Culture of
Bartonella quintana
and
Bartonella henselae
from Human Samples: a 5-Year Experience (1993 to 1998)
Authors: La Scola Bernard , Raoult Didier 
Published: December 2019

Bartonella quintana
and
Bartonella henselae
are fastidious gram-negative bacteria responsible for bacillary angiomatosis, trench fever, cat scratch disease, and endocarditis. During a 5-year period, we received 2,043 samples for culture of
Bartonella
sp. We found
Bartonella
sp. to be the etiologic agent in 38 cases of endocarditis, 78 cases of cat scratch disease, 16 cases of bacteremia in homeless people, and 7 cases of bacillary angiomatosis. We correlated the results of positive cultures with the clinical form of the disease, type of sample, culture procedure, PCR-based genomic detection, and antibody determination. Seventy-two isolates of
B. quintana
and nine isolates of
B. henselae
from 43 patients were obtained. Sixty-three of the
B. quintana
isolates and two of the
B. henselae
isolates, obtained from patients with no prior antibiotic therapy, were stably subcultured. The sensitivity of culture was low when compared with that of PCR-based detection methods in valves of patients with endocarditis (44 and 81%, respectively), skin biopsy samples of patients with bacillary angiomatosis (43 and 100%, respectively), and lymph nodes of cat scratch disease (13 and 30%, respectively). Serological diagnosis was also more sensitive in cases of endocarditis (97%) and cat scratch disease (90%). Among endocarditis patients, the sensitivity of the shell vial culture assay was 28% when inoculated with blood samples and 44% when inoculated with valvular biopsy samples, and the sensitivity of both was significantly higher than that of culture on agar (5% for blood [
P
= 0.045] and 4% for valve biopsy samples [
P
< 0.0005]). The most efficient culture procedure was the subculture of blood culture broth into shell vials (sensitivity, 71%). For patients with endocarditis, previous antibiotic therapy significantly affected results of blood culture; no patient who had been administered antibiotics yielded a positive blood culture, whereas 80% of patients with no previous antibiotic therapy yielded positive blood cultures (
P
= 0.0006). Previous antibiotic therapy did not, however, prevent isolation of
Bartonella
sp. from cardiac valves but did prevent the establishment of strains, as none of the 15 isolates from treated patients could be successfully subcultured. For the diagnosis of
B. quintana
bacteremia in homeless people, the efficiency of systematic subculture of blood culture broth onto agar was higher than that of direct blood plating (respective sensitivities, 98 and 10% [
P
< 10
−7
]). Nevertheless, both procedures are complementary, since when used together their sensitivity reached 100%. All homeless people with positive blood cultures had negative serology. The isolation rate of
B. henselae
from PCR-positive lymph nodes, in patients with cat scratch disease, was significantly lower than that from valves of endocarditis patients and skin biopsy samples from bacillary angiomatosis patients (13 and 33%, respectively [
P
= 0.084]). In cases of bacillary angiomatosis for which an agent was identified to species level, the isolation rate of
B. henselae
was lower than the isolation rate of
B. quintana
(28 and 64%, respectively [
P
= 0.003]). If culture is to be considered an efficient tool for the diagnosis of several
Bartonella
-related diseases, methodologies need to be improved, notably for the recovery of
B. henselae
from lymph nodes of patients with cat scratch disease.