Maigan Espinili Maruquin
I. Characteristics / Epidemiology
The Bartonella spp. have wide distribution worldwide wherein antibody prevalence in cats which ranged from 8–53% was recorded in Europe (Pennisi, Marsilio et al. 2013, Zangwill 2013) while approximately 5-80% of cats worldwide were recorded of serological evidence on exposure to this bacteria (Guptill 2012). They cause wide range of clinical syndromes depending on the infecting species and immune status of the infected (Zangwill 2013).
The Bartonella are small and fastidious Gram-negative bacteria which are transmitted by arthropods and infect wide range of hosts including: human, rodents, rabbits, felids, canids, ruminants. However, cats are the primary mammalian reservoir and vector for transmission (Guptill 2012). The B. henselae is known as a common species to both cats and humans. This species also cause Cat Scratch Disease (CSD) to people. It is naturally transmitted between cats by the flea itself, Ctenocephalides felis felis, or the flea feces. The Bartonella stays in the red blood cells of infected cats and ingested by flea (Chomel, Kasten et al. 1996, Pennisi, Marsilio et al. 2013). While Bartonella persists in the environment in the flea faeces, it also amplifies the infection in the flea hindgut (Finkelstein, Brown et al. 2002). The feces of a contaminated flea, which are deposited in the skin, ends up under the cat’s claw from self- scratching (Chomel, Kasten et al. 1996, Pennisi, Marsilio et al. 2013). Moreover, the tick bites may also transmit B. henselae to humans (Lucey, Dolan et al. 1992, Klotz, Ianas et al. 2011, Biancardi and Curi 2014).
While B. henselae are the most commonly detected Bartonella infection in cats and approximately 10% B. clarridgeiae, other species were reported much less commonly. However, the prevalence of different genotypes of B henselae were recorded from regional differences, and are not limited to domestic cats (Guptill 2012).
Fig. 01. The Life Cycle of Bartonella spp. (https://www.northcarolinahealthnews.org/2016/12/19/north-carolina-ranks-as-high-risk-zone-for-cat-scratch-disease/)
II. Pathogenesis/ Clinical Signs
It has been described that B. henselae were transmitted by cat fleas of infected cats to non- infected cats (Chomel, Kasten et al. 1996), or by intradermal inoculation of cats with flea excrement wherein contamination of skin wounds with flea excrement occurs (Finkelstein, Brown et al. 2002). While the infection caused by Bartonella depends on the species and the host immunity (Cunningham and Koehler 2000), infections may cause necrosis with histiocytes, lymphocytes, and giant cells, forming a granuloma for immunocompetent patients (LeBoit PE, 1997) (Biancardi and Curi 2014).
Although cats can generate antibody and cell-mediated immune responses against Bartonella infections, the species B. henselae and B. clarridgeiae are commonly chronic and relapsing. On experimentally infected cats, most were clinically normal, while severity relies on the various strains used for inoculation. Abscess were observed on the inoculation sites on cats inoculated intradermally including localized peripheral lymphadenomegaly, short periods of fever (Guptill 2012), mild neurological signs and reproductive failure (Kordick, Brown et al. 1999). On the other hand, cats who received higher doses of B. henselae, despite remaining responsive, showed lethargy, fever, partial anorexia and enlarged lymph nodes (Guptill, Slater et al. 1997, Stützer and Hartmann 2012).
Meanwhile, B. henselae naturally infected cats do not show clinical signs (Stützer and Hartmann 2012). However, Bartonella infection was suggested to be associated in chronic gingivostomatitis, but antibodies or organisms’ prevalence in diseased cats were lower (Ueno, Hohdatsu et al. 1996, Glaus, Hofmann-Lehmann et al. 1997, Quimby, Elston et al. 2008, Pennisi, La Camera et al. 2009, Belgard, Truyen et al. 2010, Dowers, Hawley et al. 2010, Namekata, Kasten et al. 2010, Pennisi, Marsilio et al. 2013). Also, there were few cases on B. henselae-associated endocarditis or myocarditis (Chomel, Wey et al. 2003, Chomel, Kasten et al. 2009). The B. henselae, however may be of importance in immune complex diseases in cats wherein a strong correlation between the presence of antibodies against Bartonella species and hyperglobulinaemia was reported (Whittemore, Hawley et al. 2012).
III. Diagnosis
Having been exposed to fleas, cats with such history, aside from having clinical signs of Batonella infection, shall be tested for possible Bartonella infection (Guptill 2012). Laboratory testing shall be required for feline blood donors owned by immunosuppressed person or when a human with Bartonella-related disease is in the cat’s home (Pennisi, Marsilio et al. 2013).
While isolation of the bacterium is considered the gold standard, a positive culture is not confirmatory (Pennisi, Marsilio et al. 2013). The relapsing nature of Bartonella bacteraemia makes the blood culture not so sensitive to diagnose. Thus, this tool is suggested for sick cats with history and clinical presentation of possible infection of Bartonella (Guptill 2012). Therefore, diagnosis is by exclusion, and by assessing the response to therapy (Pennisi, Marsilio et al. 2013).
Blood samples, aqueous humour, cerebrospinal fluid or tissues, and several gene targets may be used for PCR (Pennisi, Marsilio et al. 2013). Although standard PCR may be no more sensitive than blood culture, Real Time PCR may have better sensitivity (Valasek and Repa 2005, Kamrani, Parreira et al. 2008, Guptill 2012). The PCR products may be sequenced, which may lead to identification of Bartonella species (Guptill 2012).
Serology tests using immunofluorescent antibody (IFAT), enzyme-linked immunosorbent assay (ELISA), and western blot tests are also available (Guptill 2012). However, these are considered to be more useful in exclusion rather than confirmation (Chomel BB, et al., 1995)(Gurfield, Boulouis et al. 2001, Fabbi, De Giuli et al. 2004, Bennett, Gunn-Moore et al. 2011, Pennisi, Marsilio et al. 2013).
IV. Treatment and Management
There are several drugs that were used to Bartonella infected cats including doxycycline, amoxicillin, amoxicillin–clavulanic acid, enrofloxacin, erythromycin, rifampicin (Greene, McDermott et al. 1996, Regnery, Rooney et al. 1996, Kordick and Breitschwerdt 1997). However, no definite elimination of Bartonella infection in cats by antibiotic treatments was reported but doxycycline may be a good initial antibiotic choice wherein higher doses given for a longer time appears to be more effective (Guptill 2012).
A household with immunocompromised people or with children should have their infected cats treated, whether or not they show clinical signs. Whereas, treatment is also recommended when Bartonella species actually caused disease in a cat (Stützer and Hartmann 2012).
Transmission of B. henselae is likely to occur from infected cats to humans through contamination of scratches or other skin abrasions with flea excrement containing B. henselae. Therefore, precautions are advised: vector control, avoiding interactions with cats that result in scratches or bites, supervising children’s interactions with cats, thoroughly washing bite or scratch wounds, and acquiring new pets of known good health status that are and have been ectoparasite-free (Kaplan et al, 2009)(Guptill 2012).
References
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