Molecular epidemiology of Bartonella infections in patients with bacillary angiomatosis-peliosis
Molecular epidemiology of Bartonella infections in patients with bacillary angiomatosis-peliosis
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DOI：
10.1056/nejm199712253372603
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发表时间：
1997-12-25
影响因子：
158.5
通讯作者：
Tappero, JW
中科院分区：
文献类型：
--
作者：
Koehler, JE;Sanchez, MA;Tappero, JW
背景 杆菌性血管瘤病和杆菌性紫癜病是巴尔通体属物种感染的血管增殖表现，主要发生在感染人类免疫缺陷病毒的患者中。汉塞巴尔通体和五种巴尔通体这两个物种与杆菌性血管瘤病有关，但培养和物种形成很困难，并且对物种特异性疾病特征的系统评价很少。我们研究了 49 名超过 8 年的患者，这些患者感染了通过分子技术鉴定的巴尔通体物种，并且具有与杆菌性血管瘤病-紫癜病一致的临床病变。方法在这项病例对照研究中，对杆菌性血管瘤病-紫癜病患者和 96 名行进对照者进行了一份关于暴露的标准化调查问卷。通过分子技术确定感染巴尔通体的种类。结果49例杆菌性血管瘤病-紫癜病患者中，26例（53%）感染汉塞巴尔通体，23例（47%）感染五体巴尔通体。皮下和溶解性骨病变与 B. quintana 密切相关，而紫癜性肝炎仅与 B. henselae 相关。在整个研究期间都发现了 B. henselae 感染患者，并且在流行病学上与猫和跳蚤接触相关（P 小于或等于 0.004），而 B. quintana 患者聚集在一起，其特征是低收入（P=0.003）、无家可归。 (P=0.004) 和暴露于虱子 (P=0.03) 之前使用大环内酯类抗生素治疗似乎可以预防这两种物种的感染。结论 B. henselae 和 B. quintana 是引起杆菌性血管瘤病-紫癜病的生物体，与不同的流行病学危险因素和不同器官受累的倾向相关。 (C) 1997 年，马萨诸塞州医学会。
Background Bacillary angiomatosis and bacillary peliosis are vascular proliferative manifestations of infection with species of the genus bartonella that occur predominantly in patients infected with the human immunodeficiency virus, Two species, Bartonella henselae and B. quintana, have been associated with bacillary angiomatosis, but culture and speciation are difficult, and there has been little systematic evaluation ol the species-specific disease characteristics. We studied 49 patients seen over eight years who were infected with bartonella species identified by molecular techniques and who had clinical lesions consistent with bacillary angiomatosis-peliosis.Methods In this case-control study, a standardized questionnaire about exposures was administered to patients with bacillary angiomatosis-peliosis and to 96 marched controls. The infecting bartonella species were determined by molecular techniques.Results Of the 49 patients with bacillary angiomatosis-peliosis, 26 (53 percent) were infected with B. henselae and 23 (47 percent) with B. quintana. Subcutaneous and lytic bone lesions were strongly associated with B. quintana, whereas peliosis hepatis was associated exclusively with B. henselae, Patients with B, henselae infection were identified throughout the study period and were epidemiologically linked to cat and flea exposure (P less than or equal to 0.004), whereas those with B, quintana were clustered and were characterized by low income (P=0.003), homelessness (P=0.004), and exposure to lice (P=0.03), Prior treatment with macrolide antibiotics appeared to be protective against infection with either species.Conclusions B. henselae and B, quintana, the organisms that cause bacillary angiomatosis-peliosis, are associated with different epidemiologic risk factors and with predilections for involvement of different organs. (C) 1997, Massachusetts Medical Society.