Detection of Bartonella vinsonii subsp. berkhoffii in an HIV patient using metagenomic Next-Generation Sequencing

Abstract

Bartonella species are fastidious, aerobic bacteria that are transmitted by blood-sucking arthropods. Bartonella spp. are responsible for cat scratch disease, Carrion's disease, bacillary angiomatosis and trench fever. On the other hand, Bartonella vinsonii is rarely reported in the literature and there exist a few reports of systemic infection caused by Bartonella vinsonii in patients with acquired immunodeficiency syndrome. A 31-year-old male (diagnosed with AIDS six years ago) had persistent fever and ulceration in the right knee. The elevated levels of inflammatory markers suggested an infectious aetiology. Despite the negative findings of blood culture, metagenomic Next-Generation Sequencing of plasma detected Bartonella vinsonii. The polymerase chain reaction of whole blood and Sanger sequencing confirmed the mNGS findings. Immunohistochemical staining had later suggested bacillary angiomatosis, which was consistent with Bartonella infection. Following antibiotic treatment, the ulcers subsided significantly, but a high fever persisted. The patient died due to sudden respiratory failure.

Keywords: AIDS; Bartonella vinsonii; bacillary angiomatosis; metagenomic Next-Generation Sequencing.

Figure 1.

The diagnosis and treatment of Bartonella vinsonii infection. The lesion around the right knee was shown in (A), and red spots were seen on the right (B) and left leg (C) of the patient. mNGS results were shown in (D) and fluorescent PCR results were displayed in (E), in which blood samples collected from days 11, 13 and 14 after admission were shown as amplification curves 1 (red), 2 (green) and 3 (orange), respectively. Negative control was shown as curve 4 (dark blue). Sanger sequencing alignment was shown in (F). Haematoxylin and eosin (H&E) staining of biopsy tissue was shown in (G). Improvement of the right knee lesion was shown in (H) and the temperature chart of the patient during hospitalization was shown in (I).