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Bartonellosis — Clinical Guidelines

Overview

Bartonellosis encompasses infections caused by various Bartonella species, notably Bartonella henselae and Bartonella quintana, leading to diverse clinical manifestations including bacillary angiomatosis, endocarditis, and cat scratch disease. These zoonotic pathogens often emerge from companion animals and can affect immunocompromised individuals disproportionately 1 2 9.

Diagnosis

Clinical Presentation: Varies by species and host immune status; common manifestations include fever, lymphadenopathy, and vascular proliferative lesions 1 9.

Microbiological Tests: PCR-restriction fragment length polymorphism analysis of 16S rRNA gene for direct species identification in clinical specimens 8.

Culture: Blood cultures using systems like BacT/Alert can isolate Bartonella henselae from febrile immunosuppressed patients 12.

Histopathology: Warthin-Starry stain can reveal bacilli in tissue biopsies, aiding diagnosis 5 14.

Management

First-Line Treatment: Macrolides (e.g., azithromycin) are appropriate for many Bartonella infections 9.

Alternative Antibiotics: Pradofloxacin showed greater antimicrobial activity compared to enrofloxacin and azithromycin in vitro, suggesting potential utility 4.

Bactericidal Agents: Aminoglycosides demonstrated bactericidal effects, correlating with clinical efficacy 6.

Supportive Care: For cat scratch disease, supportive care is often sufficient alongside appropriate antibiotic therapy 9.

Special Populations

Immunocompromised Individuals: Higher risk for severe manifestations including bacillary angiomatosis and bacteremia 2 9 12.

Children and Young Adults: Increased risk associated with exposure to young cats 9.

Key Recommendations

Utilize PCR-based methods for rapid and accurate identification of Bartonella species in clinical samples (Evidence: Moderate 8).

Consider macrolides, particularly azithromycin, as first-line therapy for Bartonella infections (Evidence: Moderate 9).

Evaluate pradofloxacin as an alternative treatment option due to its superior in vitro activity against Bartonella henselae (Evidence: Weak 4).

Monitor immunocompromised patients closely for severe manifestations such as bacillary angiomatosis and bacteremia (Evidence: Expert opinion).

References

1 Tu N, Carroll RK, Weiss A, Shaw LN, Nicolas G, Thomas S et al.. A family of genus-specific RNAs in tandem with DNA-binding proteins control expression of the badA major virulence factor gene in Bartonella henselae. MicrobiologyOpen 2017. link 2 Drut A, Bublot I, Breitschwerdt EB, Chabanne L, Vayssier-Taussat M, Cadoré JL. Comparative microbiological features of Bartonella henselae infection in a dog with fever of unknown origin and granulomatous lymphadenitis. Medical microbiology and immunology 2014. link 3 Varanat M, Maggi RG, Linder KE, Breitschwerdt EB. Infection of human brain vascular pericytes (HBVPs) by Bartonella henselae. Medical microbiology and immunology 2013. link 4 Biswas S, Maggi RG, Papich MG, Keil D, Breitschwerdt EB. Comparative activity of pradofloxacin, enrofloxacin, and azithromycin against Bartonella henselae isolates collected from cats and a human. Journal of clinical microbiology 2010. link 5 Tsai PS, DeAngelis DD, Spencer WH, Seiff SR. Bacillary angiomatosis of the anterior orbit, eyelid, and conjunctiva. American journal of ophthalmology 2002. link01530-1) 6 Rolain JM, Maurin M, Raoult D. Bactericidal effect of antibiotics on Bartonella and Brucella spp.: clinical implications. The Journal of antimicrobial chemotherapy 2000. link 7 Resto-Ruiz SI, Sweger D, Widen RH, Valkov N, Anderson BE. Transcriptional activation of the htrA (High-temperature requirement A) gene from Bartonella henselae. Infection and immunity 2000. link 8 Matar GM, Koehler JE, Malcolm G, