J. M. Rolain,1 P. Brouqui,1,2 J. E. Koehler,3 C. Maguina,4 M. J. Dolan,5 and D. Raoult1,2* Unit� des Rickettsies CNRS UMR-A 6020, IFR 48, Facult� de M�decine, Universit� de la M�diterran�e, 13385 Marseille Cedex 05,1 Service des Maladies Infectieuses et Tropicales, H�pital CHU Nord, Chemin des Bourrelys, 13015 Marseille, France,2 Division of Infectious Diseases, Department of Medicine, University of California at San Francisco, San Francisco, California 94143-0654,3 Instituto de Medicina Tropical ``Alexander von Humboldt,'' Universidad Peruana Cayetano, Heredia, Lima-100, Peru,4 Defense Institute for Medical Operations, Brooks City Base, Texas 782355 *Corresponding author. Mailing address: Unit� des Rickettsies, Facult� de M�decine, 27, Boulevard Jean Moulin, 13385 Marseille Cedex 5, France. Phone: 33.04.91.32.43.75. Fax: 33.04.91.38.77.72. E-mail: [email protected].
ANTIBIOTIC SUSCEPTIBILITIES OF BARTONELLA SPECIES
Culture of Bartonella spp. Because Bartonella spp. are facultative intracellular organisms, isolation can be performed in either cell cultures or axenic media with blood-enriched agar plates (63) (Fig. 1 and 2).
However, Bartonella bacteria are very fastidious, and primary isolation is difficult, with detection of colonies only after 1 to 4 weeks of incubation on blood agar plates (63).
The growth of subcultured isolates on blood agar plates is more rapid, usually yielding colonies after 3 to 5 days.
Cell coculture systems have been reported to be more sensitive and allow more rapid growth of bartonellae than blood agar plates (63).
Since 1992, several studies have reported on the isolation of B. henselae from the blood and lymph nodes of patients with CSD, with confirmation by serology, PCR, or culture (9, 71).
However, isolation of B. henselae from the lymph nodes of CSD patients is very rare compared to the more frequent detection of B. henselae DNA in these patients by PCR assays (63, 109).
At present, there is no optimal procedure for the isolation of Bartonella species; rather, several techniques and agars (e.g., cocultivation with eukaryotic cells, in addition to plating onto rabbit blood and chocolate agars) should be combined in order to isolate strains.
In vitro susceptibilities of Bartonella species to antibiotics. The results of susceptibility testing with Bartonella spp. are summarized in Table 3. Evaluation of susceptibilities to antibiotics has been performed either in the presence of eukaryotic cells or without cells, i.e., in axenic media.
Use of these different methods of culture for the determination of the bacteriostatic activities of antibiotics yielded similar results.
Determination of antibiotic susceptibility in axenic media has been carried out either with solid media enriched with 5 to 10% sheep or horse blood or with liquid media (74, 97).
It should be noted that the conditions required to grow Bartonella during susceptibility testing do not meet the standardized criteria established by NCCLS.
Bacteria of the genus Bartonella are susceptible to many antibiotics when they are grown axenically, including penicillin and cephalosporin compounds, aminoglycosides, chloramphenicol, tetracyclines, macrolide compounds, rifampin, fluoroquinolones, and co-trimoxazole (74, 79).
However, the in vitro and the in vivo antibiotic susceptibilities of Bartonella do not correlate well for a number of antibiotics; for instance, penicillin has no in vivo efficacy, despite the very low MICs observed in vitro.
MICs for Bartonella sp. strains determined by the agar dilution technique with Columbia agar supplemented with 5% horse blooda
In vitro antibiotic susceptibilities of Bartonella species cocultivated with eukaryotic cells have also been examined.
As with agar-based susceptibilities, these studies demonstrated that Bartonella spp. are susceptible to many antibiotics in vitro (46). However, all of these antibiotics (48) had only bacteriostatic activity (47, 48).
It was recently demonstrated in vitro that aminoglycosides alone are bactericidal against Bartonella species grown either in liquid medium (91) or in endothelial cells (78).
With a recently established erythrocyte coculture model, it was found that most of the antibiotics tested (i.e., doxycycline, fluoroquinolone compounds, and beta-lactams) were not bactericidal against Bartonella (90).
Gentamicin was bactericidal at 4 μg/ml, as was rifampin. At this concentration, gentamicin was shown to enter erythrocytes slowly and to reach a peak level of 0.26 μg/ml after 24 h.
