Utility of Molecular Identification and Quantitation of Bartonella Species with Species-Specific Real-Time PCR for Monitoring Treatment Response: A Case Series

Abstract

Background:Bartonella species are intracellular bacteria capable of producing several diseases in humans. The three most common and wellknown diseases are cat scratch disease (CSD), caused by B. henselae, trench fever, caused by B. quintana and Carrion’s Disease, caused by B. bacilliformis. Signs and symptoms are very different and aspecific: Fatigue, fever, headache, lymphadenopathy, malaise, loss of weight. No data exist to support guidelines’ recommendations to decide which drugs should be optimally used and how long they should be administered. Therefore, a marker of treatment response is needed to guide treatment strategies.Methods:We report herein three cases in which a species specific Reverse-Transcriptase Polymerase-Chain-Reaction (RT PCR) developed in-house was performed and compared to serology in order to make diagnosis and to evaluate treatment response.Results:Our species-specific RT PCR seemed to play a fundamental role both in diagnosis and treatment. Moreover, a discrepancy with the serology results was found.Conclusion:Further studies are necessary to validate these results and elucidate what is the best treatment for this pleomorphic disease. However, in absence of clear guidelines, RT PCR may be useful to orientate kind of treatment ad its duration.

A systematic review on antibiotic therapy of cutaneous bacillary angiomatosis not related to major immunocompromising conditions: from pathogenesis to treatment

“…In summary, this review confirmes that cBA appears to be very rare in patients not suffering from major immunocompromising conditions but it also probably remains underdiagnosed due to the limited availability of molecular tests. However, in the era of next-generation sequencing, an active surveillance of re-emerging pathogens needs to be improved using molecular testing [ 87 , 88 ]. Moreover, it is not possible to conclude which is the best available treatment or whether the shorter therapy is more effective in these patients.…”

“…This observation further underscores the crucial role of species-specific PCR in facilitating species diagnosis. This method should be standardized and widely adopted for both diagnosis and treatment monitoring, potentially elevating the accuracy and efficiency of patient care across a variety of clinical settings [ 87 , 88 ]..…”

Touching Base with Some Mediterranean Diseases of Interest from Paradigmatic Cases at the “Magna Graecia” University Unit of Infectious Diseases: A Didascalic Review

“…After antibiotic therapy, there was a significant reduction in lymphadenopathy and fatigue, and asthenia recovered. At the last outpatient consultation, in June 2014, just a small left later cervical node was evident, followed by complete regression in January 2015 [60].…”

Comparison of Serological and Molecular Assays for Bartonella Species in Dogs with Hemangiosarcoma

“…The accuracy of serological testing in chronic bartonellosis or in manifestations other than acute CSD or endocarditis has not been rigorously assessed, though serology is thought to have poor sensitivity in these “atypical” cases based on observations that people with documented Bartonella spp. DNA in their bloodstream or tissues are often seronegative [ 24 , 25 , 26 , 27 , 28 ]. Conceptually, serology also may have poor sensitivity due to the potential for antigenic switching and immune evasion, and poor specificity for active infection since seroreactivity may persist after exposure, despite effective immunological or antibiotic elimination of the infection [ 18 , 20 , 29 ].…”