Excerpt:

Abstract
Using PCR in conjunction with pre-enrichment culture, we detected Bartonella henselae and B. vinsonii subspecies berkhoffii in the blood of 14 immunocompetent persons who had frequent animal contact and arthropod exposure.

Attempts to isolate Bartonella sp. from immunocompetent persons with serologic, pathologic, or molecular evidence of infection are often unsuccessful; several investigators have indicated that Bartonella isolation methods need to be improved (1–4). By combining PCR and pre-enrichment culture, we detected B. henselae and B. vinsonii subspecies berkhoffii infection in the blood of immunocompetent persons who had arthropod and occupational animal exposure

The Study

From November 2004 through June 2005, blood and serum samples from 42 persons were tested, and 14 completed a questionnaire, approved by the North Carolina State University Institutional Review Board. Age, sex, animal contact, history of bites, environment, outdoor activity, arthropod contact, travel, and medical history were surveyed. Bacterial isolation, PCR amplification, and cloning were performed by using previously described methods (5–7). Each blood sample was tested by PCR after direct DNA extraction, pre-enrichment culture for at least 7 days, and subculture onto a blood agar plate (Figure). An uninoculated, pre-enrichment culture was processed simultaneously as a control. Methods used for DNA extraction and conventional and real-time PCR targeting of the Bartonella 16S-23S intergenic spacer (ITS) region and heme-binding protein (Pap31) gene have been described (7,8). Conventional PCR amplicons were cloned with the pGEM-T Easy Vector System (Promega, Madison, WI, USA); sequencing was performed by Davis Sequencing, Inc. (Davis, CA, USA). Sequences were aligned and compared with GenBank sequences with AlignX software (Vector NTI Suite 6.0 (InforMax, Inc., Bethesda, MD, USA) (7,8). B. vinsonii subsp. berkhoffii, B. henselae, and B. quintana antibodies were determined by using a modification of a previously described immunofluorescence antibody assay (IFA) procedure (9

Study participants included 12 women and 2 men, ranging in age from 30 to 53 years; all of them reported occupational animal contact for >10 years (Table). Most had daily contact with cats (13 persons) and dogs (12 persons). All participants reported animal bites or scratches (primarily from cats) and arthropod exposure, including fleas, ticks, biting flies, mosquitoes, lice, mites, or chiggers. All participants reported intermittent or chronic clinical symptoms, including fatigue, arthralgia, myalgia, headache, memory loss, ataxia, and paresthesia (Table). Illness was most frequently mild to moderate in severity, with a waxing and waning course, and all but 2 persons could perform occupational activities. Of the 14 participants, 9 had been evaluated by a cardiologist, 8 each by an infectious disease physician or a neurologist, and 5 each by an internist or a rheumatologist. Eleven participants had received antimicrobial drugs.

Juvenile idiopathic arthritis (JIA) is a disease that was prominent with
increased inflammation response in immune system, appeared mostly with
peripheral arthritis and endogenous and exogenous antigens play a role
in the pathogenesis of disease. Two major reasons were thinking to be
considerably important. First of them is immunological predisposition
and the second one is environmental factors.

Infections are considered to be the most important between environmental factors but also stress and trauma are also important in the etiology of the disease. However,
the relation between JIA and infections is not clearly defined but the
relation between adult chronic arthritis and infections was
well-defined. A total of 70 patients, 26 with primer JIA, 20 with
recurrent JIA, 24 healthy control were included in this study.
Mycoplasma pneumoniae, Chlamydophila pneumoniae and C. Jejuni were
detected in 4, 1 and 1 of 10 (38.46%) patients with primer JIA,
respectively. Salmonella enteritidis, EBV, M. pneumoniae, C. jejuni and
Borrelia burgdorferi were detected in 1, 2, 2, 2, and 1 of the 8(40%)
patients with recurrent JIA, respectively. S. enteritidis were isolated
in feces culture and also identified by agglutination method. Infection
was detected in total 18 (39.13%) of patient groups. C. pneumoniae and
C. jejuni were detected in 1 and 1 of 2(8.33) healthy control groups,
respectively. Throat culture positivity was not detected in any of the
patient and healthy control groups. In conclusion, etiopathogenesis of
JIA is not clearly understood and suggested that various factors can
trigger the disease and it is the most common rheumatoid disease of
childhood. However, there are some studies focusing especially on one
infectious agent but this is the first study including such a big range
of infectious agents in the literature for the microorganisms that can
be suggested to have a role in the etiopathogenesis of JIA. We have a
conclusion in the light of our results and suggest that some
microorganisms can trigger and increase the intensity of clinical
situation according to the case. When we evaluate the primer and
recurrent JIA groups; M. pneumoniae and C. jejuni come forward and seen
common in JIA cases. We also suggest that the pre-diagnosis of
microorganisms, which can play a role as primarily or by intervening in
the etiopathogenesis of JIA and adding specific antimicrobial therapy to
the standard JIA therapy, it is possible to perform new, extended,
especially molecular based serial case studies.

PMID: 20012631 [PubMed – as supplied by publisher]

Rheumatol Int.. [Epub ahead of print]

Do infections trigger juvenile idiopathic arthritis?

Aslan M, Kasapcopur O, Yasar H, Polat E, Saribas S, Cakan H, Dirican A,
Torun MM, Ar?soy N, Kocazeybek B.

Microbiology and Clinical Microbiology Department, Cerrahpasa Medical
Faculty, Istanbul University, Kocamustafapasa, 34303, Istanbul, Turkey.