巴尔通体感染

巴尔通体菌种会导致人类发生严重的临床综合征。引起大部分感染的 3 种最主要病原体分别为汉赛巴尔通体、五日热巴尔通体和杆菌样巴尔通体

某些种属广泛分布于世界各地（汉赛巴尔通体），而其他种属通常呈局部分布（杆菌样巴尔通体）

巴尔通体经直接接触（汉赛巴尔通体经猫咬伤或抓伤）或经昆虫媒介（五日热巴尔通体经虱子、杆菌样巴尔通体经沙蝇）从受感染的自然宿主向易感人类宿主传播

巴尔通体可感染红细胞，造成血管增生，导致久热不退、淋巴结肿大以及肝脾肿大

通过培养、血清学或组织病理学确立实验室诊断。若有条件，可采用分子学技术（例如聚合酶链反应），对血液和组织样本（包括心脏瓣膜）检查十分有用

根据巴尔通体种属及临床表现类型进行治疗，但是通常包含抗生素治疗。对于某些病例（例如猫抓病），可能需进行针吸活检。

人类巴尔通体病由巴尔通体造成，巴尔通体是一兼性胞内寄生种属。自 1993 年以来，现已发现 45 种巴尔通体种属，据报道，其中部分种属可造成人类感染。[1]Jacomo V, Kelly PJ, Raoult D. Natural history of Bartonella infections (an exception to Koch's postulate). Clin Diagn Lab Immunol. 2002;9:8-18. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC119901 http://www.ncbi.nlm.nih.gov/pubmed/11777823?tool=bestpractice.com [2]Chomel BB, Boulouis HJ, Maruyama S, et al. Bartonella spp. in pets and effect on human health. Emerg Infect Dis. 2006;12:389-394. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291446 http://www.ncbi.nlm.nih.gov/pubmed/16704774?tool=bestpractice.com [3]Okaro U, Addisu A, Casanas B, et al. Bartonella species, an emerging cause of blood-culture-negative endocarditis. Clin Microbiol Rev. 2017;30:709-746. http://www.ncbi.nlm.nih.gov/pubmed/28490579?tool=bestpractice.com

在人类中已描述的三种最常见感染包括：猫抓病（汉赛巴尔通体）；Carrion 病（杆菌样巴尔通体；该疾病包括菌血症阶段 [奥罗亚热] 和出疹阶段 [秘鲁疣]）；以及战壕热（五日热巴尔通体）。[4]Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev. 1997;10:203-219. http://cmr.asm.org/cgi/reprint/10/2/203?view=long&pmid=9105751 http://www.ncbi.nlm.nih.gov/pubmed/9105751?tool=bestpractice.com [5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com

巴尔通体引起的临床综合征范围广泛，包括：不明原因久热不退、血液学表现、脑炎和脑病、全身性淋巴结肿大、肝脾病变、视网膜病、培养阴性心内膜炎、骨髓炎、关节炎、纵隔肿块和胸膜炎。[4]Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev. 1997;10:203-219. http://cmr.asm.org/cgi/reprint/10/2/203?view=long&pmid=9105751 http://www.ncbi.nlm.nih.gov/pubmed/9105751?tool=bestpractice.com [5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com

已知汉赛巴尔通体和五日热巴尔通体也可导致免疫力低下宿主发生杆菌性血管瘤病。[4]Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev. 1997;10:203-219. http://cmr.asm.org/cgi/reprint/10/2/203?view=long&pmid=9105751 http://www.ncbi.nlm.nih.gov/pubmed/9105751?tool=bestpractice.com [5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com

也存在由其他巴尔通体种属（例如，万森巴尔通体、伊丽莎白巴尔通体、clarridgeae 巴尔通体、grahamii 巴尔通体、alsatica 巴尔通体、rochalimae 巴尔通体、washoensis 巴尔通体和 koehlerae 巴尔通体）造成的人类感染，但是较为罕见。[5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com [6]Brouqui P, Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev. 2001;14:177-207. http://cmr.asm.org/cgi/content/full/14/1/177?view=long&pmid=11148009 http://www.ncbi.nlm.nih.gov/pubmed/11148009?tool=bestpractice.com [7]Daly JS, Worthington MG, Brenner DJ, et al. Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis. J Clin Microbiol. 1993;31:872-881. http://jcm.asm.org/cgi/reprint/31/4/872?view=long&pmid=7681847 http://www.ncbi.nlm.nih.gov/pubmed/7681847?tool=bestpractice.com [8]Roux V, Eykyn SJ, Wyllie S, et al. Bartonella vinsonii subsp. berkhoffii as an agent of afebrile blood culture-negative endocarditis in a human. J Clin Microbiol. 2000;38:1698-1700. http://jcm.asm.org/cgi/content/full/38/4/1698?view=long&pmid=10747175 http://www.ncbi.nlm.nih.gov/pubmed/10747175?tool=bestpractice.com [9]Avidor B, Graidy M, Efrat G, et al. Bartonella koehlerae, a new cat-associated agent of culture-negative human endocarditis. J Clin Microbiol. 2004;42:3462-3468. http://jcm.asm.org/cgi/content/full/42/8/3462?view=long&pmid=15297484 http://www.ncbi.nlm.nih.gov/pubmed/15297484?tool=bestpractice.com [10]Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother. 2004;48:1921-1933. http://aac.asm.org/cgi/content/full/48/6/1921?view=long&pmid=15155180 http://www.ncbi.nlm.nih.gov/pubmed/15155180?tool=bestpractice.com [11]Angelakis E, Lepidi H, Canel A, et al. Human case of Bartonella alsatica lymphadenitis. Emerg Infect Dis. 2008;14:1951-1953. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2634634 http://www.ncbi.nlm.nih.gov/pubmed/19046532?tool=bestpractice.com

尽管万森巴尔通体亚种 berkhoffii 主要影响动物，但是目前已经发现该种属可引起人类疾病。[12]Breitschwerdt EB, Maggi RG, Lantos PM, et al. Bartonella vinsonii subsp. berkhoffii and Bartonella henselae bacteremia in a father and daughter with neurological disease. Parasit Vectors. 2010;3:29. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859367 http://www.ncbi.nlm.nih.gov/pubmed/20377863?tool=bestpractice.com 在法国、俄罗斯、尼泊尔均有关于人类感染巴尔通体亚种 arupensis 造成发热性疾病的报道，表明该细菌在世界范围内广泛分布。[13]Bai Y, Kosoy MY, Diaz MH, et al. Bartonella vinsonii subsp. arupensis in humans, Thailand. Emerg Infect Dis. 2012;18:989-991. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358162 http://www.ncbi.nlm.nih.gov/pubmed/22607728?tool=bestpractice.com