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Didier Raoult - One of the best experts on this subject based on the ideXlab platform.
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Bartonella bovis and Candidatus Bartonella davousti in cattle from Senegal
Comparative Immunology Microbiology and Infectious Diseases, 2017Co-Authors: Mustapha Dahmani, Masse Sambou, Pierre Scandola, Florence Fenollar, Didier Raoult, Oleg MediannikovAbstract:In Senegal, domestic ruminants play a vital role in the economy and agriculture and as a food source for people. Bartonellosis in animals is a neglected disease in the tropical regions, and little information is available about the occurrence of this disease in African ruminants. Human Bartonellosis due to Bartonella quintana has been previously reported in Senegal. In this study, 199 domestic ruminants, including 104 cattle, 43 sheep, and 52 goats were sampled in villages from the Senegalese regions of Sine Saloum and Casamance. We isolated 29 Bartonella strains, all exclusively from cattle. Molecular and genetic characterization of isolated strains identified 27 strains as Bartonella bovis and two strains as potentially new species. The strains described here represent the first Bartonella strains isolated from domestic ruminants in Senegal and the first putative new Bartonella sp. isolated from cattle in Africa. (C) 2016 Elsevier Ltd. All rights reserved.
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Bartonella bovis and Candidatus Bartonella davousti in cattle from Senegal.
Comparative Immunology Microbiology and Infectious Diseases, 2016Co-Authors: Mustapha Dahmani, Masse Sambou, Pierre Scandola, Florence Fenollar, Didier Raoult, Oleg MediannikovAbstract:In Senegal, domestic ruminants play a vital role in the economy and agriculture and as a food source for people. Bartonellosis in animals is a neglected disease in the tropical regions, and little information is available about the occurrence of this disease in African ruminants. Human Bartonellosis due to Bartonella quintana has been previously reported in Senegal. In this study, 199 domestic ruminants, including 104 cattle, 43 sheep, and 52 goats were sampled in villages from the Senegalese regions of Sine Saloum and Casamance. We isolated 29 Bartonella strains, all exclusively from cattle. Molecular and genetic characterization of isolated strains identified 27 strains as Bartonella bovis and two strains as potentially new species. The strains described here represent the first Bartonella strains isolated from domestic ruminants in Senegal and the first putative new Bartonella sp. isolated from cattle in Africa.
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Identification of candidate proteins for the diagnosis of Bartonella henselae infections using an immunoproteomic approach.
FEMS microbiology letters, 2010Co-Authors: Watcharee Saisongkorh, Malgorzata Kowalczewska, Saïd Azza, Philippe Decloquement, Jean-marc Rolain, Didier RaoultAbstract:Bartonella henselae is an emerging gram-negative facultative intracellular pathogen transmitted via Ctenocephalides felis (cat fleas) or cat scratches. Bartonellosis is present mainly in the form of cat scratch disease (CSD), bacillary angiomatosis and infective endocarditis (IE). The methods used to diagnose B. henselae rely on culturing, immunofluorescent assays and molecular techniques. The objective of the present study was to identify candidate proteins for the serodiagnosis of Bartonellosis with the differential discrimination of both clinical scenarios: CSD and IE. For this, an immunoproteomic approach combined with 2-DE, immunoblotting and matrix-assisted laser desorption/ionization time-of-flight MS has been developed. Immunoproteomic profiles of sera collected from patients with CSD and IE were compared with those of blood donors. We identified several candidate proteins as phage-encoding Pap31 protein and an outer membrane protein of BH11510 that, in our view, might be useful for the serodiagnosis of Bartonellosis.
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Survey of Bartonella species infecting intradomicillary animals in the Huayllacallán Valley, Ancash, Peru, a region endemic for human Bartonellosis.
The American journal of tropical medicine and hygiene, 1999Co-Authors: Richard J. Birtles, Didier Raoult, Alejandro Llanos-cuentas, Palmira Ventosilla, Juan Canales, Eugenia Alvarez, Humberto Guerra, Nivedita Doshi, Timothy G. HarrisonAbstract:The natural cycle of Bartonella bacilliformis remains uncertain, and the suspected existence of animal reservoirs for the bacterium has never been convincingly demonstrated. We conducted a survey of Bartonella species infecting intradomicillary animals in a Bartonellosis-endemic region of Peru, obtaining blood from 50 animals living in the homes of 11 families whose children had recently had Bartonellosis. Bartonella-like bacteria were recovered from four of nine small rodents included in the study, but from none of the 41 domesticated animals. Identification and comparison of these isolates, and two Bartonella-like isolates obtained from Phyllotis mice in a different endemic region of Peru using serologic and genotypic methods indicated that although none were strains of B. bacilliformis, five were probably representatives of three previously unrecognized Bartonella species and one was a likely strain of the pathogenic species B. elizabethae.
