Basic biology of Bartonella species
- David H Spach, MD
David H Spach, MD
- Professor of Medicine
- Division of Infectious Diseases
- University of Washington
Bartonella species are fastidious, gram-negative bacteria that cause a range of manifestations, including cat scratch disease (CSD), bacillary angiomatosis (BA) and other infections in patients with HIV infection, as well as endocarditis. Bartonella has emerged as one of the leading causes of culture-negative endocarditis [1,2]. The organisms proved difficult to isolate and characterize. Analysis of Bartonella 16S ribosomal RNA was instrumental in identifying and classifying this species .
The microbiology and pathogenesis of Bartonella infections will be reviewed here. CSD, manifestations in HIV-infected patients, Bartonella endocarditis, and Bartonellosis are discussed separately. (See "Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease" and "Treatment of cat scratch disease" and "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients" and "Endocarditis caused by Bartonella" and "Clinical features, diagnosis, and treatment of Bartonella quintana infections" and "South American bartonellosis: Oroya fever and verruga peruana".)
Bartonella spp belong to the alpha-2 subgroup of the Proteobacteria based on 16S ribosomal RNA testing and are closely related to the genera Brucella and Agrobacterium. Prior to 1993, the only member of the Bartonella genus that had been identified was Bartonella bacilliformis. In 1993, DNA hybridization data led Brenner and coworkers to propose to unite the genera Bartonella and Rochalimaea, retaining the genus name Bartonella . In 1995, members of the genus Grahamella were merged with the Bartonella genus, but Grahamella spp are not known to cause human disease.
The three most important Bartonella spp known to cause human disease are B. bacilliformis, Bartonella quintana, and Bartonella henselae; other Bartonella spp reported to have caused disease in humans, but whose role is less well defined, are Bartonella elizabethae , Bartonella vinsonii [6,7], Bartonella clarridgeiae , Bartonella grahamii , Bartonella koehlerae , Bartonella alsatica , and Bartonella rochalimae . Infection with B. elizabethae may be more common than previously appreciated. As an example, investigators performed Bartonella serologic testing on samples collected in 1997 and 1998 from 204 injection drug users in New York City and found 46 percent had positive serologic reactions to B. elizabethae . In addition, one group of investigators used 16S RNA gene sequencing to identify a new serogroup of B. henselae, termed serogroup "Marseille" .
Although analysis of 16S ribosomal DNA sequences have characteristically been used to differentiate Bartonella spp, investigators have determined that nucleotide base sequence data for a 940-bp fragment of the citrate synthase-encoding gene (gltA) appears more useful than the 16S ribosomal DNA sequence data for investigating the evolutionary relationships of Bartonella spp . Phylogenetic studies have determined that the highly virulent pathogen, B. bacilliformis, is the sole representative of an ancestral lineage, and other Bartonella species that cause human disease have evolved in a separate lineage; the evolution of the newer species has correlated with their adaptation to distinct mammalian reservoirs [16,17].
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