BARTONELLA HENSELAE

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Bartonella henselae

SYNONYM OR CROSS REFERENCE: Formerly Rochalimaea henselae. Cat-scratch disease^(1-3), cat-scratch fever ⁽⁴⁾, and zoonotic bartonellae ⁽³⁾ are caused by Bartonella henselae. Infection may cause bacteremia, endocarditis, bacillary angiomatosis, bacillary hepatis, peliosis hepatis ⁽⁵⁾.

CHARACTERISTICS: B. henselae is of the Bartonellaceae family, and appear as fastidious aerobic, short, Gram-negative rods (0.2 to 0.6 µm by 0.5 to 1.0 µm) ^{(3, 4)}. They can be found in capillary walls near site of entry upon infection ⁽⁴⁾. The optimal growth temperature varies from 35°C to 37°C ⁽³⁾.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Cat-scratch disease: In 50 % of the cases, a small skin lesion appears at the inoculation site, and evolves from a papule to a vesicle and partially healed ulcers ⁽³⁾. Symptoms include low grade fever and lymphadenopathy 2 weeks after cat scratch, lick, or bite of cat flea bite ^{(1, 4)}. Headaches, sore throat and conjunctivitis, malaise, anorexia, and chills are common ^{(3, 4)}. Atypical manifestations occur in 5-10% of those infected ^{(3, 6)}. The most common is Parinaud’s oculoglandular syndrome (periauricular lymphadenopathy and palpebral conjunctivitis); Meningitis, encephalitis, osteolytic lesions, and thrombocytopenic purpura may occur. Encephalopathy is one of most serious complications of cat-scratch disease and usually occurs within 2-6 weeks after onset of lymphadenopathy and usually resolves with complete recovery. New clinical presentations associated with immunocompromised patients have been reported ^{(3, 6)}. Neuroretinitis or bacteremia can lead to chronic fatigue syndrome ⁽³⁾. One case of aggressive endocarditis has been linked to B. henselae in a cat owner ⁽³⁾. Bacillary angiomatosis is characterized by vascular proliferative lesion observed, mainly in patients with AIDS ^{(3, 6)}. B. henselae has been linked to HIV-associated brain lesions, meningoenchephalitis, encephalopathy, dementia, and neuropsychological decline ⁽³⁾. Rheumatic manifestations are also related to Bartonella infection in humans, including erythema nodosum, leukocytoclastic vasculitis, and fever of unknown origin with myalgia and arthralgia ⁽³⁾.

EPIDEMIOLOGY: Worldwide distribution ⁽³⁾. It is estimated that approximately 20,000 human cases of cat-scratch disease /annum occur in US ^{(3, 4)} where one third of cats carry the bacterium ⁽⁴⁾. Fifty five to eighty percent of cat-scratch disease cases occur in patients under 20 years old ^{(3, 6)}. Immunosuppressed individuals in the general population are at an increased risk of bacillary angiomatosis infection ⁽⁴⁾. The prevalence of infections is usually highest in warm and humid climates, where cat fleas are abundant ⁽³⁾. There is a seasonal pattern, with most cases seen in fall and winter ^{(3, 6)}.

HOST RANGE: Humans ^{(3, 4)}, cats ^{(3, 4)}, dogs ^{(1, 7)}.

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: The cat flea (Ctenocephalides felis) is thought to be the major vector by which the cat becomes infected ^{(2, 3)}. Humans become infected with B. henselae by direct or indirect contact with kittens or cats harboring the organism. Humans rarely become infected following exposure to animals other than cats ^{(1, 7)}. The role of cat fleas in human transmission seems limited ^{(3, 7)}. Human infection results from inoculation of infective flea feces at time of injury ⁽³⁾.

INCUBATION PERIOD: Skin pustules appear 3-10 days with additional symptoms developing usually within 14-21 days after injury ^{(3, 4)}.

COMMUNICABILITY: Human-to-human transmission has not been documented.

SECTION III - DISSEMINATION

RESERVOIR: Cats ^{(3, 4, 6)} and dogs ⁽⁷⁾.The domesticated housecat, Felis catus, is the most important natural host for B. henselae. Approximately 10% of pet cats and 33% of feral cats are bacteremic with the organism ⁽¹⁾.

ZOONOSIS: Can be transferred from cats to humans ⁽⁴⁾, and occasionally from dogs to humans ⁽⁷⁾.

VECTORS: The cat flea (Ctenocephalides felis) is the major vector for animal hosts ^{(1, 4)}; there is some evidence suggesting cat flea bites may lead to human infection ^{(1, 7)}.

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY/RESISTANCE: B. henselae is susceptible to several antibacterial agents ⁽¹⁾. Rifampin, ciprofloxacin, gentamicin, trimethoprim, and sulfamethoxazole have the greatest effect ⁽¹⁾. Erythromycin, doxycycline, isoniazid, and rifampin have been effective in treatment of bacillary angiomatosis in immunocompromised patients ⁽¹⁾.

DRUG RESISTANCE: Penicillins, cephalosporins, tetracycline, and erythromycin have little to no clinical effect in cat-scratch disease. Resistance to macrolides ⁽⁸⁾ and to fluoroquinolones ⁽⁹⁾ has been observed.

SUSCEPTIBILITY TO DISINFECTANTS: Information specific to B. henselae is not available, but most bacteria have been shown to be susceptible to low concentrations of chlorine, 70% ethanol, phenolics such as orthophenylphenol, ortho-benzyl-paua-chlorophenol, 2% aqueous glutaraldehyde, peracetic acid (0.001% to 0.2%) ^{(10, 11)}.

PHYSICAL INACTIVATION: Information specific to B. henselae is not available, but most bacteria can be inactivated by moist heat (121°C for 15 min - 30 min) and dry heat (160-170°C for 1-2 hours) ⁽¹²⁾.

SURVIVAL OUTSIDE HOST: Unknown.

SECTION V – FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Identification can be done by histology tests of lymph node biopsy sample, indirect fluorescent antibody assay (IFA), polymerase chain reaction (PCR) assay, restriction fragment length polymorphism (RFLP) assay, and serological tests ^{(3, 6, 7)}.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: The majority of cases of cat-scratch disease occurring in normal hosts do not require anti-infective therapy for resolution of infection ⁽¹⁾. Cat-scratch disease is usually self-limiting within several weeks ^{(3, 6)} If an antibiotic regime is required tetracycline or erythromycin are effective treatments ⁽⁴⁾.

IMMUNIZATION: None.

PROPHYLAXIS: None.

SECTION VI - LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: No documented cases ⁽⁷⁾.

SOURCES/SPECIMENS: Infected laboratory animals ⁽⁴⁾, blood ⁽³⁾, and tissue ⁽³⁾.

PRIMARY HAZARDS: Scratches, bites, and/or licks from infected laboratory animals ⁽⁷⁾.

SPECIAL HAZARDS: None.

SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 ⁽¹³⁾.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes ⁽¹⁴⁾.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities ⁽¹⁴⁾.

SECTION VIII – HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up ⁽¹⁴⁾.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration ⁽¹⁴⁾.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled ⁽¹⁴⁾.

SECTION IX – REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: November, 2010

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©
Public Health Agency of Canada, 2010
Canada

REFERENCES:

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