Diagnosis of Bartonella species infections

Diagnosis of Bartonella Species Infections

1.0 CME. This module describes the advantages and limitations of different diagnostic methodologies for confirmation of Bartonella spp. infection, as well as recent advances in sample enrichment for direct detection of infection of this immune-evasive, slow-growing bacterial infection.

Instructor

Edward Breitschwerdt, DVM
Melanie S. Steele Professor of Medicine and Infectious Diseases
Comparative Medicine Institute
NCSU College of Veterinary Medicine

Description

This module describes the advantages and limitations of different diagnostic methodologies for confirmation of Bartonella spp. infection, as well as recent advances in sample enrichment for direct detection of infection of this immune-evasive, slow-growing bacterial infection.

Learning objectives

Describe the limitations of Bartonella spp. serology for the diagnosis of bartonellosis
Describe the limitations of conventional PCR vs qPCR vs ddPCR for detection of Bartonella spp. DNA in patient specimens
Describe the diagnostic utility of enrichment culture combined with ddPCR for documentation of Bartonella spp. infections

Accreditation Statement

This session, Diagnosis of Bartonella species infections, is approved for 1.0 enduring AAFP Prescribed credit.

The AAFP has reviewed VectorWise CME, and deemed it acceptable for AAFP credit. Term of approval is from 05/15/2025 to 05/14/2026. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Evidence-based bibliography for further study

Breitschwerdt, E.B., Mascarelli, P.E., Schweickert, L.A., Maggi, R.G., Hegarty, B.C., Bradley, J.M. and Woods, C.W., 2011. Hallucinations, sensory neuropathy, and peripheral visual deficits in a young woman infected with Bartonella koehlerae. Journal of clinical microbiology, 49(9), pp.3415-3417.
Bai, Y., Kosoy, M.Y., Boonmar, S., Sawatwong, P., Sangmaneedet, S. and Peruski, L.F., 2010. Enrichment culture and molecular identification of diverse Bartonella species in stray dogs. Veterinary microbiology, 146(3-4), pp.314-319.
Balakrishnan, N., Cherry, N.A., Linder, K.E., Pierce, E., Sontakke, N., Hegarty, B.C., Bradley, J.M., Maggi, R.G. and Breitschwerdt, E.B., 2013. Experimental infection of dogs with Bartonella henselae and Bartonella vinsonii subsp. berkhoffii. Veterinary immunology and immunopathology, 156(1-2), pp.153-158.
Breitschwerdt, E.B., Maggi, R.G., Nicholson, W.L., Cherry, N.A. and Woods, C.W., 2008. Bartonella sp. bacteremia in patients with neurological and neurocognitive dysfunction. Journal of clinical microbiology, 46(9), pp.2856-2861.
Hegarty, B.C., Bradley, J.M., Lappin, M.R., Balakrishnan, N., Mascarelli, P.E. and Breitschwerdt, E.B., 2014. Analysis of Seroreactivity against Cell Culture–Derived Bartonella spp. Antigens in Dogs. Journal of veterinary internal medicine, 28(1), pp.38-41.
Kosoy, M., Bai, Y., Sheff, K., Morway, C., Baggett, H., Maloney, S.A., Boonmar, S., Bhengsri, S., Dowell, S.F., Sitdhirasdr, A. and Lerdthusnee, K., 2010. Identification of Bartonella infections in febrile human patients from Thailand and their potential animal reservoirs. The American journal of tropical medicine and hygiene, 82(6), pp.1140-1145.
Lashnits, E., Correa, M., Hegarty, B.C., Birkenheuer, A. and Breitschwerdt, E.B., 2018. Bartonella seroepidemiology in dogs from North America, 2008–2014. Journal of veterinary internal medicine, 32(1), pp.222-231.
Maggi, R.G., Mascarelli, P.E., Pultorak, E.L., Hegarty, B.C., Bradley, J.M., Mozayeni, B.R. and Breitschwerdt, E.B., 2011. Bartonella spp. bacteremia in high-risk immunocompetent patients. Diagnostic microbiology and infectious disease, 71(4), pp.430-437.
Maggi, R.G., Mozayeni, B.R., Pultorak, E.L., Hegarty, B.C., Bradley, J.M., Correa, M. and Breitschwerdt, E.B., 2012. Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease–endemic region. Emerging infectious diseases, 18(5), p.783.
Maggi, R.G., Richardson, T., Breitschwerdt, E.B. and Miller, J.C., 2020. Development and validation of a droplet digital PCR assay for the detection and quantification of Bartonella species within human clinical samples. Journal of Microbiological Methods, 176, p.106022.
Merrell, D.S. and Falkow, S., 2004. Frontal and stealth attack strategies in microbial pathogenesis. Nature, 430(6996), pp.250-256.
Nelson, C.A., Saha, S. and Mead, P.S., 2016. Cat-scratch disease in the United States, 2005–2013. Emerging infectious diseases, 22(10), p.1741.
Oliveira, A.M., Maggi, R.G., Woods, C.W. and Breitschwerdt, E.B., 2010. Suspected needle stick transmission of Bartonella vinsonii subspecies berkhoffii to a veterinarian. Journal of veterinary internal medicine, 24(5), pp.1229-1232.
Perez, C., Maggi, R.G., Diniz, P.P.V.P. and Breitschwerdt, E.B., 2011. Molecular and serological diagnosis of Bartonella infection in 61 dogs from the United States. Journal of veterinary internal medicine, 25(4), pp.805-810.
Pultorak, E.L., Maggi, R.G., Mascarelli, P.E. and Breitschwerdt, E.B., 2013. Serial testing from a 3-day collection period by use of the Bartonella Alphaproteobacteria growth medium platform may enhance the sensitivity of Bartonella species detection in bacteremic human patients. Journal of clinical microbiology, 51(6), pp.1673-1677.

About the Instructor

Edward B. Breitschwerdt, DVM

Melanie S. Steele Professor of Medicine and Infectious Diseases, NSCU College of Veterinary Medicine

Dr. Breitschwerdt is a Professor of Medicine and Infectious Diseases at North Carolina State University College of Veterinary Medicine and an Adjunct Professor of Medicine at Duke University Medical Center. He directs the Intracellular Pathogens Research Laboratory in the Center for Comparative Medicine and Translational Research at North Carolina State University and co-directs its Vector Borne Diseases Diagnostic Laboratory. He has contributed to cutting-edge research in the areas of animal and human Bartonellosis and has authored numerous book chapters and proceedings. His research group has published more that 400 manuscripts in peer-reviewed scientific journals.