Bartonella Infections
Basics
Description
- Fastidious intracellular anaerobic gram-negative bacilli:
- Infections manifest in two broad categories:
- Localized skin lesions and prominent regional lymphadenitis (cat-scratch disease [CSD])
- Bacteremia with localized vascular lesions in various organs with potential for persistent disseminated infection
- System(s) affected: cardiovascular, gastrointestinal (GI), heme/lymphatic/immunologic, hepatic, musculoskeletal, nervous, pulmonary, skin/exocrine, ocular, renal (rare)
- Synonym(s): bartonellosis; CSD; trench fever; Carrión disease; Oroya fever
Epidemiology
Incidence
- CSD: 9/100,000 annually in the United States (~25,000 cases)
- Carrión disease: 12.7/100 person-years in endemic areas (Andes Mountains); rare in the United States
- Endocarditis: estimated 3–4% of cases
- Others: unknown
Prevalence
- Worldwide
- Seroprevalence studies of B. henselae suggest that many childhood infections are asymptomatic:
- Seroprevalence in domestic cats is 25–51%.
- Highest in fall and winter
- Seroprevalence of B. quintana in homeless populations is ~10%.
Etiology and Pathophysiology
- Erythrocyte and endothelial cell invasion
- In immunocompetent hosts, disease progresses to granuloma and suppuration of lymph nodes.
- In immunocompromised hosts, can lead to angiogenesis with mixed inflammatory cell infiltrate
Genetics
No known genetic predisposition
Risk Factors
- Vector exposure with cutaneous inoculation
- B. henselae (CSD): domestic cat scratch/bite or transmitted horizontally from cat fleas and ticks
- Natural reservoir is the domestic cat.
- Transmission from dogs has been reported.
- B. quintana (trench fever): human body louse, most common in alcohol-dependent homeless males, possible flea (from rats and cats) vector
- Bartonella bacilliformis (Carrión disease): Lutzomyia sandflies from Andean South America
- B. henselae (CSD): domestic cat scratch/bite or transmitted horizontally from cat fleas and ticks
- Cell-mediated immune dysfunction (particularly in bacillary angiomatosis/bacillary peliosis)
- HIV infection (CD4+ lymphocyte count <100/μL)
- Chronic steroid use, immunosuppression, or alcohol abuse
- Vector control
- No evidence for effectiveness of postexposure chemoprophylaxis (3)[C]
- No evidence for routine testing of cats
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Citation
Domino, Frank J., et al., editors. "Bartonella Infections." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688799/0.3/Bartonella_Infections.
Bartonella Infections. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688799/0.3/Bartonella_Infections. Accessed December 12, 2024.
Bartonella Infections. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688799/0.3/Bartonella_Infections
Bartonella Infections [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 12]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688799/0.3/Bartonella_Infections.
* Article titles in AMA citation format should be in sentence-case
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