Drancourt M, Moal V, Brunet P, Dussol B, Berland Y, Raoult D
Unité des Rickettsies, Faculté de Médecine, Centre National de la Recherche Scientifique, Marseille, France.
J Clin Microbiol. 1996 May;34(5):1158-60. doi: 10.1128/jcm.34.5.1158-1160.1996.
Bartonella quintana is a reemerging pathogen responsible for trench fever, endocarditis, bacteremia, and bacillary angiomatosis. We previously reported the first case of a patient with B. quintana-induced chronic adenomegaly, and here we present a report on a second patient. A hemodialyzed patient with Sjögren's syndrome presented with mediastinal adenomegalies and secondary pancytopenia. All diagnostic investigations remained negative, except that a Bartonella-like microorganism was isolated from a bone marrow biopsy. The isolate was identified as B. quintana by a specific mouse polyclonal antibody and by determination of a partial gltA (citrate synthase-encoding) gene and 16S rRNA gene sequences. DNA of the pathogen was also detected in the adenomegaly and in the serum of the patient by PCR amplification of the gltA gene. Anti-B. quintana antibodies were never detected in the patient's serum throughout the 12-month follow-up but were detected in the serum of the patient's cat. The patient's outcome was favorable after treatment with gentamicin. Chronic adenomegaly in seronegative patients is a new clinical entity due to B. quintana.
五日热巴尔通体是一种再度出现的病原体，可引发战壕热、心内膜炎、菌血症和杆菌性血管瘤病。我们之前报道了首例由五日热巴尔通体引起慢性淋巴结肿大的病例，在此我们报告第二例患者。一名患有干燥综合征的血液透析患者出现纵隔淋巴结肿大和继发性全血细胞减少。除了从骨髓活检中分离出一种类似巴尔通体的微生物外，所有诊断检查结果均为阴性。通过特异性小鼠多克隆抗体以及测定部分gltA（编码柠檬酸合酶）基因和16S rRNA基因序列，该分离株被鉴定为五日热巴尔通体。通过对gltA基因进行PCR扩增，在患者的肿大淋巴结和血清中也检测到了病原体的DNA。在为期12个月的随访期间，患者血清中从未检测到抗五日热巴尔通体抗体，但在患者猫咪的血清中检测到了该抗体。患者接受庆大霉素治疗后预后良好。血清阴性患者的慢性淋巴结肿大是由五日热巴尔通体引起的一种新的临床病症。
