Bartonella henselae infection in diverse clinical conditions in a tertiary care hospital in north India
Rama Chaudhry1, Prathyusha Kokkayil2, Arnab Ghosh3, Tej Bahadur1, Kamala Kant1, Tanu Sagar1, Sunil Kumar Kabra4, Rakesh Lodha4, Aparajit Ballav Dey5, Vimala Menon6
1 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Microbiology, Government Medical College, Palakkad, India
3 Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
4 Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
5 Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
6 Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
Dr Rama Chaudhry
Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029
Source of Support: None, Conflict of Interest: None
Background & objectives: Bartonella henselae causes infections which closely resemble febrile illness and chronic diseases such as tuberculosis and haematological malignancies. There are not many studies on Bartonella infections from India. The present study was undertaken to diagnose B. henselae infection in diverse clinical conditions in a tertiary care hospital in north India.
Methods: A total of 145 patients including those with fever and lymphadenopathy, infective endocarditis and neuroretinitis were enrolled in the study. Whole blood, serum and lymph node aspirate and valvular vegetations if available, were obtained. Samples were plated on chocolate agar and brain-heart infusion agar containing five per cent fresh rabbit blood and were incubated at 35°C for at least four weeks in five per cent CO2with high humidity. Immunofluorescent antibody assay (IFA) was done for the detection of IgM antibodies in the serum using a commercial kit. Whole blood was used to perform polymerase chain reaction (PCR) for the citrate synthase gene (gltA).
Results: IFA was positive in 11 of 140 (7.85%) patients and PCR was positive in 3 of 140 (2.14%) patients. Culture was negative in all the cases. A higher incidence of Bartonella infection was seen in patients with fever and lymphadenopathy (n=30), seven of whom were children. In ophthalmological conditions, four cases were IFA positive.
Interpretation & conclusions: The present study shows that the threat of Bartonella infection is a reality in India. It is also an important treatable cause of fever and lymphadenopathy in children. Serology and PCR are useful tests for its diagnosis. Clinicians should consider
Bartonella infection in the differential diagnosis of febrile illnesses and chronic diseases.