Infectious Disease Compendium

Bartonella

Microbiology

Protobacteria. B. bacilliformis, B. henselae, B. quintana, Bartonella mayotimonensis, B. vinsonii  B. rattimassiliensis, and B. tribocorum. Bartonella are being discovered at a brisk rate (PubMed), (PubMed).

Epidemiologic Risks

B. bacilliformis: sand flies at 1 - 3 km up in the Andes. Really.

B. henselae: cat scratches and probably cat fleas. It is seasonal as well, peaking in the winter when the vermin come indoors to avoid the rain (PubMed). Maybe feral pigs in the US SW (PubMed), feral cats and raccoons (PubMed).

Bacteremia is common in veterinarians (PubMed) and is detectable in transfused blood (PubMed).

B. quintana: world wide, spread by the human body louse. 33% of homeless in San Francisco have lice infested with B. quintana as do those in France (PubMed). And probably it is true world wide (PubMed). Also in captive and free-ranging Japanese macaques.

B. rochalimae: previously described as a B. clarridgeiae–like organism, has been isolated from rural domestic dogs, gray foxes, 1 red fox near Paris, France, and from 11 raccoons and 2 coyotes from California (PubMed). Also urban rats in LA (PubMed).

Bartonella mayotimonensis: Bats (PubMed) (PubMed) .

B. tribocorum: Rats (PubMed).

B. australis: kangaroos. No human disease reported yet, mate.

B. vinsonii: transmission is suspected among dogs and wild canines, which are the primary reservoir. Maybe feral pigs in the US SW (PubMed).

Exotic small mammals (gerbils, squirrels, various rodents) are a source for innumerable Bartonella species (PubMed). Mmmmmm. Small rodents.

In Africa Bartonella can be found in rodents and ectoparasites (PubMed).

"Bartonella quintana was detected by suicide PCR in 4000­ year­o ld human remains, thus representing the oldest evidence to date of an arthropod­transmitted infection to human beings. This species has also been detected in human specimens from the 11th to 15th, 18th and 19th centuries. In addition, Bartonella henselae, a cat­ and flea­ associated pathogen, was detected in cat specimens from the 13th to 18th centuries, therefore demonstrating an association of the bacterium and its reservoir for over 800 years (PubMed)." Maybe the Kattenstoet was not such a bad idea after all (PubMed).

Syndromes

B. bacilliformis:

Oroya Fever: fevers after bite with headache and severe anemia from red cell destruction. Verruga Peruanna: nodular lesions after the bacteremic phase; may ulcerate and bleed.

"Although disease manifestations vary, two disparate syndromes can occur independently or sequentially. The first, Oroya fever, occurs approximately 60 days following the bite of an infected sand fly, in which infection of nearly all erythrocytes results in an acute hemolytic anemia with attendant symptoms of fever, jaundice, and myalgia. This phase of Carrión's disease often includes secondary infections and is fatal in up to 88% of patients without antimicrobial intervention. The second syndrome, referred to as verruga peruana, describes the endothelial cell-derived, blood-filled tumors that develop on the surface of the skin. " (PLoS Review).

B. henselae:

Cat Scratch Fever aka Ted Nugents disease: fevers and adenopathy; can be ocular glandular (Parinauds syndrome with conjunctivitis).

The majority of patients after a scratch will have symptoms (fatigue, arthralgias and myalgias, half of patients will seroconvert and maybe a quarter will have evidence of a blood stream infection (PubMed).

Is a cause of “SENLAT” --scalp eschar and neck lymph- adenopathy after tick bite (PubMed).

Endocarditis, usually culture negative. " a positive PCR result from a cardiac valve or blood specimen, an IgG titer ≥800 using IFA or a positive western blot may be considered as major Duke criteria for Bartonella endocarditis (PubMed)."

There are a pair of cases of prosthetic valve endocarditis cured medically (PubMed).

Bacillary angiomatosis in AIDS, Bacillary Peliosis (holes in the liver) in AIDS, acute violent encephalitis leading rapidly to a reversible coma, transverse myelitis (PubMed). So good to have vermin like cats for a pet.

Musculoskeletal involvement occurs in 10% "Myalgia (5.8%) often severe, with a median duration of 4 weeks. Arthropathy (arthralgia and/or arthritis (5.5%) occurred mainly in the medium and large joints and was classified as moderate or severe in 26 patients, with a median duration of 5.5 weeks. In 7 patients, symptoms persisted for > 1 year; 5 developed chronic disease. Tendinitis, neuralgia, and osteomyelitis occurred in 7, 4, and 2 patients, respectively" (PubMed).

B. quintana: Trench fever. Bacillary angiomatosis in AIDS, Bacillary Peliosis (holes in the liver) in AIDS, endocarditis. And endocarditis in Ethiopean children (PubMed).

Bartonella mayotimonensis: endocarditis.

B. rochalimae: Bacteremia, fever, and splenomegaly. Only a handful of cases reported, and I have small hands.

B. vinsonii: endocarditis, arthritis, neurological disease.

Treatment

B. bacilliformis: chloramphenicol 2 g qd for a week, oral tetracycline. Resistant to quinolones (PubMed).

B. henselae: azithromycin, erythromycin, doxycycline, a quinolone. In severe disease add rifampin.

B. quintana: azithromycin, erythromycin, doxycycline, a quinolone.

Notes

I had one uninsured guy who went into a coma for 3 days from CSD, and when he awoke with an enormous bill, went home and had his girl friends 3 cats put to death. I wonder if they are still together.

There is an interesting argument that the data to support the spread of Bartonella by ticks basically stinks on ice (PubMed).