Bartonella and bartonellosis--emerging and re-emerging infections. Taxonomy, bacteriology, pathogenesis and genetics

The review updates knowledge on the taxonomy, bacteriology and genetics of Bartonella as well as pathogenesis of bartonellosis. The role of Bartonella in human pathology, formerly considered to be rather modest, causes now growing anxiety. In this connection Bartonella are now believed to be the causative agents of so-called emerging and re-emerging diseases, i.e. diseases, formerly unknown to man, and diseases, believed to be eradicated and playing at present no important role in human pathology. These microorganisms are a bright example of successes of molecular biology in the detection of microorganisms, as well as in their phylogenetics and systematics.     

Multi-locus sequence analysis reveals profound genetic diversity among isolates of the human pathogen Bartonella bacilliformis

Bartonella bacilliformis is the aetiological agent of human bartonellosis, a potentially life threatening infection of significant public health concern in the Andean region of South America. Human bartonellosis has long been recognised in the region but a recent upsurge in the number of cases of the disease and an apparent expansion of its geographical distribution have re-emphasized its contemporary medical importance. Here, we describe the development of a multi-locus sequence typing (MLST) scheme for B. bacilliformis and its application to an archive of 43 isolates collected from patients across Peru. MLST identified eight sequence types among these isolates and the delineation of these was generally congruent with those of the previously described typing scheme. Phylogenetic analysis based on concatenated sequence data derived from MLST loci revealed that seven of the eight sequence types were closely related to one another; however, one sequence type, ST8, exhibited profound evolutionary divergence from the others. The extent of this divergence was akin to that observed between other members of the Bartonella genus, suggesting that ST8 strains may be better considered as members of a novel Bartonella genospecies.     

Rhinovirus diseases: pathogenesis, diagnostics and treatment

Contemporary data on human rhinovirus diseases and their pathogenesis are presented. Special attention is paid to complications which may be caused by rhinovirus infections in allergy-susceptible patients. Furthermore, approaches to the diagnostics and treatment of rhinovirus diseases are described. In particular, the advantages of molecular methods for the diagnostics of rhinovirus infection (based on the PCR) in comparison with cultural and immunochemical methods are pointed out. New investigations aimed at the development of specific antirhinovirus preparations--capsid-binding (Pleconaril), blocking the binding of the virus with cell receptors (ICAM, soluble) and inhibiting rhinovirus protease 3C--have been considered.     

Phylogenetic relationships among the agent of bacillary angiomatosis, Bartonella bacilliformis, and other alpha-proteobacteria

Bacillary angiomatosis (BA) and chronic bartonellosis are bacterial infections of humans which result in an unusual vascular proliferative tissue response. In order to determine their phylogenetic relationships, we have determined greater than 95% of the 16S rRNA sequences for these two organisms by amplification directly from infected BA tissue and from a Bartonella bacilliformis lyophilized culture. The BA agent and B. bacilliformis are closely related alpha-proteobacteria (98.5%), although the BA agent is more closely related to Rochalimaea quintana (99.1%). Contrary to previous belief, the BA agent is distinct from, and less closely related to, the cat scratch bacillus (Afipia felis) (90.7%). We propose a novel secondary structure in a hypervariable region of the 16S rRNA which is useful for alignment of primary sequences and which may be useful for design of nucleic acid probes.     

Proteomics, nanotechnology and molecular diagnostics

Sequencing of the human genome opened the way to the exploration of the proteome and this has lead to the identification of large numbers of proteins in complex biological samples. The identification of diagnostic patterns in samples taken from patients to aid diagnosis is in the early stages of development. The solution to many of the technical challenges in proteomics and protein based molecular diagnostics will be found in new applications of nanomaterials. This review describes some of the physical and chemical principles underlying nanomaterials and devices and outlines how they can be used in proteomics; developments which are establishing nanoproteomics as a new field. Nanoproteomics will provide the platform for the discovery of next generation biomarkers. The field of molecular diagnostics will then come of age.     

Bacterial zoonoses with natural focality: current trends in epidemic manifestation

Current trends in epidemic manifestation of some bacterial zoonoses with natural focality and their role in human infectious pathology have been reviewed and analyzed. Update information on the etiological agents of "emerging" and "re-emerging" infections--Astrakhan spotted fever, bartonellosis, ixodes tick-borne borrelioses, monocytic erhrlichiosis and canine brucellosis, recently isolated on the territory of Russia, is presented. The main factors at play in the process of urbanization of bacterial zoonoses are discussed.     