However, when the ability of gentamicin to kill extraerythrocytic B. quintana at the concentration of 0.26 μg/ml achieved in the erythrocyte was tested, it was found that gentamicin was not bactericidal, even after 96 h of incubation (90).
We hypothesize that erythrocytes may be a reservoir for B. quintana and that the bactericidal activity of gentamicin that was observed occurs mainly when the bacteria emerge from the erythrocytes and are found extracellularly.
[ 05. January 2008, 08:09 PM: Message edited by: AliG ]
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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adamm
Unregistered
posted
So basically there's no way we can ever be cured of bart? Or
can you get rid of an infection while treating with
bacteriostatic agents?
Any chance any better drugs have come out since the study was
Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, NSW, Australia.
OBJECTIVES: Bartonella henselae is a fastidious slow growing pathogen which is seldom cultured in the laboratory. Previous descriptions of antimicrobial susceptibility have been largely limited to feline isolates and/or laboratory reference strains, with no accounting for genotypic or phenotypic diversity.
METHODS: An optimal method of antimicrobial susceptibility testing by Etest was established to compare the antimicrobial susceptibilities of 12 different isolates of B. henselae, 5 human and 7 feline, which have previously been well characterized by 16S rRNA sequencing, multi-locus sequence typing (MLST), phase variation and passage number.
RESULTS: No difference in susceptibility could be attributed to differences in genotype, source of the isolate or passage number. Where comparisons were drawn with previously published results, these were found to be concordant.
CONCLUSIONS: We conclude that antibiotic susceptibility can be determined by a simple Etest method for B. henselae isolates. This method is reproducible among diverse strains, and is sufficiently predictable that generalizations can be confidently made about optimal antibiotic choices.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Dave6002
Frequent Contributor (1K+ posts)
Member # 9064
posted
In vitro susceptibility of Bartonella species to 17 antimicrobial compounds: comparison of Etest and agar dilution Author(s): Dorbecker C (Doerbecker, Christina), Sander A (Sander, Anna), Oberle K (Oberle, Karin), Schulin-Casonato T (Schulin-Casonato, Tanja) Source: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 58 (4): 784-788 OCT 2006
Abstract: Objectives: In vitro susceptibility testing of 31 Bartonella spp. strains including 21 Bartonella henselae isolates was performed for 17 antimicrobial agents (telithromycin, four macrolides, five fluoroquinolones, five aminoglycosides, doxycycline and rifampicin).
Methods: MICs were determined by agar dilution and Etest using chocolate agar containing 5% defibrinated sheep blood as assay medium. Longer incubation periods of 3-5 days in a humid atmosphere with 5% CO2 were required until bacterial growth became visible and MICs could be read.
Results: The ketolide telithromycin was the most active agent exhibiting the lowest MICs. The Bartonella spp. were also highly susceptible to macrolides, particularly clarithromycin, and to doxycycline and rifampicin, with MICs of <= 0.12 mg/L. Gatifloxacin, gemifloxacin and moxifloxacin were the most potent fluoroquinolones, with MICs ranging from 0.06 to 2 mg/L. Netilmicin was the most active agent among the aminoglycosides. Etest MICs correlated well with MICs determined by agar dilution.
Conclusions: Telithromycin, macrolides, doxycycline and rifampicin were the most effective agents against Bartonella spp. Our data confirm that Etest may be a reliable method for determining susceptibility of Bartonella spp.
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AliG
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posted
Here's what I don't understand.....
The first paper states that in vitro doesn't mean that it will work in vivo.
In fact, they said only Gentamycin did and they would have to get it past the erythrocytes. Did they not?
Do they just keep Txing until they've come out?
I just figured out that the third study doesn't differentiate between bactericidal and bacteriostatic actions.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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adamm
Unregistered
posted
It doesn't stipulate how to go about trying to cure it.
djf2005
Frequent Contributor (1K+ posts)
Member # 11449
posted
adamm-
im not a scientist man, but i DO know this.
no matter what these research studies show, you can, and WILL get better. if you watch dr b's vid on bart, even he states that all of the CO info is new and that patients eventually get well treating w long term multiple combos.
i guess what im trying to say is dont even let yourself believe its not possible to heal it. it is. it might not be on paper yet, but chronic lymies get well...EVENTUALLY.
hang in there bud. heres to your health.
derek
-------------------- "Experience is not what happens to you; it is what you do with what happens to you."
posted
Thanks for being so supportive! This IS the stuff I need to hear!
