms and course. The disease begins with a sudden rise in temperature, up to 39.5-40.0 ° C, the development of symptoms of general toxic syndrome. Fever with a favorable course of the disease in the absence of treatment is held up to 5-6 weeks with a subsequent slow lytic decrease in temperature. The pathognomonic sign of the disease is a pronounced anemia caused by specific damage to erythrocytes by bartonella and the subsequent drop in hemoglobin to 20-30% of the baseline level. In severe anemia, 10-40% of patients die at the 2-3rd week of the disease;believe that the cause of death in 90% of acute cases is a secondary infection caused by salmonella.
The diagnosis is established by clinical and epidemiological data and confirmed by microscopic detection of Bartonella in blood smears stained according to Romanovsky-Giemsa. Bartonella are colored in a bright red or purple color and are clearly visible in red blood cells and macrophage cells.
Carrion disease leaves a prolonged, apparently lifelong immunity. Chronicization of the process in the absence of specific treatment or following the asymptomatic, manifestly not manifested first phase of the disease, leads to disseminated development of angioendothelioma and proliferation of adjacent perivascular tissue. Peruvian wart is in fact actually an extremely pronounced bacillary angiomatosis caused by bartonella bacilliformis;its historical name reflects the local, older, designation of the disease in comparison with vascular proliferation caused by Bartonella Henseli or quintana.
Treatment is very effective with chloramphenicol or with tetracycline drugs.
BACILLAR ANGIOMATOSIS
Synonym: epithelioid angiomatosis. The disease is a manifestation of Bartonella infection and is characterized by polymorphism of the clinical picture. It is defined as "pseudo-neoplastic infectious, cutaneous vascular disease of rickettsial nature, but with features of bartonellosis" [Cockerrel et al., 1991].It can manifest itself in two forms: lesions that are noticeable on the skin, and are not affected by the skin. Morphological basis of the disease is anomalous, localized proliferation of swollen endothelial cells, often protruding into the lumen of vessels in the microcirculatory pathway of the vascular system.
In the case of the prevalence of lesions of superficially located vessels, angiomatosis of the skin develops in the form of randomly localized in different parts of the body - from face to limb - single or multiple( up to 1000 or more in one patient) painless papules. The latter, like fungi, rise above the surface of the skin on the pedicle and reach the size of the lymph nodes and small hemangiomas. Vascular formations are covered from above by a thin epithelium, when they pierce the apex, they bleed profusely.
Staining of sections in biopsy specimens using silvering reveals perivascular eosinophil aggregates with a nest of accumulations of bacteria visible in a light microscope as a black intertwining mass of rods. With electron microscopy, pleomorphic bacteria with a three-layer gram-negative membrane are clearly visible.
The clinical diagnosis of the cutaneous form of bacillary angiomatosis is based on the comparison of the manifestation of suffering and the results of the histological examination of the biopsy specimen.
With a deeper subcutaneous arrangement of pathological vascular proliferation, knotty plexuses are formed, reaching a few centimeters in diameter. They can be detected as diffusely enlarged nodes, located subcutaneously on any part of the body, including the head and back. It was noted that bacillary angiomatosis is most often developed in people with immunodeficiency, especially in AIDS patients.
The extra-cutaneous form of bacillary angiomatosis is accompanied by fever, chills, night sweats, anorexia, vomiting, and weight loss. Lung complications, bile duct obstruction, liver abscesses, bone marrow damage and others are described.
BACILLARY PURPLE HEPATITIS
Synonym: Peliolistic hepatitis. Bacillary purple hepatitis is isolated into an independent form of the disease on the basis of dominance of symptoms of liver parenchyma damage against the background of general dissemination of the pathogen in the body, especially in persons with immune system deficiency [Perkocha LA, 1990].In fact, it represents an isolated continuation or process accompanying cutaneous and extracutaneous forms of bacillary angiomatosis. The defeat of small vessels of the liver leads to the formation of cysts in them, which are filled with blood, squeeze the liver cells, disrupting their functions. Stagnant phenomena and symptoms develop in the form of nausea, vomiting, diarrhea, bloating, against a background of fever and chills. At the same time, hepatosplenomegaly, anemia, thrombocytopenia appears and the level of hepatic transaminases rises. Histologically, liver biopsies reveal multiple enlarged capillaries, as well as blood-filled cavernous spaces in the parenchyma of the organ.
