The clinical presentation of Bartonella infection is diverse, as different Bartonella species are responsible for several distinct illnesses [1] [2] [3] [4] [5]:

• Cat scratch disease (CSD) - As the name implies, CSD develops after being scratched or bitten by a cat. It is considered to be the most common form of Bartonella infection [4] [6] [7]. The disease is caused by Bartonella henselae, while cats remain a stable source of this bacterium due to cat fleas, their main vector [1] [7] [8]. The clinical course of the infection is mainly mild and self-limiting, with regional painful lymphadenopathy proximal to the site of the scratch or bite being the hallmark of CSD [2] [6]. The formation of a red-to-brown papule or a pustule at the site of the bite usually precedes lymph node enlargement [2]. Either single or multiple lymph nodes may be affected, and lymphadenopathy usually lasts about 2-3 months [6]. Less common features are fever, other constitutional symptoms, and a transient rash [8].
• Bacillary angiomatosis (BA) - A cutaneous infection caused by Bartonella henselae and Bartonella quintana, BA is distinguished by the appearance of skin-colored or red-to-purple nodules and/or papules [5] [7] [8]. Fever, malaise, headaches, hepatosplenomegaly, and lymphadenopathy are often present [7] [8]. Bartonella quintana-induced BA is primarily encountered in severely immunocompromised individuals and in homeless people [8]. On the other hand, Bartonella henselae causes BA in the immunocompetent patients, and lesions develop in visceral organs as well [2] [7] [8].
• Endocarditis - Bartonella henselae (particularly in patients who suffer from preexisting valvular lesions) and Bartonella quintana are becoming increasingly recognized as causes of endocarditis [2] [5] [8].
• Carrion's disease - This disease, caused by Bartonella bacilliformis, is restricted to certain regions of the Andes mountains in South America. This infection could be life-threatening in the absence of an early diagnosis and treatment [7] [8].
• Trench fever - Initially described during World War I, trench fever is caused by Bartonella quintana [7] [8]. Severely debilitating and recurrent cycles of fever, malaise, and bone pain are main clinical features [7] [8].

• Fever

  Trench fever [ 4, 5 ] Synonyms: shinbone fever, five-day fever, Wolhynia fever, quintana fever, His-Werner disease Epidemiology It is caused by B. quintana. Urban trench fever is now seen in alcoholics and the homeless. [patient.info]

  B. quintana is now also recognized as an etiological agent of fever and bacteremia, endocarditis, bacillary angiomatosis, and chronic lymphadenopathy. [ncbi.nlm.nih.gov]

  SUMMARY Bartonella (formerly Rochalimaea) quintana is the etiological agent of trench fever, a disease extensively reported during the World Wars. [doi.org]

  When he became ill with Oroya fever, the connection became apparent. Oroya fever is often called Carrion's disease in honor of his fatal experiment. [medical-dictionary.thefreedictionary.com]

• Anemia

  In the process, up to 90% of the host's erythrocytes are destroyed, causing severe hemolytic anemia. The anemia is accompanied by high fever, muscle and joint pain, delirium, and possibly coma. [medical-dictionary.thefreedictionary.com]

  In modern Peru, symptomatic patients who have acute-phase bartonellosis typically present with a febrile illness and systemic symptoms caused by profound anemia; most patients respond successfully to treatment with chloramphenicol. [ncbi.nlm.nih.gov]

  […] log in. bar·ton·el·lo·sis | \ -ˌel-ˈō-səs \ plural bartonelloses\ -ˌsēz \ : a disease or infection caused by bacteria of the genus Bartonella specifically : a disease of mammals including humans that occurs in South America, is characterized by severe anemia [merriam-webster.com]

  Bartonella bacilliformis can cause acute febrile anemia, designated oroya fever, and a benign skin eruption, called verruga peruana. [icd10data.com]

• Asymptomatic

  This disease should remain confined to its present endemic geographic areas in South American unless asymptomatic bacteremic persons from these areas migrate to areas where sandflies and humans exist that are capable of establishing this infection in [ncbi.nlm.nih.gov]