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serological cross reactions between bartonella quintana bartonella henselae and coxiella burnetii
Journal of Clinical Microbiology, 1996Co-Authors: Bernard La Scola, Didier RaoultAbstract:The clinical manifestations of Q fever and bartonelloses can be confused, especially in cases of infectious endocarditis. Differential diagnosis of the diseases is important because the treatments required for Q fever and bartonelloses are different. Laboratory confirmation of a suspected case of either Q fever or bartonelloses is most commonly made by antibody estimation with an indirect immunofluorescence assay. With an indirect immunofluorescence assay, 258 serum samples from patients with Q fever were tested against Bartonella henselae and Bartonella quintana antigens, and 77 serum samples from patients with infection by Bartonella sp. were tested against Coxiella burnetii antigen. Cross-reactivity was observed: more than 50% of the chronic Q fever patients tested had antibodies which reacted against B. henselae antigen to a significant level. This cross-reaction was confirmed by a cross-adsorption study and protein immunoblotting. However, because the levels of specific antibody titers in cases of Bartonella endocarditis are typically extremely high, low-level cross-reaction between C. burnetii antibodies and B. henselae antigen in cases of Q fever endocarditis should not lead to misdiagnosis, provided serology testing for both agents is performed.
Ciro Maguiña - One of the best experts on this subject based on the ideXlab platform.
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An Outbreak of Bartonella bacilliformis in an Endemic Andean Community
PloS one, 2016Co-Authors: Nuria Sanchez Clemente, Ciro Maguiña, Nelson Solórzano, Cesar Ugarte-gil, David MooreAbstract:Bartonellosis affects small Andean communities in Peru, Colombia and Ecuador. Research in this area has been limited. Retrospective review of 191 cases of Bartonellosis managed in Caraz District Hospital, Peru, during the last outbreak (2003). The majority of cases (65%) were 14 years old and younger. There was a peak in acute cases after the rainy season; chronic cases presented more constantly throughout the year. The sensitivity of blood smear against blood culture in acute disease was 25%. The most commonly used treatment for chronic disease was rifampicin; chloramphenicol was used to treat most acute cases. Complications arose in 6.8% and there were no deaths. Diagnostic and treatment algorithms for acute and chronic Bartonellosis have been developed without a strong evidence base. Preparation of ready-to-go operational research protocols for future outbreaks would strengthen the evidence base for diagnostic and treatment strategies and enhance opportunities for control.
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Chronic Bartonellosis treatment regimes and outcomes.
2016Co-Authors: Nuria Sanchez Clemente, Ciro Maguiña, Nelson Solórzano, Cesar Ugarte-gil, David MooreAbstract:Chronic Bartonellosis treatment regimes and outcomes.
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Acute Bartonellosis treatment regimes and outcomes.
2016Co-Authors: Nuria Sanchez Clemente, Ciro Maguiña, Nelson Solórzano, Cesar Ugarte-gil, David MooreAbstract:Acute Bartonellosis treatment regimes and outcomes.
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toxoplasmosis en Bartonellosis humana
Revista Médica Herediana, 2013Co-Authors: Ciro Maguiña, Eduardo Gotuzzo, Humberto Alvarez, Amador Carcelen, Juan Irrivaren, Julio C Soto, Jaime CokAbstract:Objetivo : Estudiar la complicacion oportunista producida por la toxoplasmosis en pacientes con Bartonellosis en la fase aguda hematica . Material y Metodos : Estudio prospectivo realizado en 68 pacientes de la fase febril anemizante de la Bartonellosis humana atendidos en el Hospital Nacional Cayetano Heredia. Como criterios de la complicacion infecciosa por toxoplasmosis se uso el cuadro clinico ( fiebre de origen desconocido, linfoadenomegalia, etc.) presencia de titulos Ig M positivos (Elisa, IFI) y titulos de Ig G altos (>1/1024 o un incremento mas de 4 veces del valor basal) y la presencia en biopsias de taquizoitos de Toxoplasma gondii . Resultados : De 68 pacientes con Bartonellosis en 25 (36.7%) presentaron algunas complicaciones infecciosas, de ellos 5/25 (20%) fueron debidas a toxoplasmosis reactivada. El cuadro clinico sistemico de la toxoplasmosis se caracterizo por presencia de fiebre en 5/5, lesion hepatica en 3/5, insuficiencia respiratoria en 3/5 y lesion miocardica en 2/5, 3 pacientes fueron tratados a base de pririmetamina mas clindamicina o cotrimoxazol habiendo recuperacion completa en 2 de ellos y uno fallecido con miocarditis por Toxoplasma gondii , 2 pacientes no recibieron tratamiento especifico y la enfermedad se autolimito sola; 4/5 tuvieron incrementos significativos de titulos (IFI) > 4 veces del valor basal ( rango: 4- 250 veces); 3/5 tuvieron titulo + IgM (Elisa, IFI) y en 2/5 se detecto mediante biopsia la presencia del Toxoplasma gondii en el tejido pulmonar y miocardico. Conclusion : Destacamos en forma importante la complicacion oportunista de toxoplasmosis reactivada en pacientes con Bartonellosis durante la fase aguda hematica.
