Fw: [InfectionAndInflammation] Bartonella (hard to demonstrate in certain tissues)

[Guest guest]

reposting

See table 3 MICs for aminoglycosides against various bartonella sp

Don' let Tony see that we also know that bugs can be TOUGH! he thinks we're all idiots who play with Mickey Mouse bullshit supplements!!

Nelly

[infectionAndInflammation] Bartonella (hard to demonstrate in certain tissues)

Some infections are VERY HARD to prove, even if one is willing to have one's heart valves cut up. Bartonella is one of these hard to demonstrate infections, yet it ABSOLUTELY MUST be treated as promptly and as aggressively as is necessary

Nelly

http://itsa.ucsf.edu/~koehler/pdfs/BartRxAAC2004.pdf

Endocarditis. Evidence of Bartonella infection was found in

3% of all patients diagnosed with endocarditis tested at reference

centers in three different countries (73). B. quintana (32,

37, 82, 83, 98, 99), B. henselae (31, 37, 41, 82, 83), and other

species, such as Bartonella elizabethae (27) and Bartonella vinsonii

subsp. berkhoffii (92), have been isolated from individual

patients with bacterial endocarditis. Of the Bartonella species,

B. quintana is the one that most commonly causes endocarditis,

followed by B. henselae. The first case of Bartonella endocarditis

was reported in an HIV-infected homosexual man in 1993

(98). B. quintana endocarditis has subsequently been reported

in three non-HIV-infected, homeless men in France (32). All

three patients required valve replacements because of extensive

valvular damage, and pathological investigation confirmed

the diagnosis of endocarditis.

B. quintana endocarditis is most often observed in homeless

people with chronic alcoholism and exposure to body lice and

in patients without previously known valvulopathy. B. henselae

endocarditis most often occurs in patients with known valvulopathy

who have contact with cats or cat fleas (37).

Bartonella endocarditis is usually indolent and culture negative,

and thus, diagnosis is often delayed, resulting in a mortality

rate higher than that for some other forms of endocarditis.

It was previously demonstrated (37) that patients with

Bartonella endocarditis have a higher death rate and undergo

valvular surgery more frequently than patients with endocarditis

caused by other pathogens. Selection of an adequate

treatment regimen is critical, even when Bartonella infection is

suspected but not yet documented. Among 101 patients with

Bartonella endocarditis recently described in a retrospective

study (83), 82 received aminoglycosides for a mean of 15 11

days with either a beta-lactam (64 cases) or other antibiotics

(vancomycin, doxycycline, rifampin, or co-trimoxazole).

Seventy-four of the 82 patients who received an aminoglycoside

recovered, whereas 13 of 19 of those who received no

aminoglycoside recovered (P 0.02) (84). Among the patients

treated with aminoglycosides, 65 of the 69 who recovered had

received aminoglycosides for 14 or more days, whereas 9 of the

13 patients who recovered had been treated for less than 14

days (P 0.02). *********Patients receiving an aminoglycoside were

more likely to recover fully and, if they were treated for at least

14 days, were more likely to survive, confirming the important

role of this antibiotic in the treatment of Bartonella endocarditis

(83). These data strongly support the use of aminoglycoside

therapy for at least 14 days for patients with suspected

Bartonella sp. endocarditis (Table 6, recommendation AII).

Aminoglycoside therapy should be accompanied by treatment

with a beta-lactam compound, preferably ceftriaxone (which is

especially important for patients for whom blood cultures

are negative, to adequately treat other potential bacteria that

cause culture-negative endocarditis, e.g., -lactamase-producing

Haemophilus spp.). Thus, we recommend that patients with

suspected (but culture-negative) Bartonella endocarditis receive

treatment with gentamicin for the first 2 weeks and ceftriaxone

(Table 6, recommendation BII) with or without doxycycline

(Table 6, recommendation BII) for 6 weeks (83).**********

Because chronic B. quintana bacteremia has been shown to

be optimally treated with doxycycline plus gentamicin (36), in

the absence of any prospective study for the treatment of

documented Bartonella endocarditis, it is logical that the same

regimen should be used for endocarditis when a Bartonella sp.

has been identified as the causative agent. It is important that

no difference in the frequency of surgery was observed in

patients whether or not they were treated with aminoglycosides.

This may be explained by the severity of valvular lesions

at the time when the diagnosis of endocarditis is made (37, 83).

Patients should be monitored closely, and the dose of gentamicin

should be chosen and adjusted according to the renal

function of the patient, with a twice-daily dosing schedule for

patients with renal insufficiency or those at risk for the development

of aminoglycoside-induced renal failure. If renal

dysfunction precludes the use of gentamicin for documented

Bartonella endocarditis, rifampin could be considered as the

second drug to be added to doxycycline.