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 BartonellaBartonella 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 Bartonella4. 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 Bartonella7. 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 henselaeCat 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.
Evaluation of Medicines for Human Use COMMITTEE ON HERBAL MEDICINAL PRODUCTS ASSESSMENT REPORT ON VALERIANA OFFICINALIS L., RADIX well-established use: traditional use: well-established use: traditional use: - dry extracts prepared with water - valerian tincture - expressed juice from fresh root - valerian root oil solid or liquid dosage forms for ora
response curve, an unknown specimen's activity can be correlated One (1) vial contains a strong acid (0.5M H2SO4). Store at 8.0 REAGENT PREPARATION 2-30 ° C. 1. Working Enzyme Reagent - Stable for 1 year. 3.0 PRINCIPLE I. Product Instructions Measure 0.7 ml of ‘17-OH Progesterone Enzyme Reagent’ and add to the vial containing Steroid Conjugate Buffer. Store a
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