Microbiology & Immunology

of the Hematology System

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Objectives
At the end of this session student will be able
 Discuss the major bacteria that infect the Hematology system
 Discuss the major Viruses that infect the Hematology system
 Discuss the development of the T-cells and B-cells

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Course outline
Major bacteria that infect the Hematology system
Bartonella bacilliformis
o

o Bartonella hensellae

o Bartonella quintana

Major Viruses that infect the Hematology system

o HIV

o Parvovirus B19

Immunology aspects of Hematology system

 B-cell development

 T-cell development

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General characteristics of Bartonella
Sixteen species are included in the genus
Members of the genus are short (0.3 to 0.5 × 1.0 to 1.7 μm).
Gram negative rods
aerobic rods with fastidious growth requirements.
can also grow on enriched blood agar with prolonged
incubation time (1 to 6 weeks)
There different animal reservoirs without evidence of disease
Insect vectors are also implicated in human infections
Only three species are of medically important

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…cont’d
Bartonella bacilliformis
o the cause of Oroya fever and verruga peruana

Bartonella henselae
o which causes cat-scratch disease and bacillary
angiomatosis.

Bartonella quintana
o the cause of trench fever and bacillary
angiomatosis.

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Bartonella Bacilliformis
responsible for bartonellosis , an acute febrile illness

Infection is transmitted through a bite of infected sandflies of

the genus Lutzomyia

After the bite of an infected sand fly bacteria enter the blood

The bacteria multiply, and penetrate into erythrocytes

flagella provide the organisms with the mechanical force to

invade red blood cells
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…cont’d
B. bacilliformis produces a protein that promotes deformity
(indentation) of red blood cell membranes

Due to this the infected cells become fragile

This facilitates the clearance of erythrocytes by the

reticuloendothelial system

As a result anemia develops due to RBS destruction

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…cont’d
B. bacilliformis infection has two stages:
 the initial stage is Oroya fever, a serious infectious
anemia
 eruptive stage, verruga peruana

Oroya fever is characterized by

 rapid development of severe anemia

 enlargement of the spleen and liver, and hemorrhage

into the lymph nodes.

• the cytoplasm of cells lining the blood vessels may also fill with
bacteria

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…cont’d
The resulted endothelial swelling may lead to vascular
occlusion and thrombosis.
 mortality rate of untreated Oroya fever is about 40%.

Eruptive stage, verruga peruana is chronic cutaneous form

consists of vascular skin lesions that occur in successive crops
Begins within 2-8 weeks after the initial stages and lasts for a
year or longer
Epidemiologically bartonellosis is restrected to tropical Peru,
Colombia, and Ecuador and

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Laboratory diagnosis
B bacilliformis grows in semisolid nutrient agar
 It
contains 10% rabbit serum and 0.5% hemoglobin
Incubate at 28 °C for 10 days
turbidity develops in the medium indicates growth of the
bacteria
Gram negative smalle rods can be seen in gram staining or
Gemisa staining

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Treatment, prevention and control
Penicillin, streptomycin and chloramphenicol are effective in
Oroya fever
When blood transfusions is given together with antibiotic
treatment mortality rate is reduced
Control of the is disease can achieve through elimination of
sandy fly breeding areas.
Avoiding sandy fly bite can also important in preventing the
disease

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 Bartonella hensellae

B.hensellae is small gram negative rods

B. henselae is responsible for cat-scratch disease.
Cat-scratch disease is usually a benign, self-limited illness
manifested by fever and lymphadenopathy
Disease develops about 2 weeks after contact with a cat
A primary skin lesion (papule or pustule) appear at the site of
contact.
Patient may have also headache, sore throat, or conjunctivitis.
The regional lymph nodes are markedly enlarged and
sometimes tender

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…cont’d
The enlarged regional lymph nodes may persist for several
weeks.
They may suppurate and discharge pus.

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Laboratory diagnosis
The diagnosis of cat-scratch fever is based on
1) a suggestive history and physical findings
2) aspiration of pus from lymph nodes that contain no
bacteria culturable by routine methods
3) characteristic histopathologic findings with
granulomatous lesions, which may include bacteria
seen on silver-impregnated stains.

Culture of B henselae is generally not recommended for this

relatively benign disease.

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Treatment
Cat-scratch disease is usually self-limited.
Treatment is mainly supportive, with reassurance, hot moist
soaks, and analgesics.
Aspiration of pus or surgical removal of an excessively large
lymph node
Tetracycline or erythromycin therapy may be helpful.

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…cont’d
B henselae also associated with bacillary angiomatosis
A vascular proliferative disorder seen primarily in
immunocompromised patients.
It can also seen in some immunocompetent patients.
individuals with subacute endocarditis.
Primarily involving the skin, lymph nodes, or liver and spleen
 The diagnosis is confirmed by the characteristic
histopathologic findings.
silver-stained sections demonstrate the pleomorphic bacilli.
Bactria can isolated by direct culture of biopsies.

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…cont’d
chocolate agar and heart infusion agar with 5% rabbit blood is
a media of choose.
Blood sample can also used and inoculate to same media
Sample may also cultured in eukaryotic tissue culture
As the bacteria are slow growers incubation is long
incubated in 5% CO2 at 36 °C for a minimum of 3 weeks.
Definitive identification is obtained by sequencing all or part of
16S ribosomal RNA gene.

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…cont’d
Bacillary angiomatosis is treated with oral erythromycin or
doxycycline
In patient with sever illness gentamicin also added
Treatment is give for at least 2 months

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Bartonella quintana
causative organism of trench fever (also called "5-day" fever)
A prevalent disease during World War I
Infection can be asymptomatic or sever illness
Typically, patients have severe headache, fever, weakness, and
pain in the long bones (particularly the tibia).
The fever can recur at 5-day intervals
Trench fever does not cause death but the illness is sever
No animal reservoir for this disease
human body louse spreads disease from person-to-person.

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…cont’d
Disease is primarily restricted to the homeless population with
substandard personal hygiene.
More recently, B. quintana has been associated with bacillary
angiomatosis
Bacillary angiomatosis due to B. quintana primarily involves
the skin, subcutaneous tissues, and bones.
For diagnosis treatment of bacillart angiomatosis read the
previous slides.

axum university CHS 20