Last reviewed: November 2017
Last updated: June  2017

Summary

Definition

History and exam

Key diagnostic factors

  • fever
  • skin manifestations (cat-scratch disease [CSD])
  • lymphadenopathy (CSD, Oroya fever)
  • episodic abdominal pain (CSD)
  • headache, post-orbital (trench fever)
  • maculopapular rash (trench fever)
  • nodular skin lesions (verruga peruana, Peruvian wart)

Other diagnostic factors

  • GI symptoms
  • bone and joint pain (trench fever)
  • severe pallor (Oroya fever)
  • hepatosplenomegaly (Oroya fever)
  • dyspnea, heart murmur, and signs of cardiac failure (CSD, trench fever)
  • mental state changes (CSD, Oroya fever)
  • nuchal rigidity (CSD)
  • red eye (CSD, trench fever)
  • painless visual loss, with unilateral, abrupt onset (CSD)
  • bone pain (CSD)
  • mastoiditis (CSD)
  • Janeway lesions, Osler nodes, or splinter hemorrhages (CSD, trench fever)
  • chest pain
  • photophobia
  • GI bleeding

Risk factors

  • cat scratches and bites
  • exposure to arthropod vectors
  • homelessness or poor living conditions
  • exposure to ticks
  • immunosuppression

Diagnostic investigations

1st investigations to order

  • serology: Bartonella henselae (cat-scratch disease [CSD])
  • culture: B henselae (CSD)
  • aspiration or biopsy of lymph nodes (CSD)
  • serology: B quintana (trench fever)
  • culture: Bartonella quintana (trench fever)
  • blood smear (Carrion disease)
  • culture: Bartonella bacilliformis (Carrion disease)
  • serology: B bacilliformis (Carrion disease)
  • culture: B vinsonii
  • immunofluorescence antibody (IFA) assay: B vinsonii
  • polymerase chain reaction (PCR) assay: B vinsonii
Full details

Investigations to consider

  • PCR: B henselae (CSD)
  • tuberculin skin testing (TST)
  • interferon-gamma release assays (IGRA)
  • PCR: B quintana (trench fever)
  • tissue biopsy (trench fever)
  • tissue biopsy (Carrion disease)
  • echocardiogram
  • CT abdomen
  • lumbar puncture with CSF analysis
  • bone scan
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Janak Koirala

Professor of Medicine

Chair, Division of Infectious Diseases

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JK declares that he has no competing interests.

Associate Professor of Medicine

Division of Infectious Diseases

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

VS declares that she has no competing interests.

Associate Professor

Department of Pediatrics

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

SB declares that she has no competing interests.

Peer reviewers VIEW ALL

Chief Resident and Clinical Instructor

Department of Pediatrics

The Children's Hospital of Philadelphia

Philadelphia

PA

Disclosures

TAF is an author of a reference cited in this monograph.

Professor of Pediatrics

Division of Immunology and Infectious Diseases

University of Texas Health Science Center

San Antonio

TX

Disclosures

DAC declares that he has no competing interests.

Division of Infectious Diseases

Karolinska University Hospital

Huddinge

Stockholm

Sweden

Disclosures

KW declares that she has no competing interests.

Use of this content is subject to our disclaimer