  In endemic areas, 60% of the population is seropositive to the bacteria and 10% to 15% are asymptomatic carriers. The latter are the disease reservoirs [5,12]. [scielo.br]

  The illness develops through two phases: the acute hematic phase, or Oroya fever, and the eruptive phase or Peruvian wart, both separated by an asymptomatic period. [doi.org]

• High Fever

  […] oroya fever, verruga peruana [merriam-webster.com]

  From Biology-Online Dictionary | Biology-Online Dictionary Jump to: navigation, search Carrions disease --> oroya fever a generalised, acute, febrile, endemic, and systemic form of bartonellosis; marked by high fever, rheumatic pains, progressive, severe [biology-online.org]

  The anemia is accompanied by high fever, muscle and joint pain, delirium, and possibly coma. Two to eight weeks after the acute phase, an infected individual develops verruga peruana. [medical-dictionary.thefreedictionary.com]

  Symptoms onset: Sudden with high fever, chills,severe headache, back pain. The symptoms may reappear at five day intervals and thus the disease is also called five day fever. [lyme-symptoms.com]

• Weight Loss

  Weight loss of 4.5 to 16 kg (10 to 35 lb) and cachexia (exact weight loss unknown) were also seen. Hepatomegaly was present in every patient, sometimes manifested as abdominal distention. [doi.org]

  B. vinsonii subsp. berkhoffii: Symptoms- progressive weight loss, muscle weakness, lack of coordination, headaches, muscle pain, insomnia arthralgias,profound fatigue, becoming progressively severe. [lyme-symptoms.com]

• Abdominal Pain

  This disease has two distinct phases: Oroya fever: During this phase, fever, headache, muscle aches, abdominal pain, and severe anemia may occur. [cdc.gov]

  B. washoensis: (Oropsylla Montana fleas fever) Symptoms- Meningitis, early sepsis, chills, nausea, sometimes vomiting, and epigastric and lower left side abdominal pain. Headache with severe bilateral pain in the frontal and occipital areas. [lyme-symptoms.com]

  Read More » Severe abdominal pain. Pain in your chest, legs or back. Constipation or diarrhea. Nausea and vomiting. Muscle pain, tingling, numbness, weakness or paralysis. Red or brown urine. [personalconsult.com]

  Clinically, most of these patients presented with constitutional symptoms such as weight loss and fever in addition to gastrointestinal symptoms or abdominal pain. Hepatomegaly was present in all cases. [doi.org]

• Hepatomegaly

  The most common findings were fever (usually sustained, but with temperature no greater than 39°C), pallor, malaise, nonpainful hepatomegaly, and lymphadenopathy. [doi.org]

• Jaundice

  The first, Oroya fever, occurs approximately 60 days following the bite of an infected sand fly, in which infection of nearly all erythrocytes results in an acute hemolytic anemia with attendant symptoms of fever, jaundice, and myalgia. [go.gale.com]

• Myalgia

  […] came to prominence in the first world war. manifestations of trench fever ranged from a mild influenza-like illness to a debilitating protracted or recurrent disease onset may be insidious or abrupt recognised manifestations include fevers, headache, myalgia [gpnotebook.co.uk]

  The first, Oroya fever, occurs approximately 60 days following the bite of an infected sand fly, in which infection of nearly all erythrocytes results in an acute hemolytic anemia with attendant symptoms of fever, jaundice, and myalgia. [go.gale.com]

  Although more investigations are needed, current research suggests that symptoms of Bartonella infection may include recurring fever, headaches, insomnia, joint and muscle pain, arthropathy, myalgia, neurologic dysfunction, and vasculitis. [physiciansweekly.com]

  Symptoms of fatigue, headache, myalgia, anemia, and mild liver function abnormalities B. taylorii: from genus Grahamella. T ransmitted by rodent flea Ctenophthalmus nobilis. B. vinsonii: from genus Rochalimeae. vector voles. [lyme-symptoms.com]

