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Journal of Clinical Microbiology, August 2004, p. 3462-3468, Vol. 42, No. 8
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.8.3462-3468.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Bartonella koehlerae, a New Cat-Associated Agent of Culture-Negative Human Endocarditis

Boaz Avidor,1* Merav Graidy,1 Gabi Efrat,1 Cecilia Leibowitz,1 Gregory Shapira,1 Ami Schattner,2 Oren Zimhony,3 and Michael Giladi1,4

The Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases,1 Infectious Disease Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv,4 Department of Medicine,2 Infectious Disease Unit, Kaplan Medical Center, Rehovot, Israel3

Received 16 February 2004/ Returned for modification 26 March 2004/ Accepted 14 May 2004

Bartonella koehlerae is reported for the first time to be a human pathogen that causes culture-negative endocarditis. It is also shown that this species, isolated twice before from domestic cats, can be recovered as well from a stray cat population in Israel. This work follows a recent report of the same case in which the causative agent was misidentified as B. henselae, based on serology and PCR-restriction fragment length polymorphism (RFLP) analysis (A. Schattner, O. Zimhony, B. Avidor, and M. Gilad, Lancet 361:1786, 2003). B. koehlerae was identified in the valvular tissue of an endocarditis patient by DNA sequencing of the PCR products of two Bartonella genes: the genes for citrate synthase (gltA) and riboflavin synthase (ribC). The commonly used PCR-RFLP analysis of the TaqI-digested gltA PCR product did not distinguish between B. koehlerae and B. quintana or between B. elizabethae and B. clarridgeiae. PmlI digestion of the gltA amplification product failed to differentiate between B. quintana, B. clarridgeiae, and B. elizabethae. RFLP analysis of the heat shock protein (htrA) gene by TaqI digestion misidentified B. koehlerae as B. henselae. However, RFLP analysis of the ribC PCR product, digested with TaqI, was able to distinguish between the human endocarditis-associated Bartonella species tested, B. henselae, B. quintana, B. elizabethae, and B. koehlerae, as well as between the cat-associated Bartonella species, B. henselae and B. clarridgeiae. Given the expanding number of Bartonella species emerging as human pathogens, it is suggested that PCR-RFLP analysis for the diagnosis of Bartonella infections target several genes and be coupled with DNA sequencing to avoid species identification.

* Corresponding author. Mailing address: The Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases. Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv 64239, Israel. Phone: 972-3-697-3851. Fax: 972-3-697-3850. E-mail: bavidor{at}tasmc.health.gov.il.

Journal of Clinical Microbiology, August 2004, p. 3462-3468, Vol. 42, No. 8
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.8.3462-3468.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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