Bartonella Spp Infections Diagnosed Between 2005 And 2009 By The National Rickettsial Reference Laboratory In Rio De Janeiro, Brazil

Background: Bartonellae are gram negative bacteria that parasitize erythrocytes and endothelium of several mammals, being widespread in nature. Its main source of infection to humans is the domestic cat. Bartonella infection is not notifiable, and no national data is available regarding its manifestations in Brazil. The aim of this study is to describe the cases referred with a possible diagnosis of bartonellosis to the National Rickettsial Reference Lab (LNHR) in Rio de Janeiro. Methods: A Microsoft Excel® datasheet was designed for the study, so as to correlate the Brazilian Ministry of Health Notification requests received by LNHR (SINAN, for Brazilian Spotted Fever, notifiable since 2001) and the Lab's database. The diagnosis of bartonella infection was considered definite when paired samples showed a 4-fold difference in titers detected in the Indirect Immunofluorescence Assay for B.henselae IgG antibodies from Bion, USA, and/or the polymerase chain reaction (using primers CAT1/CAT2) was positive in biological samples. Results: 54 patients had samples sent with the SINAN requests with the clinical suspicion of bartonellosis. Of these, 20 (37%) had definite infection by reactive IFA assay and/or positive PCR results (6 of 20). 19/20 patients were from Rio, 1 from Bahia. Mean age ± standard deviation was 28,9 ± 17,5 years, with median of 26. 12/20 patients were male. 14 referred contact with pets, mostly cats. Most prevalent signs and symptoms were fever and chills (11/15), adenopathy (11/12), hepatoesplenomegaly (7/13), abdominal pain (5/19), prostration (5/9), headache (5/10) and conjunctival injection (4/11). Six patients had neuroretinitis, one of which with associated meningoencephalitis. One of the 20 patients had aortic valve endocarditis which required surgery. Conclusion: More human samples are gradually being sent for Bartonella testing in LNHR, possibly because of greater medical awareness of this infection. Although classically the agent of cat-scratch disease, severe syndromes such as neuroretinitis, disseminated disease (with fever and hepatosplenomegaly) and endocarditis were seen in this first documented series of cases from Brazil. This deserves public health attention and better information to health care providers. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive