Bartonellosis

Bartonellosises unite to bunch of diseases of the human caused by Gram-negative aerobic, facultatively intracellular bacteria, requiring for the growth in hemin or cleavage products of erythrocytes.

Since 1993 of a Bartonella are categorised in a-2 to a subgroup of proteobacteriases of family Bartonellaceae, phylogenetically by the most related to sort Brucella, that particulate explains polymorphism of a clinical picture of diseases caused by them. For the human 5 independent kinds of Bartonellas of various degree of virulence are pathogenic.

In the Bartonella nature circulate among murine gnawers, rats, representatives of family cat's (cats, pumas) and dogs, causing at them an infection contamination with asymptomatic flow and a long multimonthly bacteriemia. In humans cause polymorphic on a clinical picture acute (a Werner-His disease, an Oroya fever), subacute (illness of the cat's scratches) and chronic (a bacillar angiomatosis, the Peruvian wart, a purple hepatitis, endocarditises, a long feverish condition with a bacteriemia) diseases.

History. Chronologically the diseases caused by Bartonellas, were known considerably before discovering and abjection of originators. Originators of these and other bartonellosises are open, secured and identified throughout the XX-th century, since 1916

Morphology, identification, cultivation of Bartonellas. Kinds of Bartonellas (till 1993 - Rochalimaea spp., Etc.) It is microscopically are presented by mainly short rods, the dimension 0,3-0,5o1,0-3,0 mm. In sections from the infected tissues can be bent, polymorphic, are grouped in compact clumps (clusters). Roundish forms reach 1,5 mm in diameter. Are imbued on Romanovsky-gimze; in biopsy samples from tissues - a stain with silver application on Warthing Starry; accept also an acridine an orange stain that is used in immunochemical researches. For B. bacilliformis 1-4 flagellas located on one of poles of a cell and consequently it is mobile are characteristic; for B. henselae observed one monopolar flagella; or only drank. Bacteria have accurately structured trizonal cover; last contains to 12 proteins with molecular mass from 174 to 28 kilodalton. The genome dimension is rather insignificant, within 1700-2174; a guanine and cytosine interrelation - 38,5-41,0 pier. %. Reproduction of Bartonellas descends a simple transverse fission.

In an organism of sensitive masters of a Bartonella grow on a surface of cells, and also take root and invade erythrocytes and endothelial cells of vascular system and an endocardium. Biological feature of Bartonellas is their unique ability to suscitate a proliferation of cells of an endothelium and growth of fine pots in their capillary part that leads to an angiomatosis.

On character of a food of a Bartonella are aerobic hemotroph, exacting to structure of nutrient mediums. Out of a human body and gnawers their cultivation can be carried out in body lice (B. quintana), the cat's fleas (B. henselae), and also on the firm and semifluid nutrient mediums enriched of 5-10 % of blood of the human or animals.

At primary abjection of Bartonellas from biological samples (blood, biopsy samples of lymph nodes, pathological growths on valves of heart, papules and other organs affected by illness) the sick human the withstanding of the sowed cups with an agar in optimum conditions of growth is required long, till 15-45 days and more.

Abjection of Bartonellas from blood of patients, for example, in connection with an endocarditis at seeding negative takes on other bacteria, or a lymphadenopathy after a scratching a kitten or its puncture, is considerably facilitated if to use lines of endothelial cells of other animals, and also such simple reception, as a centrifugation of blood with simultaneous destruction of erythrocytes.

Bionomics. The bionomics of Bartonellas is studied insufficiently. The endemicity of disease-producing factor Karriona - B is undoubtedly established. bacilliformis. It is extended only in the Northwest of the South America in mountain districts of the Andes protected from Pacific winds, at heights of 600-2500 m above sea level, territorially adhered to Peru, particulate Colombia and Ecuador. Life cycle of the given Bartonellas is bound to the South American type of mosquitoes - Phlebotomus, namely, Lutzomia noguchi, L. verrucarum and others, and also aboriginal murine gnawers.