• Arthralgia

  Patients who have eruptive-phase bartonellosis most often present with cutaneous verrugas but may have less specific symptoms, such as fever and arthralgias; diagnosis can be confirmed in such patients by Western immunoblotting, and most patients appear [ncbi.nlm.nih.gov]

  B. vinsonii subsp. berkhoffii: Symptoms- progressive weight loss, muscle weakness, lack of coordination, headaches, muscle pain, insomnia arthralgias,profound fatigue, becoming progressively severe. [lyme-symptoms.com]

• Skin Lesion

  Some Bartonella Infections Species Manifestations* At Risk Insect Vector Treatment Bacillary angiomatosis B. henselae, B. quintana Verrucous, fleshy skin lesions Disseminated visceral disease Lymphadenopathy Hepatosplenomegaly Immunocompromised patients [msdmanuals.com]

  Some survivors later developed a skin disease, called verruga peruana (Peruvian warts ). These skin lesions were observed prior to the 1871 outbreak-perhaps as far back as the pre-Columbian era-but a connection to Oroya fever was unknown. [medical-dictionary.thefreedictionary.com]

• Headache

  Other symptoms include joint, bone and muscle pain, headache, dizziness and pain behind the eyes. Some patients have diffuse symptoms without fever. It may cause culture-negative endocarditis. [patient.info]

  Symptoms onset: Sudden with high fever, chills,severe headache, back pain. The symptoms may reappear at five day intervals and thus the disease is also called five day fever. [lyme-symptoms.com]

  […] disease that came to prominence in the first world war. manifestations of trench fever ranged from a mild influenza-like illness to a debilitating protracted or recurrent disease onset may be insidious or abrupt recognised manifestations include fevers, headache [gpnotebook.co.uk]

  This disease has two distinct phases: Oroya fever: During this phase, fever, headache, muscle aches, abdominal pain, and severe anemia may occur. [cdc.gov]

• Neglect

  Vinetz, JM, Minnick, MF, Anderson, BE, Lima, A, Battisti, JM, Lawyer, PG and Birtles, RJ ORCID: https://orcid.org/0000-0002-4216-5044 2014, 'Oroya fever and verruga peruana: Bartonelloses unique to South America', PLoS Neglected Tropical Diseases, 8 [usir.salford.ac.uk]

  PLoS Neglected Tropical Diseases, vol. 8, no. 7, 2014. Accessed 12 Mar. 2020. Gale Document Number: GALE|A383328479 [go.gale.com]

  PLOS Neglected Tropical Diseases. Collection. https://doi.org/10.1371/journal.pntd.0002919 [plos.figshare.com]

The diagnosis of Bartonella infection may not be easy to attain without an extensive clinical and laboratory workup. For this reason, a detailed patient history and a thorough physical assessment are of essential importance in raising clinical suspicion. Preexisting infections and comorbidities (particularly immunosuppressive states and valvular heart disease), recent travel to South America, socioeconomic status, and close contact with cats, should be covered during history taking. On the other hand, physical findings could be even more persuading in pursuing a diagnosis of Bartonella infection, particularly in the setting of characteristic nodules or lymphadenopathy.

Laboratory studies, however, are the cornerstone in confirming the disease. Identification of specific IgM or IgG antibody titers through serologic testing is considered to be the optimal test, but antibody testing is not able to discriminate between different species of Bartonella [3] [8]. Blood cultures are, by some authors, a very reliable method, but problematic details such as a very long procedure time reduce its use in general practice [7] [8]. The introduction of molecular methods, mainly polymerase chain reaction (PCR), has greatly improved the overall diagnosis of bacterial infections, and they are highly recommended in the setting of Bartonella infections, as they can identify the exact species responsible for the infection [3] [5] [7].

