Bartonella Infection: An Emerging Neglected Zoonotic Disease in Sudan

Abstract

Bartonella infection occurs in three forms: Cat scratch disease (CSD) due to Bartonella henselae, Trench fever due to Bartonella quintana and Carrión's disease caused by Bartonella bacilliformis. CSD occurs worldwide and may be present wherever cats are found. The bacteria infect the red cells of cats which are usually symptomless. Transmission of the bacteria between cats is usually by fleas. Transmission to humans is by cat bites and scratches. In this paper we describe CSD for the first time in Sudan. Human cases were diagnosed pathologically at a single histopathology service center in Khartoum, Sudan. Following written informed consent, twenty four cases were enrolled in 2013, 2014 and the first quarter of 2015. The sites affected included the skin, subcutaneous tissue, lymph nodes, the lung, the spleen, brain, bone, breast, gallbladder and retro-peritoneum. In half of the cases (12/24; 50%), lymph nodes were infected. The majority (9/12; 75%) of the infected nodes were cervical. In the Hematoxylin and Eosin stained sections the bacteria were seen as clumps of black small filamentous structures. They stained positive for melanin by Masson Fontana and Melan-A. The bacteria were identified as Bartonella henselae by a specific monoclonal antibody. The disease may be more common than is realized. A high clinical index of suspicion has to be maintained to diagnose cases of Bartonella in Sudan.