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Bartonellas excluding B. bacilliformis 

Bartonellas excluding B. bacilliformis

Chapter:
Bartonellas excluding B. bacilliformis
Author(s):

Emmanouil Angelakis

, Didier Raoult

, and Jean-Marc Rolain

DOI:
10.1093/med/9780199204854.003.070642_update_001

Update:

Genetics—transfer of plasmid from bartonella to other bacteria has been demonstrated for the first time.

Epidemiology—B. alsatica has been detected in a lymph node of a patient being bitten by a rabbit and in rabbit fleas.

B. quintana has been detected in head louse nits of a homeless man.

B. henselae has been identified in skin biopsy from patients with cat scratch disease.

Identification—MALDI-TOF is an accurate rapid diagnostic tool for bartonella species.

Further reading—references updated.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 28 April 2017

Bartonella species are Gram-negative bacilli or coccobacilli belonging to the α‎2 subgroup of Proteobacteria that are closely related to the genera Brucella and Agrobacterium. Each persists in particular mammalian hosts, with transmission to humans primarily mediated by haematophagous arthropods. A remarkable feature of the genus Bartonella is the ability of a single species to cause either acute or chronic infection with either vascular, proliferative, or suppurative features, the pathological response to infection varying substantially with the host’s immunocompetence.

Clinical features

Cat-scratch disease—the most common Bartonella zoonosis, caused by B. henselae, with transmission usually occurring directly by a cat scratch. Typical presentation is with history of a cat scratch and/or bite and locoregional lymphadenopathy (which may persist for months), sometimes with fever and constitutional symptoms. A few cases present with severe systemic symptoms indicating disseminated infection. Encephalopathy and neuroretinitis are uncommon manifestations.

Trench fever—caused by B. quintana; transmitted by the body louse; typically presents as an acute febrile illness often accompanied by severe headache and pain in the long bones of the legs.

Bacillary angiomatosis—caused by B. henselae or B. quintana, particularly in immunocompromised patients (mainly those with HIV infection); presents with the gradual appearance of numerous brown to violaceous or colourless vascular tumours of the skin and subcutaneous tissues.

Bacillary peliosis—reported in immunosuppressed patients infected with B. henselae; causes vascular proliferation in solid internal organs with reticuloendothelial elements, particularly the liver (peliosis hepatis).

Bacteraemia and endocarditis—‘culture-negative’ and usually caused by B. quintana or B. henselae; patients with abnormal heart valves and those with chronic alcohol abuse are at particular risk.

Diagnosis, treatment, and prevention

Diagnosis—this is difficult because of the fastidious nature of bartonella and the nonspecific clinical manifestations; diagnostic techniques include culture from blood and other tissues, detection of organisms in lymph nodes by immunofluorescence, PCR amplification of bartonella genes, and serology.

Treatment—bartonella is susceptible to many antibiotics when grown in the laboratory, but this correlates poorly with in vivo efficacy. General recommendations are as follows: (1) cat-scratch disease—symptomatic treatment only, with azithromycin in severe or complicated cases; (2) trench fever—combination of doxycycline with gentamicin; (3) bacillary angiomatosis or peliosis—erythromycin; (4) endocarditis—gentamicin with ceftriaxone with or without doxycycline.

Prevention—B. quintana infections can be prevented by delousing, changing, or washing clothes. Immunocompromised patients should avoid contact with cats and cat fleas.

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