Microsoft word - vol 7 no 3

NATIONAL VETERINARY LABORATORY
P.O. Box 239, 1Tice Road
Franklin Lakes, NJ 07417
877-NVL-LABS (877-685-5227)
www.natvetlab.com
NEWSLETTER
Therapy of Bartonella Infection and Disease
Evelyn E. Zuckerman, Editor
Summer 2008
Vol. 7, Number 3
In This Issue:
eliminated Bartonella infection. In this case, the How to use Table 2:
The summer 2008 issue of the NVL newsletter cause of the gingivitis was not due to Bartonella response to therapy of the treated cat and go to will discuss the therapy of Bartonella infected and Bartonella was only “in the background” in the the row corresponding to the % improvement cats. We will present ways to assess Bartonella cat. Cats that show 50-75% disease improvement, therapy considering various treatment outcomes.
with a titer decrease, also probably have multiple therapy in the corresponding columns to the Clinical Aspects of Bartonella
Most often, cats with Bartonella inflammatory diseases, treated with azithromycin, rifampin, or Healthy Cats:
improvement of their disease (Table 1 & Figures 1 & 2).1-4 However, we are often asked by inflammatory signs, evaluation of the elimination practitioners what to do when a Bartonella of Bartonella infection can only be accomplished infected cat with inflammatory disease does not respond fully, or at all, to antibiotic therapy.
Tables 2 & 3 present a summary of the various Cats with Inflammatory Bartonella
scenarios that may occur when practitioners Diseases:
treat Bartonella infected cats with inflammatorydiseases.
Jan Corbishley, VT, Oradell Animal Hospital,
Many inflammatory diseases of cats have a Paramus, NJ
polymicrobial etiology. That is, Bartonella, otherbacteria, fungi and viruses can act together, in Clinical Management of Bartonella Inflammatory Diseases
inflammation in many organ systems. Follow-upevaluations Disease Improvement
inflammatory diseases show that 80% had a at End of 21 Days of
Veterinarian’s Decision:
greater than 50% improvement and 33% had total Recommendations
Azithromycin
Further Therapy
resolution of their diseases (Table 1).
Table 1
Possibilities
Clinical Response of 7,086 Cats with
Assume Bartonella is not
eliminated: Re-treat for Bartonella Bartonella Diseases
1. No improvement
% Clinical
Improvement
Improved
Excellent
2. No improvement
Excellent 80-99%
Assume Bartonella is not
3. 10-49% improved
eliminated: Re-treat for Bartonella 4. 10-49% improved
Tables 2 and 3 present various clinical therapy scenarios that the practitioner may face when treatment of Bartonella infected diseased cats Assume Bartonella is not
eliminated: Re-treat for Bartonella results in only partial clinical resolution.
5. 50-99% improved
tables give likely explanations for observed therapy outcomes and make recommendations as to further clinical protocols to follow.
6. 50-99% improved
Bartonella infected cats with inflammatory diseases can be evaluated for resolution of their 7. 100% resolved
Bartonella infection using the therapy titration 8. 100% resolved but
The observation of clinical signs does not disease recurred
always correlate with the successful elimination of Bartonella infection. For example, a cat with Assume Bartonella is not
9. 100% resolved but
eliminated: Re-treat for Bartonella improvement even though antibiotic therapy has disease recurred
Clinical and Laboratory Evaluation of
Inflammatory Diseases and Bartonella Therapy
Therapy Titration
Evaluations
Practitioner’s Clinical
Evaluation:
Bartonella
Clinical
Recommendations
improved. If there is a titerdecrease-see Table 3 row 6- Disease Improvement
Infection Status
Response and
Titration Test
Dr. Patricia Burke, Tiogue Veterinary Clinic,
1. No improvement
Coventry, RI.
Bartonella Therapy- 8 Years
During our first 8 years of Bartonella testing, 2. No improvement
we have performed 9,782 therapy titration tests Bartonella-seropositive pet cats 6 months after 3. 10-49% improved
rifampin (n=469) and doxycycline (n=151). A 2 fold titer decrease occurred in 1,119 cats (11.4%) and a 4 fold or greater titer decrease 4. 10-49% improved
therapy titer decreases (treatment success) occurred in 87.9% of Bartonella-infected cats.
78 of 88 (88.6%) Bartonella-seropositive dogs also had post therapy titer decreases (2 fold n=8, 4 fold or greater n=70). Antibiotic therapy of Bartonella-seropositive cats and dogs can be 5. 50-99% improved
effectively monitored using a comparative WB Disease Recurrence after Therapy:
Although we do not have accurate statistics for 6. 50-99% improved
the recurrence of disease following Bartonella therapy, we estimate that approximately 15% of therapy. Most of these cats have a Bartonella 7. 100% resolved
titer decrease which suggests that the recurrence is due to something other than Bartonella. Bartonella is not thecause of diseaseSuccessful disease Disease Recurrence and Therapy Titrations:
8. 100% resolved
CELEBRATE!!
in 103 Cats
Therapy Titer
9. 100% resolved but
disease recurred
10. 100% resolved but
disease recurred
What Does a Positive Bartonella
Test Mean?
How to use Table 3:
References:
Healthy cat: cat is infected but not showing any
response to therapy of the treated cat and go to the 1. Hardy, W.D., Jr., Zuckerman, E.E., Corbishley, J. et al. Successful therapy of Bartonella henselae Cat with Inflammatory Disease:
bacteremic healthy pet cats. Annual Mtg, 1nfect Dis 1. Cat is infected and Bartonella is the sole agent therapy titration result and follow the evaluations Society of America, New Orleans, September, 1996.
and recommendations in the last 2 corresponding 2. Hardy, WD, Jr., Zuckerman, EE, Corbishley, J,Gold, JWM3, 2. Cat is infected and Bartonella is the partial Kiehn, TE, and Armstrong, DA. Efficacy of high cause of the disease (polymicrobial disease) or; dose, long duration Doxycycline or Azithromycin 3. Cat is infected and Bartonella is not the cause Bartonella Re-infection
treatment for Bartonella infections in pet cats.
of any of the disease- Bartonella is “in the Bartonella treated cats can be re-infected by
Internat Conf Am Soc for Rickettsiology, Big Sky, fleas or ticks after successful therapy. Thus, it is
Cat is NOT infected and the positive test imperative
life-long
3. Hardy, WD, Jr., Corbishley, J., & Zuckerman, (detection of antibody) is an indication of past instituted.
We do not have a test that can
E.E. Azithromycin therapy of Bartonella-infected infection. The cat cleared the infection before the determine if a cat has been re-infected. If you
cats with gingivitis and stomatitis. Am. Vet. Dental suspect that a cat has been re-infected the only
Soc. Meeting, Savannah, GA, October 2002.
4. Ketring, KL, Zuckerman, EE & Hardy, WD, Jr.
most cats remain infected for years, if not their option is to re-treat for presumed Bartonella
Bartonella: A new etiological agent of feline ocular infection.

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