You’re listening to DermConsult on ReachMD. I’m Dr. Michael Greenberg, and I recently had the chance to learn more about Bartonella infections from Dr. Ed Breitschwerdt, who’s the Melanie S. Steele Distinguished Professor of Internal Medicine at North Carolina State University. Here’s Dr. Breitschwerdt talking about the impacts of this infection and this hidden epidemic.
So, Bartonella can infect erythrocytes, endothelial cells, monocytes, dendritic cells and for you as a dermatologist, there’s recent rodent studies out of China that support, what I think I’ve seen clinically, is Bartonella likes the lymphatic system as much as it likes the vascular system, so working up lengthy angitis cases can be frustrating, at best, and I think this bacteria perhaps plays a role because it can be transmitted by fleas, lice, biting flies, by ticks in the laboratory, it obviously, can persist in the skin for a long period of time. We know it can persist in blood for a long period of time and I think it’s gonna persist in skin for a long period of time. I’m the Adjunct Professor in Division of Infectious Disease at Duke and have been since about 1995, but in the context of the genus Bartonella, I clearly feel like sometimes I’ve been the kid in the woods yelling wolf and nobody else seems to believe there’s a wolf out there, but I do believe there’s a wolf out there.
If it were not for the AIDS epidemic and the recognition by dermatologists and pathologists of an unusual vasoproliferative lesion of the skin called bacillary angiomatosis, we possibly would not know that any animal or human on the North American continent and throughout much of the world was ever infected with Bartonella. What’s happened since the early 1990s is we’ve gone from not knowing these bacteria essentially existed to over 40 named species. The other thing that’s happened is that we now know that Bartonellas can be in gray squirrels, ground squirrels, flying squirrels, each having their own individual species that they’ve co-evolved with as well as bats, mice, rats, cats, dogs, cattle, sheep, and what makes this somewhat of a hidden epidemic is that periodically, these Bartonella that have co-evolved with a given animal species that remains chronically infected is they make the jump, somehow from that animal into a human. And perhaps one of the best examples is Bartonella mayotimonesis endocarditis that was diagnosed in a man at the Mayo Clinic a few years ago and at the time that his heart valve was removed, we did not know that that species existed and once it was removed, it was another 2 years before people figured out that that was a bat-associated Bartonella species. So, I think Bartonella is and has been for thousands and thousands of years a hidden epidemic that complicates the lives of physicians and other healthcare workers on a much more frequent basis than any of us would’ve guessed just a few short years ago.
That was Dr. Ed Breitschwerdt talking about Bartonella infections. For ReachMD, I’m Dr. Michael Greenberg, and to hear my full conversation with Dr. Breitschwerdt along with other episodes in this series, head on over to ReachMD.com/DermConsult, where you can Be Part of the Knowledge. Thanks for listening!