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Overview of Bartonella Infections

By Larry M. Bush, MD, Affiliate Professor of Clinical Biomedical Sciences;Affiliate Associate Professor of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University;University of Miami-Miller School of Medicine ; Maria T. Perez, MD, Associate Pathologist, Department of Pathology and Laboratory Medicine, Wellington Regional Medical Center, West Palm Beach

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Bartonella sp are gram-negative bacteria previously classified as Rickettsiae. They are facultative intracellular organisms that typically live within RBCs and endothelial cells. They cause several uncommon diseases:

Risk is higher in immunocompromised hosts (see Table: Some Bartonella Infections).

Bartonella infection (bartonellosis) is usually acquired by humans via an insect vector.

Some Bartonella Infections



At Risk

Insect Vector


Bacillary angiomatosis

B. henselae, B. quintana

Verrucous, fleshy skin lesions

Disseminated visceral disease



Immunocompromised patients

Lice, fleas

Doxycycline, azithromycin, erythromycin

Trench fever

B. quintana

Prolonged or recurrent fever



People living in conditions of crowding or poor hygiene

Immunocompromised patients at risk of disseminated infection

Body louse

Doxycycline, erythromycin, rifampin

Cat-scratch disease

B. henselae



Endocarditis in patients who have had a valvular heart disorder

Owners of cats

Immunocompromised patients at risk of disseminated infection

Possibly cat fleas (which also transmit the organism among cats)

Doxycycline, erythromycin, rifampin

Oroya fever, verruga peruana, Carrión disease

B. bacilliformis

Acute febrile hemolytic anemia, skin lesions similar to those in bacillary angiomatosis

Secondary infections

Residents of the Andes Mountains at elevations of 600–2400 m


Doxycycline, chloramphenicol, rifampin, fluoroquinolones, streptomycin

*In normal host.

Doxycycline is generally the preferred drug.

Treatment is not usually required in patients with normal immune systems; however, Bartonella bacteremia may be complicated by endocarditis.

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