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Volume 18, Number 5—May 2012

Research

Bartonella spp. Bacteremia and Rheumatic Symptoms in Patients from Lyme Disease–endemic Region

Ricardo G. Maggi, B. Robert Mozayeni, Elizabeth L. Pultorak, Barbara C. Hegarty, Julie M. Bradley, Maria Correa, and Edward B. BreitschwerdtComments to Author 
Author affiliations: North Carolina State University, Raleigh, North Carolina, USA (R.G. Maggi, E.L. Pultorak, B.C. Hegarty, J.M. Bradley, M. Correa, E.B. Breitschwerdt); Translational Medicine Group, PC, North Bethesda, Maryland, USA (B.R. Mozayeni)

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Table 1

Characteristics and Bartonella spp. PCR results for 296 patients examined by a rheumatologist, Maryland–Washington, DC, USA, August 25, 2008–April 1, 2009*

Characteristic Overall study population, no. (%) Positive Bartonella sp. result by PCR, no. (%)
Overall positive B. henselae B. koehlerae B. vinsonii subsp. berkhoffii Bartonella spp.†
Total 296 (100) 122 (62.5) 40 (13.5) 54 (18.2) 10 (3.4) 29 (9.8)
Sex
F 205 (69.3) 86 (29.0) 24 (11.7) 38 (18.5) 7 (3.4) 21 (10.3)
M 91 (30.7) 36 (12.2) 16 (17.6) 16 (17.5) 3 (3.3) 8 (8.8)
State of residence
Maryland 148 (50.0) 58 (39.2) 20 (13.5) 27 (18.2) 5 (3.4) 13 (8.8)
Virginia 76 (25.7) 37 (48.7) 13 (17.1) 19 (25.0) 0 7 (9.2)
Pennsylvania 26 (8.8) 9 (34.6) 2 (7.7) 3 (11.5) 2 (7.7) 3 (11.5)
District of Columbia 16 (5.4) 5 (31.3) 1 (6.3) 1 (6.25) 1 (6.3) 2 (12.5)
Other 30 (10.1) 13 (43.3) 4 (13.3) 4 (13.3) 2 (6.7) 4 (13.3)
Immunofluorescence antibody results
All Bartonella spp. 185 (62.5) 77 (41.6) 25 (13.5) 33 (17.8) 4 (2.1) 20 (10.8)
B. henselae 67 (22.6) 24 (35.8) 7 (10.3) 8 (11.7) 2 (2.9) 8 (11.7)
B. koehlerae 89 (30.1) 38 (42.7) 10 (11.2) 24 (26.9) 3 (3.4) 5 (5.6)
B. vinsonii subsp. berkhoffii 148 (50.0) 59 (39.8) 21 (14.1) 21 (14.1) 3 (2.0) 18 (12.1)
Self-report health assessment
Healthy 82 (27.7) 32 (39.0) 12 (14.6) 13 (15.8) 3 (3.6) 7 (8.5)
Infrequently Ill 53 (17.9) 26 (49.1) 7 (13.2) 14 (26.4) 3 (5.6) 5 (9.4)
Chronically Ill 149 (50.3) 54 (36.2) 17 (11.4) 31 (14.1) 4 (2.7) 15 (10.1)
No response 12 (4.0) 10 (83.3) 4 (33.3) 6 (50.0) 0 2 (16.7)
Animal contact
Yes 283 (95.6) 116 (40.9) 38 (13.4) 51 (18.0) 9 (3.2) 27 (9.5)
No 13 (4.4) 6 (46.2) 2 (15.4) 3 (23.1) 1 (7.7) 2 (15.4)
Type
Dog 252 (85.1) 104 (41.3) 33 (13.1) 45 (17.9) 7 (2.8) 27 (10.7)
Cat 202 (68.2) 77 (38.1) 24 (11.8) 34 (16.8) 7 (3.5) 19 (9.4)
Horse 86 (29.0) 41 (47.7) 12 (13.9) 14 (16.3) 2 (2.3) 13 (15.1)
Bird 59 (19.3) 26 (44.0) 8 (13.5) 8 (13.5) 2 (3.4) 9 (15.2)
Cattle 32 (10.8) 11 (34.4) 3 (9.3) 4 (12.5) 0 4 (12.5)
Poultry 30 (10.1) 13 (43.3) 6 (20.0) 3 (10.0) 0 4 (30.7)
Swine 25 (8.5) 10 (25.0) 5 (20.0) 2 (8.0) 0 3 (12.0)
Sheep 25 (8.5) 12 (48.0) 6 (24.0) 2 (8.0) 0 4 (16.0)
Other 12 (4.0) 12 (58.3) 4 (33.3) 1 (8.3) 0 2 (16.7)
Animal bites/scratches
Cat 154 (52.0) 64 (41.6) 21 (13.6) 27 (17.5) 6 (3.9) 14 (9.1)
Dog 118 (39.8) 52 (44.1) 18 (15.3) 22 (18.6) 2 (1.7) 13 (11.0)
Bird 12 (4.0) 10 (83.3) 3 (25.0) 4 (33.3) 2 (16.7) 3 (25.0)
Horse 14 (4.7) 9 (64.2) 2 (14.3) 3 (21.4) 1 (8.3) 3 (21.4)
Insect exposure
Mosquitoes 256 (86.5) 106 (41.4) 37 (14.4) 46 (17.9) 8 (3.1) 24 (9.4)
Ticks 229 (77.4) 96 (41.9) 29 (12.6) 43 (18.7) 10 (4.3) 23 (10.0)
Fleas 148 (50.0) 66 (44.5) 23 (15.5) 26 (17.5) 7 (4.7) 16 (10.8)
Biting Flies 160 (54.0) 68 (42.5) 25 (15.6) 27 (16.9) 5 (3.1) 16 (10.0)
Lice 38 (12.8) 17 (44.7) 7 (18.4) 3 (7.8) 0 7 (18.4)
Spiders 5 (1.7) 4 (80.0) 1 (20.0) 2 (40.0) 0 1 (20.0)
Sarcoptes mite 3 (1.0) 1 (33.3) 0 0 0 1 (33.3)
Outdoor exposure
Hiking 154 (52.0) 66 (42.9) 21 (13.6) 28 (18.2) 5 (3.3) 16 (10.4)
Wildlife rescue/rehabilitation 22 (7.4) 7 (31.8) 2 (9.1) 2 (9.1) 0 3 (14.3)
Hunting 21 (7.1) 9 (42.9) 1 (4.7) 4 (19.0) 0 4 (19.1)
Other 36 (12.2) 16 (44.4) 6 (16.7) 8 (22.2) 2 (5.6) 1 (2.8)

*Positive sample and exposure categories are not mutually exclusive (i.e., some persons had positive test results by both IFA and PCR, or could have been exposed to both cats and dogs). Median patient ages, for women and men, respectively, were as follows: overall study population, 46.0 and 36.0 y; those with positive results for overall Bartonella, 47.0 and 38.0 y, B. henselae, 44.0 and 41.0 y, B. koehlerae, 49.0 and 40.5 y, B. vinsonii subsp. berkhoffii, 43.0 and 64.0 y, and Bartonella spp., 48.0 and 24.0 y.
†Positive PCR results after using Bartonella genus primers but unable to obtain a clean sequence to determine species.

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