[ 06. June 2007, 08:29 PM: Message edited by: ConnieMc ]
Posts: 2276 | From NC | Registered: Oct 2000
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shazdancer
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Member # 1436
posted
It looks like PubMed has not even picked this up yet. Try asking at your local hospital library if they have full-text access to the New England Journal of Medicine. I will try and check on this myself tomorrow.
The IDSA guidelines say this about Bartonella...
"Because of a lack of biologic plausibility, lack of efficacy, absence of supporting data, or the potential for harm to the patient, the following are not recommended..., anti-Bartonella therapies..."
If the NEJM article by Wormser makes mention of bartonellosis and suggests treatment, I think we should roar to the skies that it contradicts the guidelines he co-authored. Those guidelines are less than a year old, and already they are being contradicted by the very people who wrote them.
-- Shaz
Posts: 1558 | From the Berkshires | Registered: Jul 2001
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robi
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posted
I have a friend with access. I just emailed her and asked her to send it to me. Probably sometime tomorrow.
robi
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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lymednva
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posted
Since when is Bart new?! Hitting the Worm on the head!!
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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shazdancer
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Member # 1436
posted
Yes, both the articles that Bea is linking to are what the 2 NEJM articles are about.
Wormser's article is really just a background article for the article by Eremeeva, Koehler, et al, about a new Bartonella species.
Wormser has this to say about Bartonella henselae:
quote:B. henselae is now regarded as the principle cause of cat scratch disease, the most frequently recognized bartonella infection in humans.... The hallmark of this infection is the prominent enlargement of lymph nodes that drain lymph from cutaneous sites where B. henselae was introduced by the bite or scratch of a cat (the reservoir for this bartonella species) or possibly by the bite of a cat's fleas.
So Wormser is willing to concede that fleas might carry Bartonella infection. What about ticks?
Later, he says that B. henselae and B. quintana can cause lesions on the skin, lymph nodes, or internal organs
quote:occurring especially (but not exclusively) in immunocompromised patients, such as those with AIDS. Both of these bartonella species are also an increasingly appreciated cause of culture-negative subacute bacterial endocarditis...
Some Lyme patients have been known to have lowered immune systems, too, Dr. Wormser.
He ends with a nod to the researcher:
quote:Meticulous bedside-to-bench research like that conducted by Eremeeva et al. is vital to the discovery of new or previously unrecognized infectious diseases.
So perhaps he should pay more heed to the "bedside-to-bench" work of some of our Lyme docs!
Regards, Shaz
Posts: 1558 | From the Berkshires | Registered: Jul 2001
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lymednva
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posted
Shazdancer said,
quote:So perhaps he should pay more heed to the "bedside-to-bench" work of some of our Lyme docs!
Touche!
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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Greatcod
Unregistered
posted
What a piece of work Wormser is. If he saw a Lymie laying in bed, he would declare that the person didn't have Lyme--just a hypochrondiac with "ordinary aches and pains". Unfortunately, the Worm is now the go-to guy for the mainstream view of Lyme. IMO, he is smart and ambitious, and much more skilled in the use of the media than Steere.
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northstar
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posted
B. henselae is now regarded as the principle cause of cat scratch disease, the most frequently recognized bartonella infection in humans.... The hallmark of this infection is the prominent enlargement of lymph nodes that drain lymph from cutaneous sites where B. henselae was introduced by the bite or scratch of a cat (the reservoir for this bartonella species) or possibly by the bite of a cat's fleas.
oh gads, I wonder if he is going to try to make this the only acceptable "objective' evidence for diagnosis?
Will patients have to bring the fleas in to prove it?
Will they have to prove that fleas are endemic to their county?
Are there studies to prove fleas can carry it?
Can they prove that flea made that bite, or does it have to be attached?
If the flea bites on the foot, and the neck or groin gland is enlarged, does that rule out bartonella h.?
ad nauseum
Northstar
Posts: 1331 | From hither and yonder | Registered: Sep 2005
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robi
Frequent Contributor (1K+ posts)
Member # 5547
posted
Here is the NEJM:
Discovery of New Infectious Diseases -- Bartonella Species Gary P. Wormser, M.D.