The bartonellic etiology of suffering can be confirmed by staining the sections using silver by Warthing-Starry, microscopic and electron microscopic examination of the preparations.
Pelionous hepatitis is in fact a special case of the so-called visceral abdominal pelosis. According to Leong S.S. et al.(1992) "Peliosis is a descriptive term for a rare( approximately 100 cases published by 1982) of a kind of pathological nosoform( enfity), developing mainly in the internal large organs as multiple tiny cysts filled with blood, which can also be large, up to several centimetersin diameter. They can be randomly scattered in the parenchyma of the affected tissue, usually without explicit restriction by cells. In most of the published cases, the liver was affected( ie, pelvic hepatitis was observed), other structures in the reticuloendothelial system, such as the spleen, lymph nodes of the abdominal cavity and bone marrow, may also be included. Rare examples of damage to the kidneys, adrenal glands, pancreas, lungs and gastrointestinal tract are described.
BARTONELLOSIS( ROCHALIMIC) SYNDROME WITH BACTERIEMIA.Endocarditis
This syndrome reflects a prolonged set of symptoms and signs accompanied by malaise, disability, anorexia, loss and recurrence of fever. Symptoms can persist for weeks and months until a diagnosis is finally established by isolating the causative agent into a selective nutrient medium and then identifying it, or by genomolecular examination of the biopsy from the lymph node [Lucey D. et al., 1992].
Manifest manifestation of this condition, in particular, for bacteremia caused by B. quintana or B. henselae, is the development of endocarditis with signs of heart failure. Such endocarditis are most often detected in streets suffering from chronic alcoholism [Fournier P. E. et al., 1999].In such cases, the syndrome manifests itself gradually, within a few months( and possibly years), by the development of a feeling of rapid fatigue, the appearance of moderate fever, loss of body weight( up to 15 kg), and other symptoms. From the heart, systolic aortic or mitral noise and rhythm disturbance are noted. Vigorous combination therapy with antibiotics leads to a drop in temperature and an improvement in general condition, but does not prevent the need for subsequent surgical replacement of the affected valves and the continued use of antibiotics.
Prognosis, treatment and prevention of Bartonellosis. The prognosis of Bartonella infection in a person depends entirely on the form of its manifestation. When Oroya's disease or chronic forms, especially in the absence of treatment and the development of morphological lesions affecting vital organs, in particular, heart valves in endocarditis, it is unfavorable. In many cases, the disease was resolved spontaneously, without any consequences in the near and distant future.
Optimum regimens for the treatment of bartonelles have not yet been established, but it is clear that the basis of their etiotropic therapy is the use of t preparations of the group of tetracyclines, macrolides and fluoroquinolones. The empirical treatment with antibiotics in clinical practice and the study of the sensitivity of Bartonella in vitro to them allow us to conclude that etiotropic treatment in all cases, in order to avoid complications associated with secondary infection and to prevent prolonged bacteremia, should be carried out vigorously and aggressively with the use of any drugs acting onGram-negative bacteria and deeply penetrating into the tissue.
Particularly persistent treatment should be performed in chronic forms of Bartonella. In particular, the treatment of bacillary angiomatosis takes from 2 weeks to several months, and in HIV-infected, perhaps for life. In this case, a good effect has erythromycin, as well as doxycycline, minocycline, tetracycline, roxithromycin, norfloxacin and ciprofloxacin. For the treatment of endocarditis of Bartonella etiology, a prolonged course of antimicrobial therapy lasting at least 4-6 months is recommended, followed by surgical removal of the affected valves and continued intravenous administration of the drug up to 6 weeks after the operation.
Prevention. Specific prophylaxis of Bartonellosis has not been developed. It is recommended to reduce close contact with cats.
To reduce the risk of diseases caused by contact with infected B. henselae cats, an inactivated vaccine is being developed. Preliminary results of her test demonstrated a cessation of bacterial transport in 97% of cases. Prevention of barteneresis associated with Bartonella quintana is based on the complete extermination of lice in the environment of the diseased.
"A Guide to Infectious Diseases"( Edited by Yu. V. Lobzin) 2000