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Overview of Bartonella Infections

By Larry M. Bush, MD, Maria T. Perez, MD

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: cat-scratch disease (see Cat-Scratch Disease), an acute febrile anemia (Oroya fever—see Oroya Fever and Verruga Peruana), a chronic cutaneous eruption (bacillary angiomatosis—see Bacillary Angiomatosis), and disseminated disease (trench fever—see Trench Fever). Risk is higher in immunocompromised hosts (see Table: Some Bartonella Infections). Bartonella infection 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

Red, nonblanching papules or nodules



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



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

Phlebotomus sandfly

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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