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Does the bacterium

behind cat scratch fever

cause chronic fatigue?

(Scientific American)

over Bartonella

n.a.v. studie Maggi (2012)







Structuur en verschijningsvormen van bacteriŽn.




In een commentaar besteedt de Scientific American (zie onder) aandacht aan

een mogelijke link tussen Bartonella en ME/CVS ("chronic fatigue")

naar aanleiding van een recente studie (zie onderaan)

van Breitschwerdt, Maggi en collega's van de North Carolina State University

naar Bartonella-infecties bij mensen met reuma-achtige klachten

die in een gebied wonen waar Lyme relatief constant (endemisch) voorkomt.





Voor het persbericht bij de studie gepubliceerd in mei 2012, klik op onderstaand logo:






Van de 296 patiŽnten die door een reumatoloog onderzocht waren,

werden bij 62,5% van de mensen antilichamen tegen

Bartonella henselae, B. koehlerae, or B. vinsonii subsp. berkhoffii gevonden, en

bij 41,1% van de patiŽnten werd via PCR de aanwezigheid van Bartonella-soorten vastgesteld.


Sommige mensen bleken positief bij serologische testen (antilichamen) maar niet bij PCR-testen,

en omgekeerd, niet alle PCR-positieve patiŽnten werden antilichamen gevonden.


Vaak kon met PCR ook de Bartonella-(onder)soort vastgesteld worden, maar niet altijd.


De conclusie die hier volgens de onderzoekers uit volgt:

gťťn enkele enkelvoudige testaanpak is sluitend, een combinatie van testmethoden is essentieel.



Kritiek en weerwoord:


De kritiek van twee onderzoeksgroepen op de studie en het weerwoord van de auteurs vindt u hier.







Voor meer informatie over Bartonella en Bartonellose en studies van de onderzoeksgroep-

Breitschwerdt en anderen, verwijs ik U graag door naar een aparte pagina over dit onderwerp.







Does the Bacterium behind Cat Scratch Fever Cause Chronic Fatigue?


The microbe that is known to cause cat scratch fever remains cloaked in mystery


By Marissa Fessenden, January 4, 2013



Recent research found fragments of Bartonella species' DNA

in 41 percent of 296 patients examined by a rheumatologist.




The findings, published in May 2012 in Emerging Infectious Diseases,

drew criticism in two letters to the editor, published last November




Complicating matters is the pathogen's elusive biology:

it evades detection within hosts

by changing proteins on its surface and

by hiding inside blood vessels.


In addition, the organism can shift strategies

depending on whether it is in a mammalian host,

such as a cat or dog, or an insect vector, such as a flea or tick.


"We are not even at the tip of the iceberg"

when it comes to understanding Bartonella,

says Jane Koehler, a professor of medicine at the University of California, San Francisco.







Enkele relevante citaten uit het studieverslag:



Serologic and BAPGM Findings


Of the 296 patients,

185 (62.5%) were seroreactive to >1 Bartonella sp. antigens and

122 (41.1%) were infected with B. henselae, B. koehlerae, B. vinsonii subsp. berkhoffii or Bartonella spp.


Of the 122 patients with Bartonella spp. infection, PCR results were positive

but DNA sequencing was unsuccessful or did not enable species identification for 29 (23.7%).


After subculture, 6 isolates were obtained from 5 samples:

3 B. henselae isolates, 2 B. koehlerae isolates, and 1 Bartonella sp. isolate

that was not fully characterized.


Of the Bartonella-infected patients,

120 (98.4%) had a positive PCR result

after DNA extraction from blood, serum, or enrichment culture, and

2 (1.6%) had a positive PCR result only after subculture isolation.


For B. henselae,

67 (22.6%) patients were seroreactive and 40 (13.5%) had positive PCR results.


Of these 40 patients,

only 7 (17.5%) were concurrently B. henselae seroreactive,

whereas 33 (82.5%) patients who had a positive PCR result

were not seroreactive to B. henselae antigens.


There was no association between B. henselae antibodies and bacteremia (p = 0.37).


For B. koehlerae,

89 (30.1%) patients were seroreactive and 54 (18.2%) had positive PCR results.


Of these 54 patients,

24 (44.4%) were seroreactive to B. koehlerae by IFA assay,

whereas 29 (53.6%) were not seroreactive to B. koehlerae antigens.


