Focal Area Infection Biology, Biozentrum, University of Basel, Switzerland.
Clin Microbiol Rev. 2012 Jan;25(1):42-78. doi: 10.1128/CMR.05009-11.
Bartonella spp. are facultative intracellular pathogens that employ a unique stealth infection strategy comprising immune evasion and modulation, intimate interaction with nucleated cells, and intraerythrocytic persistence. Infections with Bartonella are ubiquitous among mammals, and many species can infect humans either as their natural host or incidentally as zoonotic pathogens. Upon inoculation into a naive host, the bartonellae first colonize a primary niche that is widely accepted to involve the manipulation of nucleated host cells, e.g., in the microvasculature. Consistently, in vitro research showed that Bartonella harbors an ample arsenal of virulence factors to modulate the response of such cells, gain entrance, and establish an intracellular niche. Subsequently, the bacteria are seeded into the bloodstream where they invade erythrocytes and give rise to a typically asymptomatic intraerythrocytic bacteremia. While this course of infection is characteristic for natural hosts, zoonotic infections or the infection of immunocompromised patients may alter the path of Bartonella and result in considerable morbidity. In this review we compile current knowledge on the molecular processes underlying both the infection strategy and pathogenesis of Bartonella and discuss their connection to the clinical presentation of human patients, which ranges from minor complaints to life-threatening disease.
巴尔通体属（Bartonella spp.）是兼性细胞内病原体，采用独特的隐匿性感染策略，包括免疫逃避和调节、与有核细胞的密切相互作用以及红细胞内持续存在。哺乳动物中普遍存在巴尔通体感染，许多种属可作为其自然宿主或偶然的动物源性病原体感染人类。在接种到无经验的宿主中时，巴尔通体首先定植于广泛认为涉及有核宿主细胞操纵的主要小生境，例如微脉管系统。一致地，体外研究表明，巴尔通体拥有丰富的毒力因子来调节这些细胞的反应，进入并建立细胞内小生境。随后，细菌被播种到血液中，侵入红细胞并引起典型的无症状红细胞内菌血症。虽然这种感染过程是自然宿主的特征，但动物源性感染或免疫功能低下患者的感染可能改变巴尔通体的路径，并导致相当大的发病率。在这篇综述中，我们汇集了目前关于巴尔通体感染策略和发病机制的分子过程的知识，并讨论了它们与人类患者临床表现的联系，其范围从轻微不适到危及生命的疾病。
