Bartonella and Coxiella infections presenting as systemic vasculitis: case series and review of literature. (10th September 2021)

• Record Type: Journal Article
• Authors: Beydon, Maxime; Rodriguez, Christophe; Karras, Alexandre; Cez, Alexandre; Rafat, Cédric; Jourde-Chiche, Noémie; Fain, Olivier; Philipponnet, Carole; Puéchal, Xavier; Dossier, Antoine; Dupin, Nicolas; Levy, Dan; Aureau, Inès; Guillevin, Loïc; Terrier, Benjamin
• Is Part Of: Rheumatology. Volume 61:Number 6(2022)
• Page Start: 2609
• Page End: 2618
• Publication Date: 2021-09-10
• Subjects: vasculitis -- Coxiella -- Bartonella -- infectious disease -- ANCA -- cryoglobulinaemia; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab691
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: Coxiella and Bartonella spp . display particular tropism for endothelial or endocardial tissues and an abnormal host response to infections with induced autoimmunity. We aimed, through a case series combined with a comprehensive literature review, to outline characteristics of Coxiella and Bartonella infections presenting as systemic vasculitis. Methods: We retrospectively included cases of definite Coxiella and Bartonella infections presenting with vasculitis features and performed a comprehensive literature review. Results: Six cases of Bartonella infections were added to 18 cases from literature review. Causative pathogens were mainly B. henselae . Bartonella infection mimicked ANCA-associated vasculitis in 83% with PR3-ANCA and presented as cryoglobulinaemic vasculitis in 8%. GN was present in 92%, and 88% had endocarditis. Complement fractions were low in 82% and rheumatoid factor positive in 85%. Kidney biopsies showed cell proliferation, mostly crescentic, with pauci-immune GN in 29%. Outcome was favourable, with the use of antibiotics alone in one-third. Five cases of Coxiella infections were added to 16 from literature review. Sixteen had small-vessel vasculitides, mainly cryoglobulinaemia vasculitis in 75%. One patient had polyarteritis nodosa-like vasculitis and four large-vessel vasculitis. Outcome was good except for one death. A highly sensitive next generation sequencing analysis on three Coxiella - and two Bartonella -related vasculitides biopsies did not find any bacterial DNA. Conclusion: Coxiella and Bartonella are both able to induce vasculitis but display distinct vasculitis features. Bartonella mimics PR3-ANCA-associated vasculitis in the setting of endocarditis, whereas Coxiella may induce vasculitis involving all vessel sizes.