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Bartonellosis: Carrion's Disease and Other Bartonella Infections
Hunter's Tropical Medicine and Emerging Infectious Disease, 2013Co-Authors: Ciro Maguiña, Eloy E OrdayaAbstract:Abstract Carrion's disease, or South American Bartonellosis, is a bi-phasic, arthropod-borne bacterial infection caused by the fastidious, intracellular, gram-negative bacterium Bartonella baciliformis. Other new Bartonella spp., including B. rochalimae and B. ancashensis, have been diagnosed in patients with a similar presentation to Carrion's disease. South American Bartonellosis is transmitted by the bite of a sandfly (Lutzomyia spp.) that lives in the inter-Andean valleys (between 500 and 3200 meters above sea level) of Peru, Colombia, and Ecuador. Classically, it presents initially as an acute febrile-hemolytic stage (Oroya fever) and then as a chronic cutaneous illness (verruga peruana). Oroya fever is a life-threatening condition characterized by fever, pallor, and hemolytic anemia. Verruga peruana is a benign and prolonged stage distinguished by erythematous skin lesions. Other relevant diseases caused by Bartonella species include cat scratch disease, trench fever, bacillary angiomatosis, and blood culture–negative endocarditis.
Edward B Breitschwerdt - One of the best experts on this subject based on the ideXlab platform.
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Bartonella infections in cats and dogs including zoonotic aspects
BMC, 2018Co-Authors: Alejandra Álvarez-fernández, Edward B Breitschwerdt, Laia Solano-gallegoAbstract:Abstract Bartonellosis is a vector-borne zoonotic disease with worldwide distribution that can infect humans and a large number of mammals including small companion animals (cats and dogs). In recent years, an increasing number of studies from around the world have reported Bartonella infections, although publications have predominantly focused on the North American perspective. Currently, clinico-pathological data from Europe are more limited, suggesting that Bartonellosis may be an infrequent or underdiagnosed infectious disease in cats and dogs. Research is needed to confirm or exclude Bartonella infection as a cause of a spectrum of feline and canine diseases. Bartonella spp. can cause acute or chronic infections in cats, dogs and humans. On a comparative medical basis, different clinical manifestations, such as periods of intermittent fever, granulomatous inflammation involving the heart, liver, lymph nodes and other tissues, endocarditis, bacillary angiomatosis, peliosis hepatis, uveitis and vasoproliferative tumors have been reported in cats, dogs and humans. The purpose of this review is to provide an update and European perspective on Bartonella infections in cats and dogs, including clinical, diagnostic, epidemiological, pathological, treatment and zoonotic aspects
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Bartonellosis: A One Health Perspective
Confronting Emerging Zoonoses, 2014Co-Authors: Elizabeth L. Pultorak, Ricardo G. Maggi, Edward B BreitschwerdtAbstract:Recently, Bartonella, a genus comprised of fastidious, Gram-negative, intracellular bacteria, has rapidly expanded from approximately 4–5 species in the 1990s to 30–40 named or proposed species that are currently described in the literature. While Bartonellae are highly adapted to a number of mammalian reservoir hosts, substantial genetic diversity allows for the transmission of Bartonella to humans (i.e. a zoonosis) and other non-reservoir hosts. Improvements in the diagnostic sensitivity of laboratory tests have allowed researchers to identify a spectrum of Bartonella species in novel host species, including domestic animals and wildlife. Because Bartonella can infect a spectrum of accidental hosts, it is imperative that researchers determine the consequences of Bartonella spp. infection on new host populations and the impact of this genus during environmental changes, particularly natural disasters. Rapid, accurate diagnostic tests now afford researchers and clinicians the ability to conduct more reliable epidemiologic and treatment related studies that will better characterize the outcomes of Bartonella spp. infection in animals and human patients. Prevalence studies have shown that Bartonella spp. DNA can be found in numerous arthropods, though additional research is required to identify epidemiologically important competent vectors of Bartonella spp. transmission. Future Bartonella spp. research initiatives should strive to not only identify the bacterium in arthropod and host populations, but also to combine those data with epidemiologically relevant case data and ecological risk assessment. Combined efforts from professionals in animal and human medicine, vector ecology, pathogen evolution, microbial ecology, and sociology are necessary in order to create the veterinary and medical infrastructure, training, prevention, and surveillance required to thoroughly understand Bartonella spp. ecology, dynamics and control. Bartonellosis may prove to be one of the most important One Health emerging zoonotic diseases of the next decade.
