Bartonella infection

Bartonella species cause severe clinical syndromes in humans. The three most important pathogens responsible for the majority of infections are B henselae, B quintana, and B bacilliformis.

Some species are worldwide in distribution (B henselae), whereas others are geographically localised (B bacilliformis).

Bartonella species are transmitted from an infected natural host to the susceptible human host either by direct contact (cat bite or scratch for B henselae) or via an insect vector (body lice for B quintana, sand fly for B bacilliformis).

Bartonella species infect erythrocytes and cause vascular proliferation, giving rise to prolonged fever, lymphadenopathy, and hepatosplenomegaly.

Laboratory diagnosis is established by culture, serology, or histopathology. Molecular techniques such as polymerase chain reaction are useful for blood and tissue specimens, including heart valves, where available.

Treatment depends on the species of Bartonella and the type of clinical presentation, but usually consists of antibiotic therapy. In some cases (e.g., cat-scratch disease), needle aspiration may be necessary.

Human bartonellosis is caused by Bartonella, a genus of facultative intracellular bacteria. Since 1993, 45 Bartonella species have been identified, some of which have been reported to cause human infections.[1]Jacomo V, Kelly PJ, Raoult D. Natural history of Bartonella infections (an exception to Koch's postulate). Clin Diagn Lab Immunol. 2002;9:8-18. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC119901 http://www.ncbi.nlm.nih.gov/pubmed/11777823?tool=bestpractice.com [2]Chomel BB, Boulouis HJ, Maruyama S, et al. Bartonella spp. in pets and effect on human health. Emerg Infect Dis. 2006;12:389-394. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291446 http://www.ncbi.nlm.nih.gov/pubmed/16704774?tool=bestpractice.com [3]Okaro U, Addisu A, Casanas B, et al. Bartonella species, an emerging cause of blood-culture-negative endocarditis. Clin Microbiol Rev. 2017;30:709-746. http://www.ncbi.nlm.nih.gov/pubmed/28490579?tool=bestpractice.com

The three most common infections described in humans include: cat-scratch disease (B henselae); Carrion's disease (B bacilliformis), which consists of a bacteraemic phase (Oroya fever) and an eruptive phase (verruga peruana or Peruvian wart); and trench fever (B quintana).[4]Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev. 1997;10:203-219. http://cmr.asm.org/cgi/reprint/10/2/203?view=long&pmid=9105751 http://www.ncbi.nlm.nih.gov/pubmed/9105751?tool=bestpractice.com [5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com

Bartonella species are responsible for a broad spectrum of clinical syndromes, including prolonged fever of unknown origin, haematological manifestation, encephalitis and encephalopathy, generalised lymphadenopathy, hepatosplenic disease, retinopathy, culture-negative endocarditis, osteomyelitis, arthritis, mediastinal mass, and pleurisy.[4]Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev. 1997;10:203-219. http://cmr.asm.org/cgi/reprint/10/2/203?view=long&pmid=9105751 http://www.ncbi.nlm.nih.gov/pubmed/9105751?tool=bestpractice.com [5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com

B henselae and B quintana are also known to cause bacillary angiomatosis in immunocompromised hosts.[4]Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev. 1997;10:203-219. http://cmr.asm.org/cgi/reprint/10/2/203?view=long&pmid=9105751 http://www.ncbi.nlm.nih.gov/pubmed/9105751?tool=bestpractice.com [5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com

Human infections caused by other species of Bartonella (e.g., B vinsonii, B elizabethae, B clarridgeae, B grahamii, B alsatica, B rochalimae, B washoensis, and B koehlerae) do occur but are rare.[5]Maguina C, Gotuzzo E. Bartonellosis. New and old. Infect Dis Clin North Am. 2000;14:1-22. http://www.ncbi.nlm.nih.gov/pubmed/10738670?tool=bestpractice.com [6]Brouqui P, Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev. 2001;14:177-207. http://cmr.asm.org/cgi/content/full/14/1/177?view=long&pmid=11148009 http://www.ncbi.nlm.nih.gov/pubmed/11148009?tool=bestpractice.com [7]Daly JS, Worthington MG, Brenner DJ, et al. Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis. J Clin Microbiol. 1993;31:872-881. http://jcm.asm.org/cgi/reprint/31/4/872?view=long&pmid=7681847 http://www.ncbi.nlm.nih.gov/pubmed/7681847?tool=bestpractice.com [8]Roux V, Eykyn SJ, Wyllie S, et al. Bartonella vinsonii subsp. berkhoffii as an agent of afebrile blood culture-negative endocarditis in a human. J Clin Microbiol. 2000;38:1698-1700. http://jcm.asm.org/cgi/content/full/38/4/1698?view=long&pmid=10747175 http://www.ncbi.nlm.nih.gov/pubmed/10747175?tool=bestpractice.com [9]Avidor B, Graidy M, Efrat G, et al. Bartonella koehlerae, a new cat-associated agent of culture-negative human endocarditis. J Clin Microbiol. 2004;42:3462-3468. http://jcm.asm.org/cgi/content/full/42/8/3462?view=long&pmid=15297484 http://www.ncbi.nlm.nih.gov/pubmed/15297484?tool=bestpractice.com [10]Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother. 2004;48:1921-1933. http://aac.asm.org/cgi/content/full/48/6/1921?view=long&pmid=15155180 http://www.ncbi.nlm.nih.gov/pubmed/15155180?tool=bestpractice.com [11]Angelakis E, Lepidi H, Canel A, et al. Human case of Bartonella alsatica lymphadenitis. Emerg Infect Dis. 2008;14:1951-1953. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2634634 http://www.ncbi.nlm.nih.gov/pubmed/19046532?tool=bestpractice.com

Although predominantly an animal species, B vinsonii subsp. berkhoffii has been noted to cause human disease.[12]Breitschwerdt EB, Maggi RG, Lantos PM, et al. Bartonella vinsonii subsp. berkhoffii and Bartonella henselae bacteremia in a father and daughter with neurological disease. Parasit Vectors. 2010;3:29. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859367 http://www.ncbi.nlm.nih.gov/pubmed/20377863?tool=bestpractice.com Infections caused by B vinsonii subsp. arupensis in humans have been reported in France, Russia, and Nepal causing febrile illnesses, suggesting they are geographically widespread.[13]Bai Y, Kosoy MY, Diaz MH, et al. Bartonella vinsonii subsp. arupensis in humans, Thailand. Emerg Infect Dis. 2012;18:989-991. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358162 http://www.ncbi.nlm.nih.gov/pubmed/22607728?tool=bestpractice.com