Haemobartonella and Bartonella : Two Very Different Diseases!

W S A V A W C P , 2003
Susan E. Shaw, BVSc (Hons), BSc, DACVIM, DECVIM, FACVSc, MRCVS
Department of Clinical Veterinary Science, University of Bristol
UK

Although the names are similar, these feline infections are associated with different epidemiology,
pathogenesis and disease patterns.
HAEMOPLASMA INFECTION
Haemobartonella felis organisms have long been recognised as cat microparasites and are Gram-
negative, haemotropic, bacteria lacking a cell wall. They attach to the surface of host erythrocytes and
are at present, unculturable. DNA sequence analysis has shown that these bacteria are most closely
related to the genus Mycoplasma and they have recently been reclassified accordingly. Two species
have now been identified, Mycoplasma haemofelis and M. haemominutum; the former is a larger
parasite and is associated with clinical disease in cats while the latter smaller organism although
common, appears to be non-pathogenic.
Transmission and prevalence
There is minimal information available on the epidemiology of feline haemoplasma infection. The
mode of transmission has not been determined although arthropod transmission is incriminated. In
addition, although infection is recognised world-wide in cats, the prevalence of infection/exposure is
unknown due to the unavailability of serological testing.
Clinical signs
Previous reports that infection results in mild or inapparent disease may relate to M. haemominutum.
Severe haemolytic anaemia is associated with M. haemofelis infection and clinical signs include
pallor, lethargy, anorexia weight loss and depression. Intermittent fever may be present in the acute
stage of the disease while icterus is occasionally seen later in its progression. Splenomegaly and
lymphadenopathy may also occur. Haematological signs compatible with a marked regenerative
anaemia are commonly present. Both Coombs positivity and cold agglutinating antibody have been
reported in association with infection and although pathogenesis of the anaemia is thought to have an
immune-mediated component, this has not been characterised. Chronic persistent infection is
reported and may be associated with minimal clinical signs.
Diagnosis
Diagnosis by microscopic identification of organisms in blood smears is now complicated by the
recognition of the apparently apathogenic species M. haemominutum. Although close morphologic
examination may be able to distinguish the large from the smaller species of haemoplasma, the cyclic
nature of the parasitaemia makes this method of detection insensitive. The organism cannot be
cultured at present and so development of a reliable serological test has been hampered. Molecular
diagnosis using polymerase chain reactivity (PCR) analysis is definitive and recommended.
Treatment
Doxycycline (5-10 mg/kg) or enrofloxacin (5-10mg/kg) administered orally for 3-4 weeks is
recommended for cats with clinical anaemia and should be combined with blood transfusions and
prednisolone in severely affected Coombs positive cases. Although clinical response is often
achieved, parasitological cure may be less certain and successfully treated cats may become
asymptomatic carriers.
BARTONELLOSIS
Bartonellosis is caused by fastidious, Gram-negative, intraerythrocytic, arthropod-transmitted bacteria
of the genus, Bartonella. Several species are pathogenic in cats (Bartonella henselae, B. koehlerae,
B. clarridgeiae). Asymptomatic infection with B. henselae or B. clarridgeiae is common in cats, which
are therefore considered to be a major reservoir for human infection. In humans, B. henselae and B.
clarridgeiae have been shown to be the agents of the common, but usually self-limiting cat scratch
disease (CSD). However, less frequently, B. henselae has been associated with more profound
syndromes such as the vasculo-proliferative disorders, bacillary angiomatosis and peliosis hepatis, as
well as endocarditis, prolonged bacteraemia and various ocular disorders including Parinaud
oculoglandular syndrome, neuroretinitis and chorioretinitis. Genotypic and phenotypic (serological)
variations have been demonstrated among strains of B. henselae in domestic and wild cats and those
from different geographical locations. At present, the most significant division within the species
delineates strains into one of two subtypes on the basis of their 16S-rDNA gene sequence.
Transmission
Cat fleas are considered the main vector of B. henselae in cats and recent work has shown
transmission by skin inoculation of infected flea faeces. However, the role of the cat flea in the
transmission of B. henselae from cats to humans has not been proven.
Prevalence
Asymptomatic infection with Bartonella henselae (and B. clarridgeiae) is common in cats; 40-70% with
seropositivity and 9-90% with bacteraemia. Variability in reported figures may be a consequence of
small survey sizes, differences in cat population characteristics (cattery, stray, feral and captive wild
cats) and seasonal variation in prevalence as well as true differences in geographic prevalence. The
prevalence of infection appears to be higher in young to middle-aged cats but there is no breed or
gender predisposition. Although geographic environments with warm temperatures and high humidity
are reportedly associated with the highest exposure; the prevalence in cool temperate climates is also
relatively high. In recent UK surveys for B. henselae, 11% of cats surveyed were culture positive and
41% of cats were seropositive. The effect of climatic factors on the ecology of Bartonella infection
may be blurred as in colder countries, animals are kept in heated domestic or confined environments,
facilitating the maintenance of the flea life cycle.
Pathogenicity and clinical signs
Disease association with naturally occurring feline Bartonella infection is difficult to determine.
Although clinical disease (fever, lethargy, transient anaemia, lymphadenomegaly, neurological
dysfunction or reproductive failure) has been reported following experimental infections with B.
henselae and B. clarridgeiae, naturally occurring disease associated with infection is more difficult to
define because of its high prevalence in apparently asymptomatic cats. In naturally infected cats,
there is a statistical correlation with stomatitis and urinary tract disease. Uveitis associated with
intraocular Bartonella DNA and ocular IgG production has also been reported in cats. Although
Bartonella infection has been associated with other clinical syndromes such as endocarditis based on
positive blood culture, the association is difficult to evaluate unless the presence of lesional organisms
is confirmed.
Therapy
Treatment of bartonellosis and elimination of bacteraemia is problematic. Doxycycline, amoxicillin,
amoxicillin/clavulanate used at higher than recommended dose rates have been successful in
suppressing bacteraemia in experimental infections. Rifampicin and enrofloxacin are also reportedly
effective. However, total elimination of infection may be impossible despite the use of combination
therapy such as rifampicin and doxycycline, and prolonged duration (4-6 weeks) of therapy. In
addition, the risk of re-exposure is high.
CONTROL AND PREVENTION OF BOTH INFECTIONS
No vaccination is currently available for either group of organisms. The occurrence of multiple strains
with lack of cross -reactivity in the case of Bartonella, suggests that any vaccine would require
incorporation of multiple epitopes. Vaccine candidates will also need to induce cellular as well as
antibody-mediated immunity.
The prevalence of Bartonella bacteraemia in cats and the risk of Bartonella-associated disease in pet
owners, is decreased by a vigorous integrated flea control programme. When uninfected cats are
housed with B. henselae bacteraemic SPF cats in an ectoparasite-free environment, there is no
evidence of Bartonella transmission between cats. Although there is no definitive proof of arthropod
transmission of haemoplasma species, aggressive flea control is often recommended for control.
S I
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Susan E. Shaw, BVSc (Hons), BSc, DACVIM, DECVIM, FACVSc, MRCVS
Department of Clinical Veterinary Science, University of Bristol
UK