The most widespread, apparently, are disease-producing factors of the cat's scratches (cat scratch disease - English) and a Werner-His disease which transmitting agents are, accordingly, the cat's fleas and body lice of the human. The last are almost ubiquitous hexapods, their participation in transemission of Bartonellas quintan and henselae in a human body is proved and, obviously, the bartonellosises caused by these two species of microorganisms, are extended on all globe within places of a constant habitation of humans. In particular it is established high (to 68,1 %) a bacteriemia among cats and the kittens, bound with B. henselae in some states of the USA, and also in Germany, especially among animals (to 89 %) from those monogynopaediums to which children or owners of cats have tolerated illness of the cat's scratches.

Wide search of Bartonellas in connatural population of gnawers in the various countries (the USA, Bolivias, Paraguay, British Columbia (Canada), Poland and others) has taped high prevalence of Bartonellas in connatural population of gnawers, representatives cat's (pumas) and dog (coyotes). Studying of a bionomics and an epidemiology of Bartonellas proceeds.

Rather the most pathogenic for human B. bacilliformis and B. quintana it is supposed, that the significant reservoir of the given originators is the human as the asymptomatic and soft forms of an infection contamination accompanied by the long bacteriocarrier are registered. The natural reservoir for B. elizabethae also fine feral mammals, apparently, are.

Epidemiology. Obligatory registration of bartonellosises does not exist. It is known, that in days of the First World War Werner-His disease epidemy on a battlefield in Europe, affected not less than 1 million soldiers has burst. During the Second World War it has revived in the epidemic form, but in much smaller scale. Has had been ill about 80 thousand humans. With the terminal of the Second World War of flash of a Werner-His disease have stopped. About age of the infection contamination bound with B. quintana, reports have appeared in the early nineties when the originator has been taped as the cause of an opportunistic infection contamination at a HIV-infected of persons. Serological and molekuljarno-genetical researches in the different countries including in Russia have taped the latent circulation of the originator among the population and its presence in population of louses. At the population of Ukraine specific antibodies to Bartonellas quintana are taped in all age-grades in a range of 1,48-2,48 %, in France - at 0,6 % surveyed, and the endocarditises caused by the given kind of Bartonellas, are confirmed at 76,4 % in bunch of patients with an unstated aetiology of suffering (1995-1998).

Werner-His disease epidemy is bound to body lice of the human at an epidemic typhus; it is caused by a mechanical infriction of the infected excrements in skin scratches. In excrements of louses of a Bartonella quintana keep the viability exclusively longly - till 1312 days. The connatural reservoir of Bartonellas quintana is not established till now, a unique source of an infection contamination the human is considered. At louses, unlike a typhous rickettsiosis, the bartonellosis proceeds asymptomatically, the microorganism remains for life (till 30-45 days), trnsovarial transfer is absent. At the human, besides acutely proceeding feverish disease, probably long (till 2-5 years) the latent asymptomatic carriage or in a combination to chronically proceeding lymphadenopathy and an endocarditis.

Fleas Cfenocephalides felis, also as well as body lice, unlike pincers, during the life cycle eat repeatedly and illegible concerning the carrier. Thereof they serially sticking to cats or gnawers, in the environment are easily infested with Bartonellas. In their organism of a Bartonella henselae remain more than a year without influence on behaviour and a mode of life. In search of livelihood hexapods attack and the human.

The true number ill with a bartonellosis caused by a Bartonella henselae, remains obscure. But it is known, that in the USA, for example, in the early nineties most widespread rickettsiosis in this country - the spotted fever of Rocky mountains - was registered at the level exceeding 1000 cases annually whereas the case rate illness of the cat's scratches estimated in 22 000 cases from which 2000 - were hospitalised.

Diseases of humans by the acute form of the Carrion's disease known as an Oroya fever, bind to punctures of several kinds of mosquitoes. At a puncture of a mosquito of a Bartonella together with a saliva of a hexapod immediately inpour into a blood channel, attack and take root into erythrocytes and extend hematogenous by with the subsequent settling of cells of an endothelium of vascular system, lymph nodes, a lien and other organs. Thus to 90 % of erythrocytes it is hemolyzed, that causes a sharp anaemia and a clinical picture of disease.