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Bartonellosis: One Health Perspectives for an Emerging Infectious Disease
ILAR journal, 2014Co-Authors: Edward B BreitschwerdtAbstract:In recent years, an increasing number of Bartonella species have been identified as zoonotic pathogens, transmitted by animal bites, scratches, arthropods and even by needle sticks. Considering the diversity of newly discovered Bartonella species and subspecies and the large number and ecologically diverse animal reservoir hosts and the evolving spectrum of arthropod vectors that can transmit these bacteria among animals and humans, the clinical and diagnostic challenges posed by Bartonella transmission in nature are presumably much more complex than is currently appreciated by diagnosticians, vector biologists, ecologists, physicians, or veterinarians. Historically the term "Bartonellosis" was attributed to infections with Bartonella bacilliformis, transmitted by sandflies in the Peruvian Andes. Currently, however, Bartonellosis now includes infections caused by any Bartonella sp. anywhere in the world. Potentially, because Bartonella spp. can infect erythrocytes, endothelial cells, pericytes, CD34(+) progenitor cells, and various macrophage-type cells, including microglial cells, dendritic cells, and circulating monocytes in vitro, the clinical and pathological manifestations of Bartonellosis appear to be very diverse in both sick animals and human patients. Because 75% of emerging infectious diseases are zoonoses, many of which are vector-transmitted by an arthropod, a One Health approach to Bartonellosis and other zoonotic infections is needed to properly address animal health, public health, and environmental factors that influence the distribution and transmission of these bacteria. The One Health concept encourages a spirit of cooperation among animal, environmental, and human health professionals and promotes developing integrated solutions for complex problems that impact the health of animals, humans, and the planet. Importantly, substantial research is needed to define the medical importance of this genus as a cause of animal and human illnesses.
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In Pursuit of a Stealth Pathogen: Laboratory Diagnosis of Bartonellosis
Clinical Microbiology Newsletter, 2014Co-Authors: Leslie A. Wolf, Ricardo G. Maggi, Natalie A. Cherry, Edward B BreitschwerdtAbstract:Members of the genus Bartonella cause illnesses in humans and animals. Bartonella spp. are gram-negative, fastidious, facultative, intracellular pathogens transmitted by the bites of certain arthropods or by bites and scratches from infected animals. While some of the illnesses are acute and self-limiting, others are chronic, debilitating, and difficult to diagnose. Bartonella spp. are able to invade host cells and modulate the host immune response, contributing to their success as stealth pathogens. This article provides an overview of diseases caused by members of the genus Bartonella and the mechanisms of pathogenesis. The laboratory diagnosis of Bartonellosis relies on three primary methods. This article examines the evolution of culture techniques, serology, and nucleic acid amplification tests used to detect Bartonella spp. in clinical specimens and suggests areas for future research to improve laboratory diagnostics. In this way, a better understanding of the epidemiology of Bartonellosis can be achieved.
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bartonella henselae infection in a man with hypergammaglobulinaemia splenomegaly and polyclonal plasmacytosis
Journal of Medical Microbiology, 2013Co-Authors: Nandhakumar Balakrishnan, Jaspaul S Jawanda, Melissa B Miller, Edward B BreitschwerdtAbstract:Bartonella henselae is an infrequently reported cause of polyclonal plasmacytosis and hypergammaglobulinaemia. We herein document B. henselae infection in a 66-year-old patient who presented with hypergammaglobulinaemia, splenomegaly with polyclonal plasmacytosis, stroke, and suspected prosthetic aortic arch infection. Clinicians should remain cognizant of the heterogeneous clinical presentations associated with Bartonellosis.