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AliG
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posted
Adamm,
I know people have recovered from Bartonella. It's probably like Lyme in that it can't stay in there forever. It's very likely that it just takes time.
Chin up!!! Your LLMD WILL help you!
Ali
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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AliG
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posted
Adamm-
quote: Treatment thus far:
Doxy 200 mg/day for 1 month - begun immediately after bite
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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AliG
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posted
You only took the high dose ABX for 1 month & it gave you liver damage?
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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adamm
Unregistered
posted
Well, the concentrations of liver enzymes in my blood were found
AliG
Frequent Contributor (1K+ posts)
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posted
I don't know, sorry. I haven't had them elevated. That would have been a good question for the LLMD.
Maybe someone else might have more info on elevated liver enzymes.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Michelle M
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posted
They have to be SERIOUSLY elevated before getting really concerned.
Mine were elevated after three weeks on IV Rocephin.
Took a one-week break and they went back to normal.
Glad your LLMD is monitoring you.
As long as you're being monitored, you'll be fine; just taking a break restores things to normal pretty rapidly.
Michelle
Posts: 3193 | From Northern California | Registered: Apr 2005
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AliG
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posted
Thanks Michelle,
That's good to know!
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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AliG
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posted
Sorry JR,
I didn't acknowledge you. HOW RUDE!
Cute joke! LOL
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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JRWagner
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posted
No problem...wink, wink...
Excuse me while I SCRATCH MY CAT! Man, it feels WARM in here...hmmmmmm
Seriously, if I can be such...Ted Nugent DID have a bad case of Bartonella...thus the song "CAT SCRATCH FEVER". He thought he was going to die, etc. (Hate his attitude and music...but he has a right to do whatever, etc.).
When I had cats I had them tested for Bart, even though they were indoor cats. Zip...same result for my tests, but we all know how THAT song goes!
THE PROBLEM IS THE TESTING!!!! Too many different strains of whatever, not enough tests to cover them all.
Peace, Love, and Wellness, JRW
Posts: 1414 | From Ny, Ny | Registered: Oct 2002
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AliG
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posted
I certainly agree about the testing. I hope they get it together in my lifetime!
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Thanks for the great discussion on this topic. To pick up where JR and AliG were discussing: is it crucial or even beneficial to get our pet cats tested? I have three of my own, and upon positive diagnosis for Bartonella, my LLMD has instructed to have them all tested. Any thoughts/advice/suggestions would be very greatly appreciated.
Posts: 85 | From Texas | Registered: Dec 2007
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adamm
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posted
Under what names is gentamicin marketed?
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Keebler
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Member # 12673
posted
-
I once worked for an agency "Deaf Services."
From stories I heard, gentamicin is not a drug you want. Or, if so, extreme caution is required regarding deafness. Dosage and duration as well as method of delivery might be crucial.
One abstract below is working on getting around that with a specific form of Vitamin E - but just with short term use.
I'd want proof positive first, though, that all parts and functions of ears would not be compromised.
alpha-Tocopherol protective effects on gentamicin ototoxicity: an experimental study.
Fetoni AR, Sergi B, Ferraresi A, Paludetti G, Troiani D.
Institute of Otolaryngology, Catholic University of Rome, Rome, Italy.
Gentamicin, acting as an iron chelator, activates membrane lipid peroxidation (MPL) and induces free radical formation, as observed in vitro and in vivo.
Antioxidants, such as alpha-tocopherol, are able to suppress MLP, thus attenuating tissue damage.
The present study was designed to investigate the possible protective effects of alpha-tocopherol on gentamicin ototoxicity. The study was carried out on albino guinea pigs (250-350 g).
. . .
All animals were treated for 14 days. . .
Gentamicin induced progressive high-frequency hearing loss of 50-60 dB SPL. alpha-Tocopherol co-therapy slowed the progression of hearing loss.
The significant loss of outer hair cells (OHCs) in the cochlear basal turn in gentamicin-treated animals was not observed in the cochleas of animals protected with alpha-tocopherol.
This study supports the hypothesis that alpha-tocopherol interferes with gentamicin-induced free radical formation, and suggests that this drug may be useful in protecting OHC function from aminoglycoside ototoxicity, thus reducing hearing loss.
AliG
Frequent Contributor (1K+ posts)
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posted
Sorry HamDune,
That's not been a subject I've familiarized myself with. Perhaps someone else can offer you some info.
Thanks Keebler,
That's great info on Gentamicin!
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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