Bartonella infection

Last reviewed: 29 Aug 2022
Last updated: 01 Jun 2022

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)
More key diagnostic factors

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
Other diagnostic factors

Risk factors

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

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
More 1st investigations to order

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
More investigations to consider

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

Disclosures

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

Disclosures

SB declares that she has no competing interests.

Peer reviewers

Todd A. Florin, MD

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 topic.

Dennis A. Conrad, MD

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.

Katarina Westling, MD, PhD

Division of Infectious Diseases

Karolinska University Hospital

Huddinge

Stockholm

Sweden

Disclosures

KW declares that she has no competing interests.

  • Bartonella infection images
  • Differentials

    • Bacterial adenitis
    • Infectious mononucleosis
    • Cytomegalovirus infection
    More Differentials
  • Guidelines

    • CDC health information for international travel (yellow book): Bartonella infections
    • Infective endocarditis in childhood: 2015 update
    More Guidelines
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