Serologic testing for Bartonella in Manitoba, Canada, 2010–2020: a retrospective case series

Carl Boodman; Terence Wuerz; Philippe Lagacé-Wiens; Robbin Lindsay; Antonia Dibernardo; Jared Bullard; Derek R. Stein; Yoav Keynan

doi:10.9778/cmajo.20210180

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Figure 1:
Long underwear stained with human blood due to body lice ectoparasitosis acquired in Winnipeg, Canada.
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Figure 2:
Body lice, Pediculus humanus humanus, seen on clothing acquired from a patient experiencing houselessness in Winnipeg.

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Table 1:

Results of Bartonella serologic tests ordered in Manitoba, 2010–2020^*

Year	Result; no. (%) of tests
Year	Negative	Equivocal	Positive	Total
2010	46 (90.2)	5 (9.8)	0 (0.0)	51
2011	56 (83.6)	9 (13.4)	2 (3.0)	67
2012	57 (86.4)	9 (13.6)	0 (0.0)	66
2013	46 (97.9)	0 (0.0)	1 (2.1)	47
2014	72 (93.5)	4 (5.2)	1 (1.3)	77
2015	80 (82.5)	15 (15.5)	2 (2.1)	97
2016	70 (80.5)	15 (17.2)	2 (2.3)	87
2017	101 (91.8)	6 (5.4)	3 (2.7)	110
2018	125 (89.3)	13 (9.3)	2 (1.4)	140
2019	105 (91.3)	8 (7.0)	2 (1.7)	115
2020	138 (87.9)	10 (6.4)	9 (5.7)	157
Total	896 (88.4)	94 (9.3)	24 (2.4)	1014

↵* For both adult and pediatric patients.

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Table 2:

Demographic characteristics of adults who had serologic positivity for Bartonella and received care at a participating hospital

Patient no.	Age, yr	Gender^*	Home area^†	Year	Comorbidities	Substance use	Housing	Animal exposure
1	48	Male	Winnipeg	2020	HIV infection, ectoparasitosis	Alcohol, intravenous crystal methamphetamine use	Single room, previously houseless	None
2	35	Male	NE-MB1	2020	Rheumatic heart disease, schizophrenia, ectoparasitosis	Alcohol, cannabis	Housed	None
3	33	Male	NE-MB1	2020	Anxiety, depression	Intravenous crystal methamphetamine use, alcohol	Houseless	None
4	53	Male	Winnipeg	2020	None	Alcohol, baclofen	Single room, meals at shelter	None
5	62	Male	Winnipeg	2020	Depression, ectoparasitosis	Alcohol	Single room (clothes, food at shelter)	None
6	57	Male	Winnipeg	2020	HIV infection, HCV infection	Alcohol, intravenous crystal methamphetamine use	Houseless	None
7	63	Male	Winnipeg	2020	Anxiety	Unknown	Single room, previously houseless	None
8	65	Male	Winnipeg	2020	Syphilis, HCV infection	Unknown	Housed	None
9	63	Male	Winnipeg	2020	Unknown	Unknown	Houseless (shelter)	None
10	38	Female	Winnipeg	2019	HIV infection, HCV infection, tuberculosis	Intravenous crystal methamphetamine use, alcohol	Housed	Cat
11	31	Female	Winnipeg	2018	Congenital patent ductus arteriosus	None	Housed	None
12	39	Male	Winnipeg	2017	Nephrolithiasis	Alcohol	Housed	Cat
13	20	Female	Winnipeg	2017	None	None	Housed	Cat
14	53	Male	Winnipeg	2017	Neuroendocrine tumour, pulmonary embolism	None	Housed	Cat
15	47	Male	Nunavut	2015	None	Alcohol	Housed	None
16	62	Female	NW-MB2	2014	Type 2 diabetes	Alcohol	Housed	Hunting

Note: HCV = hepatitis C virus, NE-MB1 = 1 remote community in northeastern Manitoba, NW-MB2 = 1 remote community in northwestern Manitoba.
↵* As documented in the hospital chart.
↵† As determined by the postal code in the medical chart.

