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Bartonella infection

Последний просмотренный: 15 Sep 2025
Last updated: 13 Jun 2023

Резюме

定义

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)
Full details

Other diagnostic factors

  • gastrointestinal 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
  • gastrointestinal bleeding
Full details

Risk factors

  • cat scratches and bites
  • exposure to arthropod vectors
  • homelessness or poor living conditions
  • history of cardiac valvular disease
  • immunosuppression
Full details

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 cerebrospinal fluid (CSF) analysis
  • bone scan
Full details

Treatment algorithm

INITIAL

suspected Bartonella endocarditis

ACUTE

cat-scratch disease: no endocarditis, hepatic involvement or bacillary angiomatosis

trench fever: no endocarditis or bacillary angiomatosis

bacillary angiomatosis

peliosis hepatis or hepatosplenic microabscesses

confirmed Bartonella endocarditis

Carrion disease: Oroya fever

Carrion disease: verruga peruana

Bartonella vinsonii infection

Contributors

Authors

Janak Koirala, MD, MPH, FACP, FIDSA
Janak Koirala

Professor Emeritus of Medicine

Division of Infectious Diseases

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JK declares that he has no competing interests.

Vidya Sunadareshan, MD, MPH

Professor of Medicine

Chair, Division of Infectious Diseases

Southern Illinois University School of Medicine

Springfield

IL

Declarações

VS declares that she has no competing interests.

Sangita Basnet, MD, FAAP

Professor of Pediatrics

Department of Pediatrics

Southern Illinois University School of Medicine

Springfield

IL

Declarações

SB declares that she has no competing interests.

Revisores

Russell Wesley Steele, MD

​Professor of Pediatrics and Infectious Diseases

Tulane University School of Medicine

New Orleans

LA

Declarações

RWS declares that he has no competing interests.

Miguel G. Madariaga, MD, MSc

​Infectious Diseases Consultant

Naples Community Hospital

Naples

FL

Declarações

MGM declares that he has no competing interests.

Katarina Westling, MD, PhD

Division of Infectious Diseases

Karolinska University Hospital

Huddinge

Stockholm

Sweden

Declarações

KW declares that she has no competing interests.

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Referências

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Principais artigos

Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000 Mar;14(1):1-22;vii. Resumo

Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother. 2004 Jun;48(6):1921-33.Texto completo  Resumo

Florin TA, Zaoutis TE, Zaoutis LB. Beyond cat scratch disease: widening spectrum of Bartonella henselae infection. Pediatrics. 2008 May;121(5):e1413-25. Resumo

Centers for Disease Control and Prevention. Bartonella infection. Jan 2022 [internet publication].Texto completo

Prutsky G, Domecq JP, Mori L, et al. Treatment outcomes of human bartonellosis: a systematic review and meta-analysis. Int J Infect Dis. 2013 Oct;17(10):e811-9.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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  • Guidelines

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    Mais Guidelines
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