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
- gastrointestinal symptoms
- bone and joint pain (trench fever)
- severe pallor (Oroya fever)
- hepatosplenomegaly (Oroya fever)
- dyspnoea, 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 haemorrhages (CSD, trench fever)
- chest pain
- gastrointestinal bleeding
- photophobia
Risk factors
- cat scratches and bites
- exposure to arthropod vectors
- homelessness or poor living conditions
- history of cardiac valvular disease
- 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's disease)
- culture: Bartonella bacilliformis (Carrion's disease)
- serology: B bacilliformis (Carrion's disease)
- immunofluorescence antibody (IFA) assay: B vinsonii
- polymerase chain reaction (PCR) assay: B vinsonii
- culture: B vinsonii
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's disease)
- echocardiogram
- CT abdomen
- lumbar puncture with cerebrospinal fluid (CSF) analysis
- bone scan
Treatment algorithm
suspected Bartonella endocarditis
cat-scratch disease: no endocarditis, hepatic involvement or bacillary angiomatosis
trench fever: no endocarditis or bacillary angiomatosis
bacillary angiomatosis
peliosis hepatis or hepatosplenic micro-abscesses
confirmed Bartonella endocarditis
Carrion's disease: Oroya fever
Carrion's disease: verruga peruana
Bartonella vinsonii infection
Contributors
Authors
Janak Koirala, MD, MPH, FACP, FIDSA
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
Russell Wesley Steele, MD
Professor of Pediatrics and Infectious Diseases
Tulane University School of Medicine
New Orleans
LA
Disclosures
RWS declares that he has no competing interests.
Miguel G. Madariaga, MD, MSc
Infectious Diseases Consultant
Naples Community Hospital
Naples
FL
Disclosures
MGM 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.
Differentials
- Bacterial adenitis
- Infectious mononucleosis
- Cytomegalovirus infection
More DifferentialsGuidelines
- CDC health information for international travel (yellow book): Bartonella infections
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: bartonellosis
More Guidelines- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer