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Published on: October 16, 2018
Detection of Bartonella vinsonii subsp. berkhoffii in an HIV patient using metagenomic Next-Generation Sequencing
Yuru Shi1, Jing Yang1, Yingjie Qi1
1Department of Clinical Laboratory, Infection Hospital Area of the First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China.
Abstract:
Bartonella species are fastidious, aerobic bacteria that are transmitted by blood-sucking arthropods. Bartonella spp. are responsible for cat scratch disease, Carrion's disease, bacillary angiomatosis and trench fever. On the other hand, Bartonella vinsonii is rarely reported in the literature and there exist a few reports of systemic infection caused by Bartonella vinsonii in patients with acquired immunodeficiency syndrome. A 31-year-old male (diagnosed with AIDS six years ago) had persistent fever and ulceration in the right knee. The elevated levels of inflammatory markers suggested an infectious aetiology. Despite the negative findings of blood culture, metagenomic Next-Generation Sequencing of plasma detected Bartonella vinsonii. The polymerase chain reaction of whole blood and Sanger sequencing confirmed the mNGS findings. Immunohistochemical staining had later suggested bacillary angiomatosis, which was consistent with Bartonella infection. Following antibiotic treatment, the ulcers subsided significantly, but a high fever persisted. The patient died due to sudden respiratory failure.
Insights
Metagenomic sequencing identified Bartonella vinsonii, a rare bacterial cause of systemic infection, in an AIDS patient with persistent fever and knee ulcers. This highlights the utility of advanced sequencing in diagnosing uncommon infectious diseases.
Area of Science:
- Microbiology
- Infectious Diseases
- Genomics
Background:
- Bartonella species cause various human diseases, including cat scratch disease and bacillary angiomatosis.
- Systemic infections by Bartonella vinsonii are rare, with limited reports in immunocompromised individuals.
Observation:
- A patient with acquired immunodeficiency syndrome (AIDS) presented with persistent fever and knee ulceration.
- Standard blood cultures were negative, but metagenomic Next-Generation Sequencing (mNGS) of plasma detected Bartonella vinsonii.
Findings:
- Polymerase chain reaction and Sanger sequencing confirmed the mNGS results.
- Immunohistochemistry suggested bacillary angiomatosis, consistent with Bartonella infection.
- Despite antibiotic treatment, the patient experienced persistent fever and died from respiratory failure.
Implications:
- Metagenomic sequencing is a valuable tool for diagnosing rare infectious agents, especially in immunocompromised patients.
- Bartonella vinsonii should be considered in the differential diagnosis of unexplained febrile illnesses and ulcerative lesions in AIDS patients.
- Further research is needed to understand the pathogenesis and treatment of Bartonella vinsonii systemic infections.
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