Bartonellosis

A gram-negative bacterial infection caused by bacteria of the genus Bartonella, transmitted by ticks, flies and mosquitoes and is characterized by fever, headache, muscle pain, enlargement of the lymph nodes and anemia

Cat scratch disease lesion

Cause

A bacterial infection caused by bartonella henselae.

Transmission

It is transmitted to humans from a scratch, bite, or lick from a cat.

Cat scratch disease (CSD), Bartonella henselae

• Low-grade fever
• Enlarged, tender lymph nodes that develop 1–3 weeks after exposure
• A papule or pustule at the site of the scratch

Rarely, eye infections, severe muscle pain, or encephalitis (swelling of the brain) may occur.

Cat-scratch-disease

Trench fever, Bartonella quintana

• Fever (may occur once or repeatedly)
• Headache
• Rash
• Bone pain, mainly in the shins, neck, and back

Carrión’s disease, Bartonella bacilliformis

Verruga peruana, mular form.

This disease has two distinct phases:

• Oroya fever: During this phase, fever, headache, muscle aches, abdominal pain, and severe anemia may occur.
• Verruga peruana (Peruvian warts): During this later phase, growths form under the skin and develop into red-to-purple vascular sores that can become raw or bleed.

Phlebotomus sp

Diagnosis

• CSD may be diagnosed presumptively in patients with typical signs and symptoms and a compatible exposure history. Serology can confirm the diagnosis, although cross-reactivity may limit interpretation in some circumstances. In general, lymph node aspiration is not recommended except to relieve severe pain and swelling or in cases where the diagnosis is unclear.
  • B. henselae DNA may be detected by PCR or culture of lymph node aspirates or blood, though sensitivity of these methods is not optimal for blood samples.
  • Since B. henselae is a fastidious, slow-growing bacterium, cultures should be held for a minimum of 21 days.
• Trench fever can be diagnosed by isolation of B. quintana from blood cultured on blood or chocolate agar under 5% CO2. Microcolonies can be seen after 21 days of incubation at 37°C.
  • Trench fever can also be diagnosed by serology.
• Carrión’s disease is typically diagnosed via blood culture or direct observation of the bacilli in peripheral blood smears during the acute phase of infection (Oroya fever).
• Endocarditis due to Bartonella species can be diagnosed by serology and by PCR or culture of excised heart valve tissue.

Treatment

The use of antibiotics to shorten the course of disease is debated. Most cases of cat scratch disease (CSD) resolve without treatment, although some patients may develop complications from disseminated disease. Azithromycin has been shown to decrease lymph node volume more rapidly compared to no treatment. The recommended dose of azithromycin for CSD is:

• For adults and children > 45.5 kg: 500 mg on day 1, followed by 250 mg for 4 days
• For children ≤ 45.5 kg: 10 mg/kg on day 1, followed by 5 mg/kg for 4 days

A number of other antibiotics are effective against Bartonella infections, including penicillins, tetracyclines, cephalosporins, and aminoglycosides. Since aminoglycosides are bactericidal, they are typically used as first-line treatment for Bartonella infections other than CSD. Often, with serious infections, more than one antibiotic is used.

Trench fever, Carrión’s disease, and endocarditis due to Bartonella spp. are serious infections that require antibiotic treatment. Health care providers should consult with an expert in infectious diseases regarding treatment options.

Cat scratch disease

Other complications

Bacillary angiomatosis

Bacillary angiomatosis (caused by B. henselae or B. quintana) and bacillary peliosis (caused by B. henselae) occur primarily in people with weakened immune systems, such as those with advanced HIV infection. Bacillary angiomatosis may result in lesions in the skin, under the skin, in bone, or in other organs. Bacillary peliosis causes sores in the liver and spleen.

Subacute endocarditis

Many Bartonella species can cause infection of the heart valves (subacute endocarditis), which is often culture negative

Cat scratch disease

Prevention of bartonella henselae

• Avoid rough play with cats, particularly strays and kittens, to prevent scratches. This is especially important for people who have weakened immune systems.
• Wash hands promptly after handling cats.
• Treat cats for fleas using fipronil and other spot-on treatments.
• Products that contain permethrin should not be used on cats.
• Use a flea collar or similar topical preventive on dogs (fipronil, methoprene, imidocloprid, or permethrin), especially if you have both cats and dogs in your household.
• Keep cats indoors and away from stray cats.
• People who have weakened immune systems should avoid owning cats less than one-year-old.
• Trench fever, Bartonella quintana
• Avoid exposure to human body lice. Body lice are typically associated with crowded living conditions and limited access to bathing and clean clothes.
• Do not share clothing, beds, bedding, and towels used by a person who might have body lice.
• Information about treating body lice is also available.

Prevention of Carrión’s disease, Bartonella bacilliformis

• Use insect repellentsexternal icon and wear long-sleeved shirts and long pants to avoid sand fly bites in areas where Carrión’s disease is common (South America).
• If possible, limit outdoor activities at dawn and dusk, when sand flies are most active.

Bartonellosis Resources
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