Nelson Solórzano - One of the best experts on this subject based on the ideXlab platform.
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An Outbreak of Bartonella bacilliformis in an Endemic Andean Community
PloS one, 2016Co-Authors: Nuria Sanchez Clemente, Ciro Maguiña, Nelson Solórzano, Cesar Ugarte-gil, David MooreAbstract:Bartonellosis affects small Andean communities in Peru, Colombia and Ecuador. Research in this area has been limited. Retrospective review of 191 cases of Bartonellosis managed in Caraz District Hospital, Peru, during the last outbreak (2003). The majority of cases (65%) were 14 years old and younger. There was a peak in acute cases after the rainy season; chronic cases presented more constantly throughout the year. The sensitivity of blood smear against blood culture in acute disease was 25%. The most commonly used treatment for chronic disease was rifampicin; chloramphenicol was used to treat most acute cases. Complications arose in 6.8% and there were no deaths. Diagnostic and treatment algorithms for acute and chronic Bartonellosis have been developed without a strong evidence base. Preparation of ready-to-go operational research protocols for future outbreaks would strengthen the evidence base for diagnostic and treatment strategies and enhance opportunities for control.
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Chronic Bartonellosis treatment regimes and outcomes.
2016Co-Authors: Nuria Sanchez Clemente, Ciro Maguiña, Nelson Solórzano, Cesar Ugarte-gil, David MooreAbstract:Chronic Bartonellosis treatment regimes and outcomes.
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Acute Bartonellosis treatment regimes and outcomes.
2016Co-Authors: Nuria Sanchez Clemente, Ciro Maguiña, Nelson Solórzano, Cesar Ugarte-gil, David MooreAbstract:Acute Bartonellosis treatment regimes and outcomes.
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Cytokines and T-Lymphocute count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study.
Revista do Instituto de Medicina Tropical de Sao Paulo, 2011Co-Authors: Erick Huarcaya, Ciro Maguiña, Nelson Solórzano, Ivan Best, Juan Rodriguez-tafur, Julio Menacho, Douglas López De Guimaraes, José Chauca, Palmira VentosillaAbstract:Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities of CD4+ and CD8+ T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the elevated levels of IFN-γ and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in animal models.
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Immunological response in cases of complicated and uncomplicated Bartonellosis during pregnancy
Revista do Instituto de Medicina Tropical de Sao Paulo, 2007Co-Authors: Erick Huarcaya, Ciro Maguiña, Nelson Solórzano, Ivan Best, Lawrence LeemanAbstract:Bartonellosis (Carrion's Disease) during pregnancy is associated with high rates of maternal and perinatal mortality. We report the immunological patterns in two cases of human Bartonellosis during pregnancy. One patient had an uncomplicated course while the second patient developed life threatening anasarca and cardiac tamponade. The patient with a complicated course had a Th1 response with a higher elevation of IL-10. This elevation has been associated with poor outcome pregnancies during bacterial infections.
Paulo Eduardo Neves Ferreira Velho - One of the best experts on this subject based on the ideXlab platform.
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Cutaneous manifestations of Bartonellosis
Anais brasileiros de dermatologia, 2019Co-Authors: Karina De Almeida Lins, Marina Rovani Drummond, Paulo Eduardo Neves Ferreira VelhoAbstract:Bartonellosis are diseases caused by any kind of Bartonella species. The infection manifests as asymptomatic bacteremia to potentially fatal disorders. Many species are pathogenic to humans, but three are responsible for most clinical symptoms: Bartonella bacilliformis, Bartonella quintana, and Bartonella henselae. Peruvian wart, caused by B. bacilliformis, may be indistinguishable from bacillary angiomatosis caused by the other two species. Other cutaneous manifestations include maculo-papular rash in trench fever, papules or nodules in cat scratch disease, and vasculitis (often associated with endocarditis). In addition, febrile morbilliform rash, purpura, urticaria, erythema nodosum, erythema multiforme, erythema marginatus, granuloma annularis, leukocytoclastic vasculitis, granulomatous reactions, and angioproliferative reactions may occur. Considering the broad spectrum of infection and the potential complications associated with Bartonella spp., the infection should be considered by physicians more frequently among the differential diagnoses of idiopathic conditions. Health professionals and researchers often neglected this diseases.
