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Drugs & Diseases > Infectious Diseases
BARTONELLOSIS (BARTONELLA INFECTION)
Updated: Mar 09, 2022
* Author: Kassem A Hammoud, MD; Chief Editor: Pranatharthi Haran Chandrasekar,
MBBS, MD more...
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Sections
Bartonellosis (Bartonella Infection)
* Sections Bartonellosis (Bartonella Infection)
* Overview
* Background
* Pathophysiology
* Epidemiology
* Prognosis
* Show All
* Presentation
* History
* Physical
* Causes
* Show All
* DDx
* Workup
* Laboratory Studies
* Imaging Studies
* Other Tests
* Histologic Findings
* Show All
* Treatment
* Medical Care
* Surgical Care
* Consultations
* Prevention
* Show All
* Medication
* Medication Summary
* Antibiotics
* Show All
* Questions & Answers
* References
Overview
BACKGROUND
Bartonellosis comprises infections caused by pathogens in the genus Bartonella.
[1] In 1909, AL Barton described organisms that adhered to RBCs. The name
Bartonia, later Bartonella bacilliformis, was used for the only member of the
group identified before 1993. Rochalimaea (named for Rocha-Lima), a similar
group, were recently combined with Bartonella. Although these organisms were
originally thought to be rickettsiae, Bartonella bacteria can be grown on
artificial media, unlike rickettsiae.
Almost 20 species belong to the genus Bartonella. [1] Three Bartonella species
are currently considered important causes of human disease, but other
significant human pathogens in this genus were found to causes disease in humans
occasionally. In one study, serum specimens from 114 patients hospitalized with
a febrile illness were tested with an indirect immunofluorescence assay (IFA)
using rodent and human Bartonella pathogens; five patients had high-titer
seroconversion to rodent-associated Bartonella. [2]
B bacilliformis causes Oroya fever and verruga peruana. Bartonella henselae
causes cat scratch disease (CSD) and peliosis of the liver (often called
bacillary peliosis). Bartonella quintana causes trench fever. [3] Both B
henselae and B quintana may cause bacillary angiomatosis, infections in homeless
populations, and infections in patients with HIV. [1]
New Bartonella species that may cause human disease include Bartonella vinsonii
subspecies berkhoffii, Bartonella clarridgeiae, Bartonella tamiae, Bartonella
rochalimae,Bartonella elizabethae, Bartonellakoehlerae, Bartonella grahamii, and
Bartonellaalsatica. [1] Candidatus Bartonella mayotimonensis and Candidatus
Bartonella melophagi were respectively isolated from the aortic valve of a
patient with culture-negative endocarditis and the blood of two patients with
symptoms consistent with bartonellosis. [4, 5] Several of these other species
are found in animals. Candidatus Bartonella ancashi was isolated from the blood
of a patient with verruga peruana in Peru. [6] Numerous other Bartonella species
that can potentially cause human disease have been discovered in ticks.
For additional information on emerging and reemerging infectious diseases, see
Medscape’s Emerging and Reemerging Infectious Diseases Resource Center.
Next: Pathophysiology
PATHOPHYSIOLOGY
The transmission of Bartonella species occurs by traumatic contact with infected
animals or by vectors like cat fleas or other blood-sucking arthropods (eg, sand
fly, Phlebotomus for B bacilliformis). [1]
B bacilliformis, which uses a polar flagellum for motility, adheres to and
invades RBCs. After entry, the organism replicates in vacuoles. This species
also makes an endothelial cell–stimulating factor that causes proliferation of
both endothelial cells and blood vessels.
B henselae and B quintana do not bind to intact human erythrocytes in the same
way that B bacilliformis does; however, these organisms make a protein binder
that adheres to feline RBC membranes, and they penetrate into endothelial cells.
Both species also initiate production of an endothelial cell–stimulating factor.
Because lysis-centrifugation blood cultures show enhanced isolation of B
henselae and B quintana, intracellular forms are most likely present in humans.
Erythrocytes may serve as a reservoir for Bartonella species.
B quintana also invades endothelial cells and forms bacterial aggregates that
are taken internally by the invasome, a unique phagosomal structure. [7] These
proliferate and make intracellular blebs.
Previous
Next: Pathophysiology
EPIDEMIOLOGY
FREQUENCY
United States
Cat scratch disease caused by B henselae infection occurs in approximately 1 per
10,000 persons.
B quintana is found worldwide and causes febrile outbreaks. Poor sanitation and
lack of personal hygiene strongly correlate with transmission by the body louse
Pediculus humanus. B quintana is emerging as a recognized cause of disease among
homeless persons and persons with AIDS. Trench fever syndrome is found among
people with alcoholism and those who are homeless. Persons who are indigent in
inner-city Seattle were evaluated for antibodies to B quintana. Approximately
20% of these people had antibody titers of 1:64 or greater; in comparison, this
titer was found in only 2% of blood donors. [8]
International
B bacilliformis transmission is limited to the Andes Mountains at elevations of
1000-3000 meters because of the habitat of the sand fly Phlebotomus, now called
Lutzomyia. Outbreaks of B bacilliformis infection occur only in the Andes. Cases
elsewhere in the world are found in travelers.
B henselae is found throughout the world in association with both domestic and
feral cats. The cat flea Ctenocephalides felis is an arthropod vector. B
henselae and other Bartonella species have been isolated from ticks, but their
competence in disease transmission is unclear. [9, 10]
One study from Eastern China done on rabies clinic and blood donors (557
patients) found a seroprevalence of about 20%. Patients bitten by a dog had a
higher seroprevalence compared with blood donors (27% vs 14%). [11]
B quintana infection has been reported in 16% of homeless hospitalized patients
in France.
