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)
- 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
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
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
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 microabscesses
confirmed Bartonella endocarditis
Carrion disease: Oroya fever
Carrion 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
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.
Differentials
- Bacterial adenitis
- Infectious mononucleosis
- Cytomegalovirus infection
More DifferentialsGuidelines
- CDC health information for international travel (yellow book): Bartonella infections
- Infective endocarditis in childhood: 2015 update
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