Fwd: [CaliforniaLyme] Bartonella -Emerging Infect Diseases. May,18 2012

[Guest guest]

Re: Bartonella - Emerging Infect DiseasesFrom: LymeBarb@...To: californialyme Sent: Monday, April 23, 2012 3:31:51 PMSubject: [CaliforniaLyme] Bartonella -Emerging Infect Diseases. May,18 2012

Note: Because bacterial infections related to Lyme Disease may notinitially manifest themselves as a bulls eye rash, patients who moveout of a Lyme Disease-endemic region may be even more likely to bemisdiagnosed or alternatively diagnosed. The authors specificallyaddress the difficulties in diagnosis saying, "It is becomingincreasingly clear that no single diagnostic strategy will conï¬rminfection with a Bartonella sp. in immunocompetent patients."Emerg Infect Dis. 2012 May;18(5):783-91. doi: 10.3201/eid1805.111366.Bartonella spp. Bacteremia and Rheumatic Symptoms in Patients fromLyme Disease-endemic Region.Maggi RG, Mozayeni BR, Pultorak EL, Hegarty BC, Bradley JM, Correa M,Breitschwerdt EB.AbstractBartonella spp. infection has been reported in association with anexpanding spectrum of symptoms and lesions.For this cross-sectional study, we enrolled only patients examined bya rheumatologist in the land–Washington, DC, USA, area from August25, 2008, through April 1, 2009. Because Bartonella spp. are knowntoprimarily infect cells within the vascular system, includingerythrocytes, endothelial cells, and potentially circulating andtissue macrophages (1,5,6), selection was biased by patients who hadhistorical, physical examination, orlaboratory evidence of small vessel disease, including a subset ofpatients with a prior diagnosis of Lyme disease or chronic post–Lymesyndrome. We also included patients with chronic joint pain, priordocumentation of synovialvascular infl ammation, or a diagnosis of rheumatoid arthritis. Among296 patients examined by a rheumatologist, prevalence of antibodiesagainst Bartonella henselae, B. koehlerae, or B. vinsonii subsp.berkhoffii (185 [62%]) and Bartonella spp. bacteremia (122 [41.1%])was high.Conditions diagnosed before referral included Lyme disease (46.6%),arthralgia/arthritis (20.6%), chronic fatigue (19.6%), andfibromyalgia (6.1%). However, the diagnostic criterion uponwhich these infections were based was not available for review becauseall prior diagnoses were self-reported. Overall, 185 (62.5%) of 296patients had antibodies to B. henselae, B. koehlerae, or B. vinsoniisubsp. berkhofï¬ i, and 122 (41.1%) were positive for Bartonella spp.according to PCR. In most instances, DNA sequencing of the ampliï¬ edproduct facilitated identiï¬ cation of the infecting species. Theprevalence of antibodies against Bartonella spp. (93 [67.4%]) andbacteremia [57 [1.3%]) among 138 patients with a prior diagnosis ofLyme disease did not differ from that of the overall study population.Because our analysis was restricted to patients selected by arheumatologist practicing in a Lyme disease–endemic region,extrapolations to other regions or other rheumatology practices mightnot be applicable.B. henselae bacteremia was significantly associated with priorreferral to a neurologist, most often for blurred vision, subcorticalneurologic deficits, or numbness in the extremities, whereas B.koehlerae bacteremia was associated with examination by an infectiousdisease physician.This cross-sectional study cannot establish a causal link betweenBartonella spp. infection and the high frequency of neurologicsymptoms, myalgia, joint pain, or progressive arthropathy in thispopulation; however, the contribution of Bartonella spp. infection, ifany, to these symptoms should be systematically investigated.The full study can be read here:http://wwwnc.cdc.gov/eid/article/18/5/pdfs/11-1366.pdf

[Guest guest]

And Bart is immune, like demodex mites. Some are infected and never have a

symptom. Immune is key to our recovery, and continued health.

>

> Re: Bartonella - Emerging Infect Diseases

>

> ----- Forwarded Message -----

> From: LymeBarb@...

> californialyme

> Sent: Monday, April 23, 2012 3:31:51 PM

> Subject: [CaliforniaLyme] Bartonella -Emerging Infect Diseases. May,18 2012

>

>

>

>

>

>

>

> Note: Because bacterial infections related to Lyme Disease may not

> initially manifest themselves as a bulls eye rash, patients who move

> out of a Lyme Disease-endemic region may be even more likely to be

> misdiagnosed or alternatively diagnosed. The authors specifically

> address the difficulties in diagnosis saying, " It is becoming

> increasingly clear that no single diagnostic strategy will conï¬rm

> infection with a Bartonella sp. in immunocompetent patients. "

>

> Emerg Infect Dis. 2012 May;18(5):783-91. doi: 10.3201/eid1805.111366.

>

> 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.

>

> Abstract

> Bartonella spp. infection has been reported in association with an

> expanding spectrum of symptoms and lesions.

>

> For this cross-sectional study, we enrolled only patients examined by

> a rheumatologist in the land†" Washington, DC, USA, area from August

> 25, 2008, through April 1, 2009. Because Bartonella spp. are known

> to

> primarily infect cells within the vascular system, including

> erythrocytes, endothelial cells, and potentially circulating and

> tissue macrophages (1,5,6), selection was biased by patients who had

> historical, physical examination, or

> laboratory evidence of small vessel disease, including a subset of

> patients with a prior diagnosis of Lyme disease or chronic post†" Lyme

> syndrome. We also included patients with chronic joint pain, prior

> documentation of synovial

> vascular infl ammation, or a diagnosis of rheumatoid arthritis. Among

> 296 patients examined by a rheumatologist, prevalence of antibodies

> against Bartonella henselae, B. koehlerae, or B. vinsonii subsp.

> berkhoffii (185 [62%]) and Bartonella spp. bacteremia (122 [41.1%])

> was high.

>

> Conditions diagnosed before referral included Lyme disease (46.6%),

> arthralgia/arthritis (20.6%), chronic fatigue (19.6%), and

> fibromyalgia (6.1%). However, the diagnostic criterion upon

> which these infections were based was not available for review because

> all prior diagnoses were self-reported. Overall, 185 (62.5%) of 296

> patients had antibodies to B. henselae, B. koehlerae, or B. vinsonii

> subsp. berkhofï¬ i, and 122 (41.1%) were positive for Bartonella spp.

> according to PCR. In most instances, DNA sequencing of the ampliï¬ ed

> product facilitated identiï¬ cation of the infecting species. The

> prevalence of antibodies against Bartonella spp. (93 [67.4%]) and

> bacteremia [57 [1.3%]) among 138 patients with a prior diagnosis of

> Lyme disease did not differ from that of the overall study population.

> Because our analysis was restricted to patients selected by a

> rheumatologist practicing in a Lyme disease†" endemic region,

> extrapolations to other regions or other rheumatology practices might

> not be applicable.

>

> B. henselae bacteremia was significantly associated with prior

> referral to a neurologist, most often for blurred vision, subcortical

> neurologic deficits, or numbness in the extremities, whereas B.

> koehlerae bacteremia was associated with examination by an infectious

> disease physician.

>

> This cross-sectional study cannot establish a causal link between

> Bartonella spp. infection and the high frequency of neurologic

> symptoms, myalgia, joint pain, or progressive arthropathy in this

> population; however, the contribution of Bartonella spp. infection, if

> any, to these symptoms should be systematically investigated.

>

> The full study can be read here:

> http://wwwnc.cdc.gov/eid/article/18/5/pdfs/11-1366.pdf

>