Other species, such as B clarridgeiae, may be a cause of asymptomatic infection
in cats.
Review of studies from the United States, Japan, and France showed a seasonality
in cat scratch disease. In the United States, most cases are diagnosed during
the last 6 months of the year, in Japan most of the transmission occurs from
September to December with a peak in November, and in France most cases were
found between September and April with a peak in December. This is likely
related to the weather, reproductive behavior of cats, their contact frequency
with humans, and flea activity. [12]
MORTALITY/MORBIDITY
Cat scratch disease usually causes self-limited regional adenopathy. Acute
hemiplegia has been reported in an 11-year-old boy. [13] Encephalopathy is the
most common neurologic complication but is rare.
B henselae is a common cause of culture-negative endocarditis. Valve replacement
is required in approximately 80% of cases, but overall prognosis is good, with
survival rates in excess of 80%. [14] In a 2003 article in Medicine by Houpikian
and Raoult, Bartonellaendocarditis was associated with B quintana in 75% of
cases and with B henselae in 25% of cases. They reported a mortality rate of 7%
among 99 patients with Bartonella endocarditis. [15]
Trench fever is a self-limited relapsing febrile illness. Affected persons
regularly recover, even without treatment. Liver abscesses and spleen abscesses
in the absence of endocarditis in an immunocompetent host have been described.
[16, 3]
Disseminated forms of bartonellosis develop in patients infected with HIV, solid
organ transplants and other immunocompromised patients. [17] Bacillary
angiomatosis and culture-negative endocarditis are caused by B henselae and B
quintana. Peliosis hepatis is caused by B henselae. Mortality is low but
morbidity is caused by direct organ involvement of bacillary angiomatosis;
relapses are common, especially with short courses of treatment.
Carrión disease commonly affects the pediatric population in Peru and Ecuador.
Mortality and morbidity of the acute phase vary because of superimposed
infections and other complications. Mortality rates associated with the eruptive
phase, known as Peruvian wart, are extremely low. [18]
SEX
Manifestations of cat scratch disease in pregnant women are the same as in
immunocompetent patients. An article by Bilavsky et al reviewed 19 women with
the disease. There was no major adverse effect on the pregnancy in all of them
except one abortion during the first trimester. Causality to cat scratch disease
could not be established. There was no deleterious effects on the newborns or
long-term sequelae in patients. [19]
Previous
Next: Pathophysiology
PROGNOSIS
Cat scratch disease rarely results in neurologic sequelae. Adenopathy persists
for 6-24 months in 20% of patients. After several months, the lesions of
visceral organs calcify or resolve.
Trench fever is a nonlethal and self-limiting disease, although relapses and
chronic bacteremic states are well known. [3]
Bartonella endocarditis has caused fatalities and usually requires surgical
repair. Of 22 cases reported by Raoult and colleagues in 1996, 19 patients
underwent valvular surgery, and 6 patients died. [20]
Immunocompromised patients with bacillary angiomatosis or peliosis hepatis
respond well to antibiotics. Relapse may occur.
Previous
Clinical Presentation
REFERENCES
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CONTRIBUTOR INFORMATION AND DISCLOSURES
Author
Kassem A Hammoud, MD Associate Professor, Division of Infectious Diseases,
University of Kansas Medical Center
Kassem A Hammoud, MD is a member of the following medical societies: Infectious
Diseases Society of America
Disclosure: Nothing to disclose.
Coauthor(s)
Daniel R Hinthorn, MD, FACP Vice Chair of Internal Medicine, Professor of
Internal Medicine, Pediatrics (Hon), and Family Medicine (Hon), Director,
Division of Infectious Diseases, University of Kansas Medical Center
Daniel R Hinthorn, MD, FACP is a member of the following medical societies:
American Academy of Family Physicians, American College of Physicians, American
Society for Microbiology, Infectious Diseases Society of America, International
Society for Antiviral Research, Kansas Medical Society
Disclosure: Nothing to disclose.
Brian S Edwards, MD † Consulting Staff, Department of Infectious Diseases,
Cotton O'Neil Clinic
Disclosure: Nothing to disclose.
Specialty Editor Board
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of
Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug
Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine,
Molecular Genetics and Microbiology, Medical University of South Carolina
College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson
Veterans Affairs Medical Center
Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical
societies: Charleston County Medical Association, Infectious Diseases Society of
America, South Carolina Infectious Diseases Society
Disclosure: Nothing to disclose.
Chief Editor
Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious
Disease, Department of Internal Medicine, Wayne State University School of
Medicine
Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical
societies: American College of Physicians, American Society for Microbiology,
International Immunocompromised Host Society, Infectious Diseases Society of
America
Disclosure: Nothing to disclose.
Additional Contributors
Larry I Lutwick, MD, FACP Editor-in-Chief, ID Cases; Moderator, Program for
Monitoring Emerging Diseases; Adjunct Professor of Medicine, State University of
New York Downstate College of Medicine
Larry I Lutwick, MD, FACP is a member of the following medical societies:
American Association for the Advancement of Science, American Association for
the Study of Liver Diseases, American College of Physicians, American Federation
for Clinical Research, American Society for Microbiology, Infectious Diseases
Society of America, Infectious Diseases Society of New York, International
Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs
Society of Practitioners in Infectious Diseases
Disclosure: Nothing to disclose.
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