Abstract

Objectives

Coxiella and Bartonella sp. display particular tropism for endothelial or endocardial tissues and an abnormal host response to infections with induced autoimmunity. We aimed, through a case series combined with a comprehensive literature review, to outline characteristics of Coxiella and Bartonella infections presenting as systemic vasculitis.

Methods

We retrospectively included cases of definite Coxiella and Bartonella infections presenting with vasculitis features and performed a comprehensive literature review.

Results

Six cases of Bartonella infections were added to 18 cases from literature review. Causative pathogens were mainly B. henselae. Bartonella infection mimicked anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis in 83% with PR3-ANCA and presented as cryoglobulinemic vasculitis in 8%. Glomerulonephritis was present in 92%, and 88% had endocarditis. Complement fractions were low in 82% and rheumatoid factor positive in 85%. Kidney biopsies showed cell proliferation, mostly crescentic, with pauci-immune glomerulonephritis in 29%. Outcome was favorable, with the use of antibiotics alone in one third. Five cases of Coxiella infections were added to 16 from literature review. Sixteen had small-vessel vasculitides, mainly cryoglobulinemia vasculitis in 75%. One patient had polyarteritis nodosa-like vasculitis and four large-vessel vasculitis. Outcome was good except for one death. A highly sensitive next generation sequencing analysis on 3 Coxiella and 2 Bartonella-related vasculitides biopsies did not find any bacterial DNA.

Conclusion

Coxiella and Bartonella are both able to induce vasculitis but display distinct vasculitis features. Bartonella mimics PR3-ANCA-associated vasculitis in the setting of endocarditis, whereas Coxiella may induce vasculitis involving all vessel sizes.

中文翻译：

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巴尔通体和柯氏杆菌感染表现为全身性血管炎：病例系列和文献复习

摘要

目标

Coxiella和Bartonella sp。对内皮或心内膜组织表现出特殊的趋向性，以及对诱导性自身免疫感染的异常宿主反应。我们旨在通过病例系列结合全面的文献综述，概述表现为全身性血管炎的Coxiella和Bartonella感染的特征。

方法

我们回顾性地纳入了具有血管炎特征的明确Coxiella和Bartonella感染病例，并进行了全面的文献回顾。

结果

文献复习18例中增加巴尔通体感染6例。致病病原体主要是B. henselae。巴尔通体感染在 83% 的 PR3-ANCA 中与抗中性粒细胞胞浆抗体 (ANCA) 相关的血管炎相似，在 8% 的情况下表现为冷球蛋白血症性血管炎。92% 存在肾小球肾炎，88% 存在心内膜炎。82% 的补体分数较低，85% 的类风湿因子呈阳性。肾活检显示细胞增殖，主要是新月体，29% 为少免疫性肾小球肾炎。结果是有利的，三分之一单独使用抗生素。科西拉五例从文献综述中将感染添加到 16 种。16 例有小血管炎，75% 主要是冷球蛋白血症血管炎。1例患者有结节性多动脉炎样血管炎和4例大血管血管炎。除了一人死亡外，结果很好。对 3 个Coxiella和 2 个Bartonella相关血管炎活检组织的高度灵敏的下一代测序分析没有发现任何细菌 DNA。

结论

Coxiella和Bartonella都能够诱发血管炎，但表现出不同的血管炎特征。巴尔通体在心内膜炎的情况下类似于 PR3-ANCA 相关的血管炎，而柯氏杆菌可能诱发涉及所有血管大小的血管炎。