Allergy and autoimmunity: Molecular diagnostics,therapy, and presumable pathogenesis

Allergic and autoimmune diseases represent immunopathological reactions of an organism to antigens. Despite that the allergy is a result of exaggerated immune response to foreign antigens (allergens) and autoimmune diseases are characterized by the pathological response to internal antigens (autoantigens), the underlying mechanisms of these diseases are probably common. Thus, both types of diseases represent variations in the hypersensitivity reaction. A large percentage of both the adult and pediatric population is in need of early diagnostics of these pathologies of the immune system. Considering the diversity of antibodies produced in allergic and autoimmune disease and the difficulties accompanying clinical diagnosing, molecular diagnostics of these pathological processes should be carried out in several stages, including screening and confirmatory studies. In this review, we summarize the available data on the molecular diagnostics and therapy of allergic and autoimmune diseases and discuss the basic similarities and differences in the mechanisms of their development.     

Diversity and abundance of phlebotomine of the genus Lutzomyia (Diptera: Psychodidae) in areas of forest in the northeast of Manacapuru, Amazonas State, Brazil

The genus Lutzomyia has great importance in the New World, with some species implicated in the transmission of causal agents of leishmaniases, bartonellosis and arboviruses. From April 2003 to June 2004 an investigation was undertaken on the richness and abundance of the sand fly fauna in the northeast area of Manacapuru county, Amazonas State. The captures were carried out, with 16 light traps CDC, in areas of forest known as terra firme along the highway Manuel Urbano. In the period of 13 months we collected a total of 10,446 sandfly specimens, 3,908 males (38%) and 6,465 females (62%), distributed in 43 species belonging to the genus Lutzomyia, 10 subgenera and six species groups. These results evidenced a diversified and abundant sand fly fauna, with some species not yet reported for Manaus county, close to the study area.     

An Outbreak of Bartonella bacilliformis in an Endemic Andean Community

Background

Bartonellosis affects small Andean communities in Peru, Colombia and Ecuador. Research in this area has been limited.

Methods

Retrospective review of 191 cases of bartonellosis managed in Caraz District Hospital, Peru, during the last outbreak (2003).

Results

The majority of cases (65%) were 14 years old and younger. There was a peak in acute cases after the rainy season; chronic cases presented more constantly throughout the year. The sensitivity of blood smear against blood culture in acute disease was 25%. The most commonly used treatment for chronic disease was rifampicin; chloramphenicol was used to treat most acute cases. Complications arose in 6.8% and there were no deaths.

Conclusions

Diagnostic and treatment algorithms for acute and chronic bartonellosis have been developed without a strong evidence base. Preparation of ready-to-go operational research protocols for future outbreaks would strengthen the evidence base for diagnostic and treatment strategies and enhance opportunities for control.     

Urinary proteomics: towards biomarker discovery, diagnostics and prognostics

During recent years, the proteomics field has moved onward to clinical applications, particularly for biomarker discovery, diagnostics and prognostics of human diseases. The urine is one of the ideal clinical samples for such applications because it is readily available in almost all patients, and its collection is very simple and non-invasive. Urinary proteomics thus becomes one of the most interesting subdisciplines in the clinical proteomics area. This article highlights and updates recent progress in the urinary proteomics field for clinical applications.     

Staining of Bartonella henselae with carboxyfluorescein diacetate succinimidyl ester for tracking infection in erythrocytes and epithelial cells

Bartonella infection (Bartonella henselae in particular) is responsible for a widening spectrum of human diseases. The persistent colonization of erythrocytes is a feature of Bartonella infection. Endothelial and epithelial cells are also widely used to study the pathogenesis of bartonellosis in vitro. Exploring a convenient method for visualizing the bacillus without affecting infectivity would be very interesting. Carboxyfluorescein diacetate succinimidyl ester (CFSE) has been previously used for staining several bacterial species to study their adhesion to host cells. The present study demonstrated the efficiency and safety of using CFSE in staining B. henselae. The staining of bacillus-invaded erythrocytes and epithelial cells in vitro successfully allowed for flow cytometry and confocol microscopy analyses. Parallel tests using untreated bacteria confirmed that CFSE staining did not result in side effects on the infectivity of B. henselae. Labeling Bartonella with CFSE is a valuable method for studying the bacteria-host interaction.     