One patient with a positive B. koehlerae PCR result

did not have a concurrent IFA test result (serum not submitted).


There was an association between B. koehlerae seroreactivity and bacteremia (p = 0.008);

seroreactive patients were more likely to be infected (odds ratio [OR] 2.25 [1.22Ė4.15]).


For B. vinsonii subsp. berkhoffii,

148 (50.0%) patients were seroreactive by IFA testing to at least 1 of 3 genotypes, and

10 (3.4%) had a positive PCR.


Of these 10 patients,

3 were infected with genotype I, 6 were infected with genotype II, and

for 1 patient the genotype could not be defined on the basis of readable DNA sequence.


Seroreactivity to genotypes I, II, and III was found for

77 (26.0%), 102 (34.5%), and 82 (27.7%) patients, respectively.


There was

no association between B. vinsonii subsp. berkhoffii seroreactivity and bacteremia.




It is becoming increasingly clear that

no single diagnostic strategy will confirm infection with a Bartonella sp. in immunocompetent patients.




Cats are the primary reservoir hosts for B. henselae and B. koehlerae,

whereas canids, including dogs, coyotes and foxes,

are the primary reservoir hosts for B. vinsonii subsp. berkhoffii.








Bartonella spp. bacteremia and rheumatic symptoms

in patients from Lyme disease-endemic region.

Maggi RG, Mozayeni BR, Pultorak EL, Hegarty BC, Bradley JM, Correa M, et al.

Emerg Infect Dis. 2012 May;18(5):783-91. doi: 10.3201/eid1805.111366.





Bartonella spp. infection has been reported

in association with an expanding spectrum of symptoms and lesions.


Among 296 patients examined by a rheumatologist,

prevalence of antibodies

against Bartonella henselae, B. koehlerae, or B. vinsonii subsp. berkhoffii (185 [62%]) and

Bartonella spp. bacteremia (122 [41.1%]) was high.


Conditions diagnosed before referral included

Lyme disease (46.6%), arthralgia/arthritis (20.6%), chronic fatigue (19.6%), and fibromyalgia (6.1%).


B. henselae bacteremia was significantly associated with prior referral to a neurologist,

most often for blurred vision, subcortical neurologic deficits, or numbness in the extremities,

whereas B. koehlerae bacteremia was associated with examination by an infectious disease physician.


This cross-sectional study cannot establish a causal link

between Bartonella spp. infection and

the high frequency of neurologic symptoms, myalgia, joint pain, or progressive arthropathy

in this population;


however, the contribution of Bartonella spp. infection, if any,

to these symptoms should be systematically investigated.


The genus Bartonella comprises at least 26 species or subspecies of vector-transmitted bacteria,

each of which has evolved to cause chronic bacteremia in >1 mammalian reservoir hosts.


Among these,

bartonellae of 14 species or subspecies have been implicated in zoonotic diseases

including cat-scratch disease,

which is caused by B. henselae transmission during a cat bite or scratch and

characterized by acute onset of self-limiting fever and regional lymphadenopathy (7Ė9).


Recent observations, however, are causing a paradigm shift

from the assumption that

infection with a Bartonella sp. consistently induces an acute, self-limiting illness

to the realization that

subsets of infected, immunocompetent patients can become chronically bacteremic.


After B. henselae was confirmed as the primary cause of cat-scratch disease in the early 1990s,

several reports described an association between the newly identified bacterium and

rheumatic disease manifestations,

variously described as rheumatoid, reactive, or chronic progressive polyarthritis.


One study, however, failed to isolate B. henselae

from synovial fluid of 20 patients with chronic arthritis.


Because epidemiologic evidence supports an association

between rheumatic symptoms and cat-scratch disease and

because arthritis is a primary disease manifestation of Borellia burgdorferi infection (Lyme disease),

we explored whether antibodies against and bacteremia with Bartonella spp.

can be detected in patients examined for arthropathy or chronic myalgia.


Our primary objective was to determine

the serologic and molecular prevalence of Bartonella spp. bacteremia

in patients referred to a clinical rheumatologist.


We also compared

self-reported symptoms, health history, and demographic factors with Bartonella spp. bacteremia

as determined by an enrichment blood culture platform

combined with PCR amplification and DNA sequencing, when possible,

to determine the Bartonella species and strain.