• Bartonella Bacilliformis

  […] an acute infection caused by Bartonella bacilliformis, transmitted by the bite of a sandfly. [medical-dictionary.thefreedictionary.com]

  Keywords: Bartonellosis; Bartonella bacilliformis ; Carrion's disease; Epidemiology; High Forest; Peru. [doi.org]

  Infections by the genus bartonella. Bartonella bacilliformis can cause acute febrile anemia, designated oroya fever, and a benign skin eruption, called verruga peruana. [icd10data.com]

  Human diseases that have been identified to be caused by one of the Bartonella bacteria include; cat scratch fever (Bartonella henselae), Carrion’s disease (Bartonella bacilliformis), and trench fever (Bartonella quintana). [longislandlymedisease.com]

• Blood Culture Positive

  Of the 77 patients with eruptive-phase bartonellosis, only 15 had a thin-film blood smear done; the results for 2 (13%) of 15 patients were positive, and both of those patients also had positive blood cultures for B. bacilliformis. [doi.org]

While some of these diseases can resolve spontaneously without treatment, in other cases, the disease is fatal without antibiotic treatment. [ncbi.nlm.nih.gov]

Treatment References Angelakis E, Raoult D. Pathogenicity and treatment of Bartonella infections. Int J Antimicrob Agents 2014;44:16–25. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D. [cdc.gov]

Prognosis Usually self-limiting. Trench fever re-infection may occur within 3-6 months because antibodies do not give full protection. [patient.info]

Abstracts: Thirty-Fifth Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 4‐8, 2012; San Antonio, TX Abstract Inflammatory breast cancer (IBC) is a very aggressive type of advanced breast cancer with a poor prognosis. [cancerres.aacrjournals.org]

Prognosis Antibiotics have dramatically decreased the fatality associated with bartonellosis. Prior to the development of antibiotics, the fever was fatal in 40% of cases. With antibiotic treatment, that rate has dropped to 8%. [medical-dictionary.thefreedictionary.com]

There was no deleterious effects on the newborns or long-term sequelae in patients. [16] Prognosis Catscratch disease rarely results in neurologic sequelae. Adenopathy persists for 6-24 months in 20% of patients. [emedicine.medscape.com]

B. quintana is now also recognized as an etiological agent of fever and bacteremia, endocarditis, bacillary angiomatosis, and chronic lymphadenopathy. [ncbi.nlm.nih.gov]

SUMMARY Bartonella (formerly Rochalimaea) quintana is the etiological agent of trench fever, a disease extensively reported during the World Wars. [doi.org]

SUMMARY: Bartonella infections continue to be a burden worldwide and epidemiologic features may guide preventive measures in high-risk regions and populations. [ncbi.nlm.nih.gov]

Poverty and louse infestation were the main epidemiological factors associated with B. quintana infections during wartime. [doi.org]

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 ). [emedicine.medscape.com]

Prevention Avoiding sandfly bites is the primary means of prevention. Sandfly eradication programs have been helpful in decreasing the sandfly population, and insect repellant can be effective in preventing sandfly bites. [medical-dictionary.thefreedictionary.com]

SUMMARY: Bartonella infections continue to be a burden worldwide and epidemiologic features may guide preventive measures in high-risk regions and populations. [ncbi.nlm.nih.gov]

Prevention of human infection depends on elucidation of the natural history and means of feline infection. [jcm.asm.org]

Resources Centers for Disease Control and Prevention http://www.cdc.gov/ NIH/National Institute of Allergy and Infectious Diseases Office of Communications and Government Relations http://www.niaid.nih.gov/ [longislandlymedisease.com]

Peruski Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (Y. Bai, M.Y. Kosoy) ; Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.H. Diaz, J. [doi.org]

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3. Kosoy M, Bai Y, Sheff K, et al. Identification of Bartonella Infections in Febrile Human Patients from Thailand and Their Potential Animal Reservoirs. Am J Trop Med Hyg. 2010;82(6):1140-1145.
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6. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D. Recommendations for Treatment of Human Infections Caused by Bartonella Species. Antimicrob Agents Chemother. 2004;48(6):1921-1933.
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