Summary about Disease
Bartonellosis is a bacterial infection caused by bacteria of the Bartonella genus. It encompasses a range of diseases, the most common being cat-scratch disease (CSD). Other forms include trench fever, Oroya fever, and verruga peruana. The infection can affect humans and animals, with cats being a common reservoir for *Bartonella henselae*, the primary cause of CSD.
Symptoms
Symptoms vary depending on the specific Bartonella species and the individual's immune system. Common symptoms include:
Cat-scratch disease (CSD): Swollen and tender lymph nodes (lymphadenopathy) near the site of a scratch or bite, fever, fatigue, headache, skin lesions (papules or pustules) at the inoculation site.
Trench fever: Recurrent fever, headache, bone pain (especially in the shins), dizziness.
Oroya fever: Acute febrile anemia, characterized by fever, headache, muscle pain, and rapid onset of severe anemia.
Verruga peruana: Chronic eruptive skin lesions (vascular nodules) that can bleed easily.
Other possible symptoms: Endocarditis (inflammation of the heart lining), neurological symptoms (e.g., encephalitis), eye problems (e.g., neuroretinitis).
Causes
Bartonellosis is caused by various Bartonella species. The mode of transmission varies:
Cat-scratch disease (CSD): Primarily through scratches or bites from cats, especially kittens, infected with Bartonella henselae. Flea feces can also transmit the bacteria to cats, and cats can spread it to humans.
Trench fever: Transmitted by body lice.
Oroya fever and Verruga peruana: Transmitted by sandflies.
Other Bartonella species: May be transmitted by other vectors (e.g., ticks, fleas) or through blood transfusions (rare).
Medicine Used
Treatment depends on the specific form of Bartonellosis and the severity of the infection. Common antibiotics used include:
Cat-scratch disease (CSD): Azithromycin (especially for severe cases or in immunocompromised individuals), doxycycline, ciprofloxacin, trimethoprim-sulfamethoxazole. In many cases, CSD is self-limiting and only symptomatic treatment is necessary.
Trench fever: Doxycycline, azithromycin.
Oroya fever: Chloramphenicol, ciprofloxacin, ceftriaxone, azithromycin.
Verruga peruana: Rifampin, azithromycin, ciprofloxacin.
Is Communicable
? Bartonellosis is not directly communicable from person to person, with the exception of possible transmission via blood transfusion (rare). The bacteria are typically transmitted through vectors (e.g., fleas, lice, sandflies) or animal reservoirs (e.g., cats).
Precautions
Cat-scratch disease (CSD): Avoid scratches and bites from cats, especially kittens. Wash any cat scratches or bites thoroughly with soap and water. Control fleas on cats. Immunocompromised individuals should exercise extra caution when interacting with cats.
Trench fever: Practice good personal hygiene, especially regular bathing and changing clothes. Control lice infestations.
Oroya fever and Verruga peruana: Use insect repellent, wear protective clothing, and sleep under mosquito nets in areas where sandflies are prevalent.
General Precautions: Thoroughly cook meat, avoid close contact with wild animals.
How long does an outbreak last?
The duration of symptoms varies depending on the form of Bartonellosis:
Cat-scratch disease (CSD): Lymph node swelling can last for several weeks to months, even with treatment. Other symptoms usually resolve within a few weeks.
Trench fever: Fever can be recurrent over weeks or months.
Oroya fever: The acute phase typically lasts for several weeks.
Verruga peruana: Lesions can persist for months to years if untreated.
How is it diagnosed?
Diagnosis typically involves:
Clinical evaluation: Assessing symptoms and medical history (e.g., cat exposure, travel history).
Blood tests:
Bartonella antibody tests (IFA, ELISA). A positive test suggests past or present infection.
Bartonella PCR: Detects *Bartonella* DNA in blood or tissue samples.
Lymph node biopsy: May be performed in cases of CSD to rule out other causes of lymphadenopathy.
Culture: Bartonella can be difficult to culture, but may be attempted in certain cases.
Timeline of Symptoms
This is a general guideline and can vary.
Cat-scratch disease (CSD):
3-10 days after scratch/bite: Small papule or pustule at the site of inoculation.
1-3 weeks: Regional lymph node swelling (lymphadenopathy).
Other symptoms (fever, fatigue, headache) may develop within a few weeks.
Trench fever:
Incubation period: 5-20 days.
Symptoms: Recurrent fever, headache, bone pain.
Oroya fever:
Incubation period: 2-4 weeks.
Symptoms: Rapid onset of fever, headache, muscle pain, and severe anemia.
Verruga peruana:
Several weeks to months after Oroya Fever or initial infection: Eruptive skin lesions (vascular nodules).
Important Considerations
Immunocompromised individuals (e.g., HIV/AIDS, organ transplant recipients) are at higher risk of severe Bartonellosis.
Bartonellosis can be difficult to diagnose due to its varied symptoms and the challenges of culturing the bacteria.
The optimal treatment regimen for Bartonellosis is not always clear, and treatment guidelines may vary. Consult with an infectious disease specialist for complex cases.
Some individuals may experience chronic or relapsing symptoms despite antibiotic treatment.