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Bartonella Infection

Bartonelloses

Several forms of Bartonella infection have been described in the literature, the most important being cat-scratch disease, endocarditis, bacillary angiomatosis, and trench fever. Vectors and modes of acquisition depend on the underlying bacterial subtype. The diagnosis relies on clinical findings and use of various tests to confirm Bartonella as the causative agent, primarily serologic and molecular methods, such as polymerase chain reaction.


Presentation

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
  • To determine the prevalence of Bartonella infection among patients presenting with fever, we evaluated 382 patients in San Francisco.[ncbi.nlm.nih.gov]
  • Infections caused by Bartonella spp should be considered in transplant recipients with fever of unknown origin.[ncbi.nlm.nih.gov]
  • 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.[cmr.asm.org]
Anemia
  • […] infection Possibly cat fleas (which also transmit the organism among cats) ‡ Doxycycline † , erythromycin , rifampin , ( gentamicin IV added for 2 wk for endocarditis) Oroya fever , verruga peruana, Carrión disease B. bacilliformis Acute febrile hemolytic anemia[msdmanuals.com]
  • […] infection Possibly cat fleas (which also transmit the organism among cats) ‡ Doxycycline †, erythromycin, rifampin, ( gentamicin IV added for 2 wk for endocarditis) Oroya fever, verruga peruana, Carrión disease B. bacilliformis Acute febrile hemolytic anemia[merckmanuals.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]
  • Hematologic exams showed a moderate anemia. Serologic studies for HIV and Treponema pallidum were negative. The histopathologic results of two biopsies were compatible with Peruvian wart. Oral treatment with ciprofloxacin (500 mg BID) was begun.[ncbi.nlm.nih.gov]
  • 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]
Pallor
  • The most common findings were fever (usually sustained, but with temperature no greater than 39 C), pallor, malaise, nonpainful hepatomegaly, and lymphadenopathy.[doi.org]
  • Physical exam showed moderate pallor of skin and mucosa.[doi.org]
High Fever
  • 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]
  • 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]
  • 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]
Chills
  • 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]
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]
  • Hepatomegaly was present in all cases.[doi.org]
Skin Lesion
  • Although bartonellosis is a rare infection in liver transplantation recipients, it should always be included in the differential diagnosis of patients presenting with fever, central nervous system (CNS) symptoms, skin lesions, lymphadenopathy, and hepatitis[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • The bacilli, which could not be cultured, were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis.[doi.org]
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]
  • 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]
  • The 4 patients had some common clinical symptoms, such as headache, myalgias, dizziness, and fatigue. In addition, 3 of the patients had elevated levels of liver enzymes.[doi.org]
  • Within weeks of returning home, the patient visited a doctor complaining of fever, myalgia, difficulties sleeping, headaches, and mild cough.[doi.org]
  • The acute phase is characterized by fever, moderate to severe pallor, general discomfort and myalgias.[doi.org]
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]
  • Atypical presentations include prolonged fever ( 2 weeks), malaise, fatigue, myalgia and arthralgia, weight loss, splenomegaly, and Parinaud's oculoglandular syndrome ( 9 ).[doi.org]
Headache
  • […] 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]
  • 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]
  • Fever, malaise, headaches, hepatosplenomegaly, and lymphadenopathy are often present. Bartonella quintana-induced BA is primarily encountered in severely immunocompromised individuals and in homeless people.[symptoma.com]
  • 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]
  • This disease has two distinct phases: Oroya fever: During this phase, fever, headache, muscle aches, abdominal pain, and severe anemia may occur.[cdc.gov]
Stroke
  • […] antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke[emedicine.com]

Workup

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
  • 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]
  • 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.[symptoma.com]
  • Also positive Bartonella bacilliformis serology has been found in 60% of the inhabitants of endemic areas of Carrion's disease [5,12].[scielo.br]
  • Human Bartonellosis caused by Bartonella bacilliformis Topic: infectious diseases Author: Cesar Henriquez Camacho Keywords: human bartonellosis bacilliformis Versions: In Engllish: View lecture Original: Original type: PPT Submitted on: 12/07/2002 Last[pitt.edu]
  • The behavior of Bartonella bacilliformis in Macacus rhesus. Journal of Experimental Medicine 1926, 44: 697–714. Google Scholar 42. Noguchi H: Etiology of Oroya fever. IV. The effect of inoculation of anthropoid apes with Bartonella bacilliformis.[doi.org]
Blood Culture Positive
  • Among the 3 pregnant women who had eruptivephase bartonellosis, 1 had a blood culture positive for B. bacilliformis. All 3 women received antimicrobial therapy with rifampin, and the babies were born with no complications or lesions. Mortality.[doi.org]
  • In that study, homeless people with blood cultures positive for B. quintana were randomized to receive either no treatment (untreated controls) or a combination of gentamicin (3 mg/kg of body weight/day i.v. for 14 days) and doxycycline (200 mg/day p.o[doi.org]

Treatment

  • 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 of persons with both typical and atypical CSD.[ncbi.nlm.nih.gov]
  • Despite lack of a standard treatment, good visual outcomes were generally reported in patients with ocular bartonellosis.[ncbi.nlm.nih.gov]
  • Because there are only two reports of randomized clinical trials for the treatment of Bartonella infections, an unequivocal treatment for all Bartonella infections does not exist, and thus, antibiotic treatment recommendations differ for each clinical[doi.org]
  • Immunocompromised patients, such as those undergoing immunosuppressive treatments for cancer, organ transplant patients, and people with HIV/AIDS, are more likely to develop severe, life-threatening disease symptoms.[longislandlymedisease.com]

Prognosis

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

Etiology

  • 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.[cmr.asm.org]
  • Some reports have demonstrated the increased frequency of GA in patients with human immunodeficiency virus infection, again raising the possibility of an infectious etiology.[ncbi.nlm.nih.gov]
  • Further research is required to determine the etiologic agent.[ncbi.nlm.nih.gov]

Epidemiology

  • 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]
  • Table 1 lists the four Bartonella human pathogens along with the their known epidemiology and the scope and range of disease associated with each.[ncbi.nlm.nih.gov]
  • Poverty and louse infestation were the main epidemiological factors associated with B. quintana infections during wartime.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

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 ).[emedicine.com]

Prevention

  • 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]
  • Resources Centers for Disease Control and Prevention NIH/National Institute of Allergy and Infectious Diseases Office of Communications and Government Relations[longislandlymedisease.com]
  • Prevention of human infection depends on elucidation of the natural history and means of feline infection.[jcm.asm.org]
  • 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]
  • 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]

References

Article

  1. Chomel BB, Boulouis H-J, Breitschwerdt EB, et al. Ecological fitness and strategies of adaptation of Bartonella species to their hosts and vectors. Vet Res. 2009;40(2):29.
  2. Chomel BB, Boulouis H-J, Maruyama S, Breitschwerdt EB. Bartonella Spp. in Pets and Effect on Human Health. Emerg Infect Dis. 2006;12(3):389-394.
  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.
  4. Ciceroni L, Pinto A, Ciarrocchi S, Ciervo A. Bartonella infections in Italy. Clin Microbiol Infect. 2009;15(Suppl2):108-109.
  5. Edouard S, Nabet C, Lepidi H, Fournier P-E, Raoult D. Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review. Patel R, ed. Journal of Clinical Microbiology. 2015;53(3):824-829.
  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.
  7. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
  8. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013.

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Last updated: 2019-07-11 21:09