| name: | Bartonellosis |
| also known as: | Bartonella Infection; Trench Fever (Wolhynia Fever, Quintan Fever, Shin Bone Fever); Cat Scratch Fever; Carrion's Disease; Oroya Fever; Bacillary Angiomatosis Bacillary Peliosis (BA/BP); ICD 083.8; ICD 088.0 |
| also see: | Typhus; Rocky Mountain Spotted Fever; Q Fever; Cat Scratch Fever; Trench Fever; Rickettsial Disease; ICD |
| description: | Bartonellosis is an infection caused by the bacteria bartonella, a rickettsial bacteria, and is characterized by fever, anemia, skin rash with eruptions, and an illness similar to cat scratch fever which is also caused by a bartonella species. Forms of bartonellosis include: 1. skin eruptions characterized by cat scratch fever 2. trench fever which is different than trench mouth and trench foot 3. Other types of bartonellosis include Carrion disease and Oroya fever. Trench fever was first described in military personnel during WW I and WW II (fever in the trenches) and is characterized by fever, weakness, dizziness, headache. Cat scratch fever is described elsewhere. Oroya fever presents with sudden fever, weakness, muscle aches and pains, headache, confusion, delirium, and coma. Similar infections to bartonellosis include typhus, malaria, relapsing fever. Risk of bartonella infection increased with HIV infection, AIDS, immunodeficiency disease, immunosuppressive drugs, house cats with ticks or fleas, body lice. |
| signs & symptoms: | Seven variations: 1. Cat scratch fever: macular papular rash, regional lymph node enlargement, fever, malaise, abscess or suppuration of lymph nodes. 2. Atypical Cat scratch fever: oculoglandular symptoms including pinkeye, lymph node enlargement, retinitis, can progress to encephalitis, as well as enlarged liver and enlarged spleen. 3. Bacteremia including trench fever, Quintan fever, Wolhynia fever, skin bone fever including sudden fever, weakness, dizziness, headache, and back pain, rash, as well as enlarged liver and enlarged spleen. 4. Carrion's disease including Oroya fever: fever, anemia, morbid course, skin eruptions. 5. Endocarditis including heart murmur 6. Bacillary Angiomatosis Bacillary Peliosis (BA/BP) often infecting immunocompromised hosts such as AIDS and includes ulcerating skin nodules, lymph node enlargement, enlarged liver and enlarged spleen 7. Neurologic symptoms seen in AIDS such as behavior and cognitive dysfunction, dementia |
| diagnosis: | Based on signs, symptoms, history and exam, as well as a blood test for specific antibodies, biopsy. Differential diagnosis includes for Cat scratch fever include plague, tularemia, other causes of lymphadenitis, staph infection, strep infection, lymphoma. Differential diagnosis of bartonella bacteremia include cryptococcus, histoplasmosis, Valley fever, mycobacterium avium complex, babesiosis, rickettsial disease. Differential diagnosis of bartonella endocarditis include other causes of slow-growing endocarditis Differential diagnosis of BA/BP includes Kaposi's sarcoma, pyogenic granuloma Differential diagnosis neurologic include other causes of encephalitis. |
| treatment: | Treatment might include antibiotics, such as chloramphenicol, rifampin which is a leprosy drug, aminoglycosides such as gentamicin, erythromycin, azithromycin, doxycycline, and cipro. Although antibiotics have proven somewhat helpful with trench fever and Oroya fever, they are less effective with cat scratch fever. Although caused by bacteria, bartonellosis infections often need to run their course. Treatment can be by disease type: 1. Oroya fever: chloramphenicol + a beta-lactam or a Quinolone such as cipro for 10 days 2. verruga peruana: rifmapin for 10 days 3. cat scratch disease: possibly no antibiotics and allow to run it's course although antibiotics usually prescribed, such as rifampin, azithromycin, quinolones such as cipro, trimethoprim/sulfamethoxazole, and aminoglycosides such as gentamicin 10-14 days plus general home measures. 4. retinitis: doxycycline + rifampin 4-6 weeks 5. trench fever: doxycycline 4 weeks + gentamicin 2 weeks 6. endocarditis: doxycycline 6 weeks + gentamicin 2 weeks 7. angiomatosis: erythromycin or doxycycline 3 months 8. peliosis: erythromycin or doxycycline 4 months |
| prevention: | None other than avoiding exposure. |
| outcome: | Illness often resolves on its own although antibiotics might be helpful. |
skynetMD suggests the following:
| if: | If the person has signs of bartonella infection such as fever, anemia, skin rash with eruptions, weakness, muscle aches and pains, headache, and especially confusion |
| go to: | Go to the doctor or the hospital. |
Last updated 4/3/2008