Laboratory diagnosis of Yersinia infection and its improvement

Results of the bacteriological and serological tests of patients with Y. enterocolitica and Y. pseudotuberculosis infections for the period from 1994 to 2004 were analyzed. Main reasons of imperfect laboratory diagnostics were revealed, such as, low sensitivity of bacteriologic test, nonobservance of existing recommendations on diagnostics of Yersinia infections, performing of single but not repeated serologic test, absence of necessary laboratory equipment. Main ways of improving of quality of Y. enterocolitica infections and differential diagnostics were of Y. pseudotuberculosis defined.     

Molecular tools for companion diagnostics

The heterogeneous nature of cancer results in highly variable therapeutic responses even among patients with identical stages and grades of a malignancy. The move towards personalised medicine in cancer therapy has therefore been motivated by a need to customise therapy according to molecular features of individual tumours. Companion diagnostics serves to support early drug development, it can provide surrogate markers in clinical trials, and also guide selection of individual therapies and monitoring of responses in routine clinical care. The era of companion diagnostics can be said to have begun with the introduction of the HercepTest - a first-of-a-kind diagnostic tool developed by DakoCytomation in 1998 to select patients for therapy with the anticancer drug Herceptin (trastuzumab). Herceptin and the paired test proved that companion diagnostics can help guide patient-tailored therapies. We will discuss herein technologies to analyse companion diagnostics markers at the level of DNA, RNA or protein, focusing on a series of methods developed in our laboratory that can facilitate drug development and help stratify patients for therapy.     

Application of endoscopy in pediatric and adolescent gynecology

Early proper diagnostics and treatment of developmental age pathologies in most cases facilitate correct sex organ development, as well as reproductive functions formation. To make the foregoing possible, it is necessary to apply minimally invasive and safest methods like vaginoscopy, hysteroscopy and laparoscopy. The main application field of vaginoscopy and hysteroscopy in pediatric and adolescent gynecology is the diagnosis and treatment of vulvar and vaginal pathologies and developmental anomalies of sex organ. The laparoscopy is becoming a more and more popular method in the treatment of adnexal tumors in children, due to its little invasiveness, quick recovery and less severe pain complaints after the surgery. The application of these endoscopic procedures should always be preceded by the complex noninvasive diagnostics, such as ultrasonography and magnetic resonance imaging. The endoscopic procedures facilitate wide-ranging diagnostics and simultaneously therapeutic management, ensuring minimal invasion and high safety of the surgery. They should be considered diagnostics and treatment of choice in the pathology of vulva, vagina, developmental anomalies of sex organ and adnexal tumors in patients of the developmental age.     

Bartonellosis,an increasingly recognized zoonosis

Cat scratch disease is the most common zoonotic infection caused by Bartonella bacteria. Among the many mammals infected with Bartonella spp., cats represent a large reservoir for human infection, as they are the main reservoir for Bartonella henselae, Bartonella clarridgeiae and Bartonella koehlerae. Bartonella spp. are vector‐borne bacteria, and transmission of B. henselae by cat fleas occurs mainly through infected flea faeces, although new potential vectors (ticks and biting flies) have been identified. Dogs are also infected with various Bartonella species and share with humans many of the clinical signs induced by these infections. Although the role of dogs as source of human infection is not yet clearly established, they represent epidemiological sentinels for human exposure. Present knowledge on the aetiology, clinical features and epidemiological characteristics of bartonellosis is presented.     