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Table 3:

Clinical characteristics and outcomes of adults with serologic positivity for Bartonella

Patient no.	Clinical presentation/ test indication	Interpretation	B. henselae titre	B. quintana titre	Species identified^*	Antimicrobial (duration of treatment, d)	Surgical treatment	Outcome (length of follow-up, mo)
1	AV/MV endocarditis (14 mm × 6 mm^†), aortic root abscess, pulmonary and splenic emboli, arterial aneurysms	Confirmed B. quintana	8192	8192	B. quintana (16S AV)	Gentamicin (4), ceftriaxone (42), doxycycline (42)	AV/MV replacement	Survived (12)
2	MV endocarditis (18 mm × 7 mm^†), intracranial aneurysm	Probable B. quintana	8192	8192	No	Ceftriaxone (43), vancomycin (21), daptomycin (22)	Endovascular coiling (MCA aneurysm)	Survived (6)
3	MV endocarditis (16 mm × 9 mm^†), ruptured intracranial mycotic aneurysm	Probable B. quintana	8192	8192	No	Ceftriaxone (56), vancomycin (56), doxycycline (56), gentamicin (14)	Endovascular coiling (MCA aneurysm)	Survived (6)
4	AV/MV endocarditis (14 mm × 6 mm^†), intracranial emboli	Probable B. quintana	8192	8192	No	Ceftriaxone (15), vancomycin (15)	None (declined)	Died
5	MV endocarditis (21 mm × 6 mm^†), splenic emboli	Confirmed B. quintana	8192	8192	B. quintana (16S AV)	Gentamicin (14), doxycycline (42)	MV replacement	Survived (3)
6	Ectoparasitosis, cellulitis	Probable B. quintana	512	256	No	Doxycycline (7)	None	Survived (0)
7	Fever, rash, ectoparasitosis	Probable B. quintana	64	256	No	None	None	Survived (0)
8	Gastroduodenal artery hemorrhage	False-positive	256	Negative	–	None	Arterial embolization	Survived (0)
9	Ectoparasitosis, shin pain	Probable B. quintana	64	256	No	None	None	Survived (0)
10	PV endocarditis^‡	Probable B. henselae	256	Negative	No	None	None	Survived (0)
11	AV/PV endocarditis,^‡ splenic infarcts	Confirmed B. quintana	8192	8192	B. quintana (16S AV)	Gentamicin (14), doxycycline (42)	AV replacement, PDA closure	Survived (12)
12	Axillary lymphadenopathy, fever	Probable B. henselae	1024	512	No	Azithromycin (5)	None	Survived (0)
13	Axillary lymphadenopathy, fever	Probable B. henselae	512	NA	No	Azithromycin (5)	None	Survived (0)
14	AV endocarditis^‡	Probable B. henselae	4096	2048	No	Doxycycline (42), rifampin (14)	AV replacement	Survived (6)
15	AV/MV/PV endocarditis,^‡ ruptured intracranial aneurysm	Confirmed B. quintana	4096	NA	B. quintana (rpoB gene sequencing)	Ceftriaxone (42), doxycycline (42), gentamicin (14)	AV/MV replacement, PV repair, craniotomy, aneurysm clip	Died
16	AV/MV endocarditis,^‡ aortic dissection	Confirmed B. quintana	1024	NA	B. quintana (16S AV)	Ceftriaxone (42), doxycycline (42)	AV/MV replacement	Survived (6)

Note: 16S = 16S rRNA sequencing, AV = aortic valve, MCA = middle cerebral artery, MV = mitral valve, NA = not applicable, PDA = patent ductus arteriosus, PV = pulmonary valve.
↵* On explanted cardiac valves.
↵† Largest vegetation documented.
↵‡ Vegetation size was not documented in the available medical chart.