PCR amplification of Bartonella koehlerae from human blood and enrichment blood cultures

Abstract

<p>Abstract</p> <p>Background</p> <p>Cats appear to be the primary reservoir host for <it>Bartonella koehlerae</it>, an alpha Proteobacteria that is most likely transmitted among cat populations by fleas (<it>Ctenocephalides felis</it>). <it>Bartonella koehlerae </it>has caused endocarditis in a dog and in one human patient from Israel, but other clinically relevant reports involving this bacterium are lacking. Despite publication of numerous, worldwide epidemiological studies designed to determine the prevalence of <it>Bartonella </it>spp. bacteremia in cats, <it>B. koehlerae </it>has never been isolated using conventional blood agar plates. To date, successful isolation of <it>B. koehlerae </it>from cats and from the one human endocarditis patient has consistently required the use of chocolate agar plates.</p> <p>Results</p> <p>In this study, <it>Bartonella koehlerae </it>bacteremia was documented in eight immunocompetent patients by PCR amplification and DNA sequencing, either prior to or after enrichment blood culture using <it>Bartonella </it>alpha Proteobacteria growth medium. Presenting symptoms most often included fatigue, insomnia, joint pain, headache, memory loss, and muscle pain. Four patients were also infected with <it>Bartonella vinsonii </it>subsp. <it>berkhoffii </it>genotype II. After molecular documentation of <it>B. koehlerae </it>infection in these patients, a serological test was developed and serum samples were tested retrospectively. <it>Bartonella koehlerae </it>antibodies were not detected (titers < 1:16) in 30 healthy human control sera, whereas five of eight patient samples had <it>B. koehlerae </it>antibody titers of 1:64 or greater.</p> <p>Conclusions</p> <p>Although biased by a study population consisting of individuals with extensive arthropod and animal exposure, the results of this study suggest that <it>B. koehlerae </it>bacteremia is more common in immunocompetent people than has been previously suspected. Future studies should more thoroughly define modes of transmission and risk factors for acquiring infection with <it>B. koehlerae</it>. In addition, studies are needed to determine if <it>B. koehlerae </it>is a cause or cofactor in the development of arthritis, peripheral neuropathies or tachyarrhythmias in patients.</p