Bartonella and Coxiella infections presenting as systemic vasculitis: case series and review of literature

Abstract

Objectives Coxiella and Bartonella sp. display particular tropism for endothelial or endocardial tissues and an abnormal host response to infections with induced autoimmunity. We aimed, through a case series combined with a comprehensive literature review, to outline characteristics of Coxiella and Bartonella infections presenting as systemic vasculitis. Methods We retrospectively included cases of definite Coxiella and Bartonella infections presenting with vasculitis features and performed a comprehensive literature review. Results Six cases of Bartonella infections were added to 18 cases from literature review. Causative pathogens were mainly B. henselae. Bartonella infection mimicked anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis in 83% with PR3-ANCA and presented as cryoglobulinemic vasculitis in 8%. Glomerulonephritis was present in 92%, and 88% had endocarditis. Complement fractions were low in 82% and rheumatoid factor positive in 85%. Kidney biopsies showed cell proliferation, mostly crescentic, with pauci-immune glomerulonephritis in 29%. Outcome was favorable, with the use of antibiotics alone in one third. Five cases of Coxiella infections were added to 16 from literature review. Sixteen had small-vessel vasculitides, mainly cryoglobulinemia vasculitis in 75%. One patient had polyarteritis nodosa-like vasculitis and four large-vessel vasculitis. Outcome was good except for one death. A highly sensitive next generation sequencing analysis on 3 Coxiella and 2 Bartonella-related vasculitides biopsies did not find any bacterial DNA. Conclusion Coxiella and Bartonella are both able to induce vasculitis but display distinct vasculitis features. Bartonella mimics PR3-ANCA-associated vasculitis in the setting of endocarditis, whereas Coxiella may induce vasculitis involving all vessel sizes.

Querying ANCA‐associated vasculitis in chronic Q fever–associated membranoproliferative glomerulonephritis

“…5 Whilst Bartonella infection mimics AAV in 83% with PR3-ANCA in case series, Coxiella has been found potentially to induce vasculitis of all vessel sizes. 2 Interestingly, in this case, temporal change in PR3-ANCA titre in association with chronic Q fever suggests probable causality between infection and autoimmune phenomena.…”

“…Recent cases have elucidated autoimmune vasculitides associated with chronic infection. 2 This pathogen acts both as a mimic and an inducer of autoimmune disease, thereby causing a diagnostic dilemma. We report a case of chronic Q fever presenting with membranoproliferative glomerulonephritis and new anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) positivity.…”

Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis – our experience and a pooled analysis

“…A total of 89 cases with Bartonella IE-associated GN were included in this study (54 published case reports and case series ( 16 – 69 ), and 18 (17 published, 1 presented) conference abstracts ( 70 – 87 ), and four cases diagnosed at our institution). A flowchart for including cases is shown in Figure 1 .…”

Coexistence of cryoglobulinemia and ANCA-associated vasculitis in a chronic brucellosis patient -a case report and literature review

“…The patient completely recovered after the combined use of glucocorticoids, antibiotic therapy and surgical valve repair [ 9 ]. A recent study revealed Bartonella infection could also induce immune-related glomerulonephritis with the coexistence of ANCA and cryoglobulinemia and subacute endocarditis [ 47 ]. Although there are some similarities in clinical features, the pathological changes and prognosis in different infection-related vasculitis varied from one case to another.…”