Careful microbiologic evaluation of patients with various illnesses has led to the discovery of many important pathogens in recent decades, including human immunodeficiency virus (HIV), legionella species, Borrelia burgdorferi (the agent of Lyme disease), human herpesvirus 8 (HHV-8), and numerous others. Success in these endeavors, however, was critically dependent on the availability of the appropriate technology for both the detection of the microorganism and its characterization to the level necessary to permit clear differentiation from already recognized pathogens. The delay between the recognition of a particular clinical syndrome and the identification of its causative agent has been highly variable. Whereas HIV, for example, was discovered within 2 to 3 years after the recognition of AIDS, it took more than 120 years to establish that HHV-8 was the cause of Kaposi's sarcoma.
Bartonella are small, curved, pleomorphic, gram-negative rods. A characteristic feature of these bacteria is their adherence to and invasion of erythrocytes, although this phenomenon is dependent on the erythrocytes' species of origin. A unique facet of infection with bartonella is the ability of these microorganisms to stimulate neovascular proliferation in tissues, presumably by causing endothelial-cell proliferation and migration. Although highly fastidious, bartonella are often cultivable, and available methods for analyzing the genetic and protein compositions of the isolated microorganism permit very precise molecular characterization. Having used such an approach, Eremeeva et al. present compelling evidence in this issue of the Journal (pages 2381-2387) that a new bartonella species, Bartonella rochalimae sp. nov., should be added to the list of recognized human pathogens.
Of the 19 recognized and extant species and subspecies in the expanding bartonella genus before the report by Eremeeva et al., perhaps 9 had been linked to human infections, but only 3 of them had been implicated in such infections frequently. The spectrum of clinical illness varies with the species causing the infection, but even among patients infected with the same species, the clinical features can be surprisingly variable. At times, the clinical illness caused by these microorganisms is so distinctive that bartonella infection would be at or near the top of the differential diagnosis, whereas in other patients the presentation is completely nonspecific.
B. henselae is now regarded as the principal cause of cat scratch disease, the most frequently recognized bartonella infection in humans. The cause of cat scratch disease was not conclusively elucidated until more than 40 years after its recognition as a clinical entity in 1950. The hallmark of this infection is the prominent enlargement of lymph nodes that drain lymph from cutaneous sites where B. henselae was introduced by the bite or scratch of a cat (the reservoir for this bartonella species) or possibly by the bite of a cat's fleas. In the majority of cases, either a papule or pustule or residual evidence of a bite or scratch remains visible, though the skin site must be examined carefully to discern it.
B. quintana, transmitted by the human body louse (Pediculus humanus), is the cause of a relapsing febrile illness associated with prominent limb pain. The term "trench fever" was first applied to this condition in a publication describing an outbreak among British military personnel during World War I. Because of its association with human body lice, infection with this bartonella species is closely associated with homelessness in urban areas and with poor personal hygiene.
Both B. quintana and B. henselae are causes of bacillary angiomatosis, which consists of small lesions showing histologic evidence of neovascular proliferation (see photograph). These lesions are typically found on the skin but can also involve regional lymph nodes and a variety of internal organs, occurring especially (but not exclusively) in immunocompromised patients, such as those with AIDS. Both of these bartonella species are also an increasingly appreciated cause of culture-negative subacute bacterial endocarditis (i.e., cases in which blood cultures are negative for conventional pathogens). Both can cause febrile illnesses in patients with AIDS, but only B. henselae has been linked to bacillary peliosis, an unusual disorder characterized by the development of numerous blood-filled cystic structures as large as several millimeters in diameter; these infected lesions typically occur in the liver, spleen, or lymph nodes of patients with AIDS or other highly immunocompromised patients.
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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posted
Not surprised -- no mention of transmission by ticks -- guess that will warrant another article -- but probably only if he can discover a new strain of Bartonella and get it named after himself.
Bea Seibert
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Hitting the Worm on the head!!
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