The use of discrete characters in discriminant analysis for diagnosis of pulmonary tuberculosis and for classification of patients differing in treatment efficiency based on polymorphisms at nine codominant loci-HP,GC, TF,PI, PGM1, GLO1, C3, ACP1 and ESD

Discriminant analysis was used to differentiate patients with pulmonary tuberculosis (N = 106) from healthy individuals (N = 328) and patients whose treatment was efficient (N = 71) from those whose treatment was inefficient (N = 35). The analysis involved the data on nine polymorphic codominant loci: HP, GC, TF, PI, PGM1, GLO1, C3, ACP1, and ESD. The loci were selected by significance of differences in genotype frequencies between tuberculosis patients and healthy controls (GC, TF, PI, C3, ACP1) or between the two groups of patients differing in treatment efficiency (HP, GC, PI, PGM1, C3, ESD). Discrimination was based on a graphic method of Bayes classification procedure with a single-variate nomograph allowing easy estimation of the a posteriori probabilities for an individual to be classified. The two groups of patients proved to be discriminated sufficiently well (probability of misclassification Perr = 0.24), whereas discrimination between tuberculosis patients and healthy individuals was less efficient (Perr = 0.33). The method was proposed as a means of predicting the efficiency of treatment in pulmonary tuberculosis. Along with clinical, roentgenological, and laboratory examination, discriminant analysis may be employed as an accessory test in diagnostics of pulmonary tuberculosis, especially when the diagnosis is questionable.     

From morphologic to molecular: established and emerging molecular diagnostics for breast carcinoma

Diagnostics in the field of breast carcinoma are constantly evolving. The recent wave of molecular methodologies, both microscope and non-microscope based, have opened new ways to gain insight into this disease process and have moved clinical diagnostics closer to a 'personalized medicine' approach. In this review we highlight some of the advancements that laboratory medicine technology is making toward guiding the diagnosis, prognosis, and therapy selection for patients affected by breast carcinoma. The content of the article is largely structured by methodology, with a distinct emphasis on both microscope based and non-microscope based diagnostic formats. Where possible, we have attempted to emphasize the potential benefits as well as limitations to each of these technologies. Successful molecular diagnostics, applied in concert within the morphologic context of a patient's tumor, are what will lay the foundation for personalized therapy and allow a more sophisticated approach to clinical trial stratification. The future of breast cancer diagnostics looks challenging, but it is also a field of great opportunity. Never before have there been such a plethora of new tools available for disease investigation or candidate therapy selection.     

Systematic relationships among Lutzomyia sand flies (Diptera: Psychodidae) of Peru and Colombia based on the analysis of 12S and 28S ribosomal DNA sequences

Lutzomyia spp. are New World phlebotomine sand flies, many of which are involved in the transmission of human diseases, such as leishmaniases and bartonellosis. The systematic classification of the approximately 400 species in the genus has been based on morphological characters, but the relationships within the genus are still very much in question. We have inferred phylogenies of 32 species of phlebotomine sand flies belonging to seven sub-genera and two species groups, by using fragments of the mitochondrial small subunit (12SrRNA) and of the nuclear large subunit (28SrRNA) ribosomal gene sequences. The subgenus Helcocyrtomyia and the Verrucarum species group, prominent representatives of the Peruvian sand fly fauna, were represented by 11 and 7 species, respectively. Although based on a limited number of taxa, the resulting phylogenies, based on 837 characters, provide an initial phylogenetic backbone for the progressive reconstruction of infrageneric relationships within Lutzomyia.     

Chronic pancreatitis, pancreatic adenocarcinoma and the black box in-between

Pancreatic cancer is a challenging disease for patients, doctors and researchers who for decades have searched for a cure for this deadly malignancy. Although existing mouse models of pancreatic cancer have shed light on the mechanistic basis of the neoplastic conversion of the pancreas, their impact in terms of offering new diagnostics and therapeutic modalities remains limited. Chronic pancreatitis is an inflammatory disease of the pancreas that is associated with a gradual damage of the organ and an increased risk of developing neoplastic lesions. In this review, we propose that detailed studies of chronic inflammatory processes in the pancreas will provide insights into the evolution of pancreatic cancer. This information may prove useful in the design of effective therapeutic strategies to battle the disease.     

Isolation, structure and properties of new endogenous peptides]

Large scale isolation and determination of amino acid sequences of endogenous peptides from various biological sources (bovine brain and red bone marrow, siberian ground squirrel brain) were carried out. A number of earlier unknown peptides were identified, many of them showing distinct activity in vivo and/or in vitro. Analysis of more than 170 isolated peptide structures resulted in the hypothesis suggesting functional proteins, in particular hemoglobin, to serve also as a source of the peptide "background" which has its own biological significance. Further directions of investigating the endogenous peptide material are mapped. Its potential for developing diagnostics for somatic diseases is demonstrated on patients with CNS disorders.