Serologic testing for Bartonella in Manitoba, Canada, 2010-2020: a retrospective case series.

CMAJ open Pub Date : 2022-05-31 Print Date: 2022-04-01 DOI:10.9778/cmajo.20210180
Carl Boodman, Terence Wuerz, Philippe Lagacé-Wiens, Robbin Lindsay, Antonia Dibernardo, Jared Bullard, Derek R Stein, Yoav Keynan
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引用次数: 0

Abstract

Background: Bartonella are gram-negative bacilli not identified by routine bacterial culture. The objectives of this study were to review the results of all serologic testing for Bartonella ordered in Manitoba, Canada, and to review cases with positive test results among adults to assess species identification, risk factors, clinical manifestations and outcomes.

Methods: This retrospective study included all Bartonella serologic tests ordered in Manitoba and performed at the National Microbiology Laboratory, Winnipeg, from Jan. 1, 2010, until Dec. 31, 2020. We analyzed the aggregate data for all serologic tests for Bartonella for patients of all ages. We reviewed the charts of adult (age ≥ 18 yr) patients with serologic positivity for Bartonella who had a medical chart at 1 of Winnipeg's 2 largest hospitals (Health Sciences Centre and St. Boniface Hospital) to extract clinical and demographic data and create a case series. Descriptive statistics were performed.

Results: During the study period, 1014 Bartonella serologic tests were ordered in adult and pediatric patients, of which 24 (2.4%) gave a positive result. Sixteen adults (12 men and 4 women; mean age 48 yr) seen at a participating hospital had a positive result. Molecular species-level identification occurred on explanted cardiac valves in 5 (31%) of the 16 cases; B. quintana was identified in all 5. Six patients (38%) were diagnosed with probable B. quintana infection, for a total of 11 B. quintana cases (69%); 8 (73%) of the 11 had endocarditis. Four cases of B. quintana infection (36%) were associated with rural residence. Four cases (25%) of probable B. henselae were identified; 2 patients had fever and lymphadenopathy, and 2 had endocarditis. The remaining patient was deemed to have a false-positive result as his B. henselae titre was at the threshold for positivity, his B. quintana serologic test gave a negative result, and his clinical syndrome was not suggestive of Bartonella infection. Two patients died; both had multivalvular B. quintana endocarditis with ruptured intracranial mycotic aneurysms.

Interpretation: Bartonella quintana was a common cause of Bartonella serologic positivity among adults in Manitoba in 2010-2020 and was associated with endocarditis and systemic embolization. As B. quintana is transmitted by body lice, active case finding for people who lack suitable housing, both in urban and rural settings, should prioritize those with elevated Bartonella titres to receive echocardiography and detect endocarditis before systemic embolization occurs.

加拿大马尼托巴省2010-2020年巴尔托巴菌血清学检测:一个回顾性病例系列
背景:巴尔onella是一种革兰氏阴性杆菌,未经常规细菌培养鉴定。本研究的目的是审查在加拿大马尼托巴省下令进行的所有巴尔onella血清学检测的结果,并审查成年人中检测结果呈阳性的病例,以评估物种识别、风险因素、临床表现和结果。方法:这项回顾性研究包括2010年1月1日至2020年12月31日在曼尼托巴省订购并在温尼伯国家微生物实验室进行的所有巴尔托拉血清学检测。我们分析了所有年龄段患者巴尔托内拉所有血清学检测的汇总数据。我们回顾了温尼伯2家最大医院(健康科学中心和圣博尼法斯医院)中的1家医院的Bartonella血清学阳性成年(年龄≥18岁)患者的病历,以提取临床和人口统计数据并创建病例系列。进行描述性统计。结果:在研究期间,对成人和儿童患者进行了1014次巴尔托内拉血清学检测,其中24次(2.4%)结果呈阳性。在参与医院就诊的16名成年人(12名男性和4名女性;平均年龄48岁)的结果呈阳性。在16例中,5例(31%)的移植物心脏瓣膜发生了分子物种水平的鉴定;B.quintana在所有5株中均被鉴定。6名患者(38%)被诊断为可能的五分之一B.quintana感染,共有11例五分之一B.病例(69%);11例中有8例(73%)发生心内膜炎。四例(36%)昆塔纳双歧杆菌感染病例与农村居住有关。确定了4例(25%)可能的鸡伤寒杆菌;2例有发热和淋巴结病,2例有心内膜炎。剩下的患者被认为是假阳性结果,因为他的亨氏双歧杆菌滴度处于阳性阈值,他的昆塔氏双歧杆菌血清学检测结果为阴性,他的临床综合征不提示巴尔他菌感染。两名患者死亡;两人都患有多发性五分型B.quintana心内膜炎,并伴有颅内真菌性动脉瘤破裂。解释:2010年至2020年,五型巴尔托纳菌是曼尼托巴省成年人巴尔托纳血清学阳性的常见原因,与心内膜炎和系统性栓塞有关。由于五倍体是通过体虱传播的,在城市和农村环境中,对缺乏合适住房的人进行积极的病例发现,应优先考虑巴尔托内拉滴度升高的人接受超声心动图检查,并在系统性栓塞发生前检测心内膜炎。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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