Antibiotic Treatment of Bartonella Infections

Instructor

Monica E. Embers, PhD
Associate Professor in the Division of Immunology
Director of Vector-borne Disease Research
Tulane National Primate Research Center

Description

This course is an educational resource for clinicians to enhance their understanding and treatment approaches for Bartonella infections. Dr. Embers provides an in-depth exploration of the various diseases caused by Bartonella spp., such as Cat Scratch Disease, Carrion’s Disease, and Trench Fever, emphasizing the complexity of treating these infections. It delves into the challenges of diagnosing Bartonella due to its elusive nature and the bacteria’s ability to evade the host’s immune system through mechanisms like intracellular location, biofilm formation, antigenic variation, immune suppression, molecular mimicry, evasion of phagocytosis, and subversion of host cell functions. The lecture also addresses the current standard of care, highlighting the variability of treatment based on the specific Bartonella infection and the promising avenues of research, especially the potential of combination therapy.

Learning objectives

1. Discuss the different microenvironments in which  Bartonella species exist in vivo, and how these environments affect antibiotic efficacy.
2. Analyze research efforts and results with single and combination therapy for Bartonelloses.
3. Describe the current standard of care for treatment of Bartonella infections 

This session, Antibiotic Treatment of Bartonella Infections, is approved for 0.5 enduring AAFP Prescribed credits.

The AAFP has reviewed One Health Medical Education for a Changing Climate, and deemed it acceptable for AAFP credit. Term of approval is from 01/02/2024 to 01/01/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Evidence-based bibliography for further study

References

• Angelakis, E. and D. Raoult (2014). “Pathogenicity and treatment of Bartonella infections.” Int J Antimicrob Agents 44(1): 16-25.
• Breitschwerdt, E. B., R. G. Maggi, W. L. Nicholson, N. A. Cherry and C. W. Woods (2008). “Bartonella sp. bacteremia in patients with neurological and neurocognitive dysfunction.” J Clin Microbiol 46(9): 2856-2861.
• Breitschwerdt, E. B., J. M. Bradley, R. G. Maggi, E. Lashnits and P. Reicherter (2020). “Bartonella Associated Cutaneous Lesions (BACL) in People with Neuropsychiatric Symptoms.” Pathogens 9(12). 
• Bullard, R. L., E. L. Olsen, M. A. Cheslock and M. E. Embers (2024). “Evaluation of the available animal models for Bartonella infections.” One Health 18: 100665.
• Foucault, C., P. Brouqui and D. Raoult (2006). “Bartonella quintana characteristics and clinical management.” Emerging infectious diseases 12(2): 217-223.
• Gadila, S. K. G. and M. E. Embers (2021). “Antibiotic Susceptibility of Bartonella Grown in Different Culture Conditions.” Pathogens 10(6). Accession Number: 34201011 PMCID: PMC8229624 
• Gescher DM, Mallmann C, Kovacevic D, Schmiedel D, Borges AC, Schweickert B, Göbel UB, Moter A. A view on Bartonella quintana endocarditis–confirming the molecular diagnosis by specific fluorescence in situ hybridization. Diagn Microbiol Infect Dis. 2008 Jan;60(1):99-103. doi: 10.1016/j.diagmicrobio.2007.07.012. Epub 2007 Sep 21. PMID: 17889492.
• Harms A, Dehio C. Intruders below the radar: molecular pathogenesis of Bartonella spp. Clin Microbiol Rev. 2012 Jan;25(1):42-78. doi: 10.1128/CMR.05009-11. PMID: 22232371; PMCID: PMC3255967.
• Merrell, D. S. and S. Falkow (2004). “Frontal and stealth attack strategies in microbial pathogenesis.” Nature 430(6996): 250-256.
• Rolain, J. M., P. Brouqui, J. E. Koehler, C. Maguina, M. J. Dolan and D. Raoult (2004). “Recommendations for treatment of human infections caused by Bartonella species.” Antimicrob Agents Chemother 48(6): 1921-1933.
• Zheng, X., X. Ma, T. Li, W. Shi and Y. Zhang (2020). “Effect of different drugs and drug combinations on killing stationary phase and biofilms recovered cells of Bartonella henselae in vitro.” BMC Microbiol 20(1): 87.