Diagnosis, treatment, and prevention of Bartonella infections in HIV-infected patients
- David H Spach, MD
David H Spach, MD
- Professor of Medicine
- Division of Infectious Diseases
- University of Washington
Bartonella infections can cause serious morbidity and mortality in HIV-infected patients, particularly those with advanced immunosuppression .
This topic will address the diagnosis, treatment, and prevention of Bartonella infections in HIV-infected patients. The epidemiology and clinical manifestations of disease are discussed elsewhere. (See "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients".)
General background — The diagnosis of Bartonella infections can be challenging in HIV-infected patients and usually requires a combination of tests. The approach to making the diagnosis should consist of obtaining one or more definitive diagnostic tests in combination with serologic testing. Depending on the patient's clinical presentation, tests used to make a definitive diagnostic tests may include culture of a tissue or blood sample, Bartonella polymerase chain reaction (PCR) testing on a tissue or blood sample, and/or tissue biopsy with histopathologic examination and appropriate staining.
A positive result from more than one type of definitive test provides the strongest evidence for a diagnosis of Bartonella infection. However, since each of the definitive tests has limitations, serologic testing for Bartonella is often used as supportive evidence for infection.
Culture — Bartonella species are fastidious gram-negative bacteria that require specific laboratory conditions to enhance the yield. The likelihood of isolating of the organism from blood increases if the blood sample is collected in pediatric or adult isolator tubes (Wampole, Cranbury, New Jersey), or in tubes containing ethylenediaminetetraacetic acid (EDTA). Bartonella species have occasionally been isolated from BACTEC (Becton Dickinson Diagnostic Instrument Systems, Sparks, Maryland) bottles.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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