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false negative results in Bartonellosis diagnosis
Vector-borne and Zoonotic Diseases, 2019Co-Authors: Marina Rovani Drummond, Marilene Neves Da ,silva, Amanda Roberta De ,almeida, Luciene Silva Dos Santos, Pedro Paulo Vissotto De Paiva Diniz, Rodrigo Nogueira Angerami, Paulo Eduardo Neves Ferreira VelhoAbstract:Abstract We report a fatal case of Bartonella henselae bacteremic patient. He had negative serology and PCRs from whole blood and liquid culture; only ftsZ nested PCR was positive from the blood li...
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Bartonella henselae AS A PUTATIVE CAUSE OF CONGENITAL CHOLESTASIS
Revista do Instituto de Medicina Tropical de Sao Paulo, 2016Co-Authors: Paulo Eduardo Neves Ferreira Velho, Marina Rovani Drummond, Maria Ângela Bellomo-brandão, Renata Ferreira Magalhães, Gabriel Hessel, Maria Lourdes Barjas-castro, Cecília Amélia Fazzio Escanhoela, Gilda Maria Barbaro Del Negro, Thelma Suely OkayAbstract:Severe anemia and cholestatic hepatitis are associated with bartonella infections. A putative vertical Bartonella henselae infection was defined on the basis of ultrastructural and molecular analyses in a three-year-old child with anemia, jaundice and hepatosplenomegaly since birth. Physicians should consider Bartonellosis in patients with anemia and hepatitis of unknown origin.
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Cryptogenic Hepatitis and Bartonellosis
Digestive diseases and sciences, 2012Co-Authors: Paulo Eduardo Neves Ferreira Velho, Marna E. EricsonAbstract:To the Editor, We read with great interest the recent review on cryptogenic hepatitis (CH), Cryptogenic Chronic Hepatitis and Its Changing Guise in Adults, written by Dr. Czaja. Its frequency in the general population can be as high as 5.4% [1]. Dr. Czaja asks for ‘‘insights into CH that require a span of observation or reliance on deductions from a constellation of nonspecific features.’’ From our point of view, CH contains crypta (Latin meaning hidden or secret) etiologies. Alternatively, it could be called idiopathic hepatitis as it is not an independent disease entity. These etiologic factors may be infectious in origin and it is our inability to detect them that hinders our understanding of cryptogenic/idiopathic hepatitis. The best example is the hepatitis C virus. Before the 1990s, this hepatitis was considered cryptogenic and at that time CH had a different expression and outcome compared to current medical practice. As our knowledge and diagnostic capabilities advance, so will the clinical outcome [1]. In his manuscript, the author proposes a diagnostic algorithm based on an extensive literature review and his broad clinical experience working with liver disease patients. Even so, he recognizes that we must continue to look for other possible etiologies. We propose that bacterial hepatitis should be included in the first stage of assessment. Bartonella henselae can cause chronic hepatitis inflammation in adults or in children [2, 3]. These bacteria can be found worldwide. Cats are one of the most important reservoirs though many other mammals and arthropods have been identified as well. Humans can be asymptomatic or oligosymptomatic Bartonella spp. carriers [4–6]. Blood donors can also have Bartonella spp. bacteremia [7, 8]. Bartonella henselae can cause nonspecific liver inflammation as they can cause bacillary angiomatosis in liver, bacillary peliosis hepatis as well as granulomatous hepatitis with or without necrosis [2, 3]. Bartonella spp. infection has been reported in liver transplant recipients [9– 11]. The recipients may have been previously infected or contracted the infection through donor liver [5] or blood transfusion [12]. Bartonella spp. can also co-infect patients with viral hepatitis B and C [13–15] and, perhaps, could be related to recurrences after liver transplantation or de novo hepatitis in these patients. Undiagnosed Bartonella spp. infection may influence the survival rate of this population of transplant recipients, especially those with CH. Coordinated international efforts should be initiated to discover other etiologies to CH. We hypothesize that infection with the bacteria Bartonella spp. is an etiologic agent of CH/idiopathic hepatitis and propose that testing for this pathogen needs to be incorporated into the routine algorithm for liver transplant donors and recipients. P. E. N. F. Velho (&) M. E. Ericson Department of Dermatology/Center for Drug Design, University of Minnesota, 420 Delaware St. S.E., MMC98, Minneapolis, MN 55455, USA e-mail: pvelho@unicamp.br; pevelho@umn.edu
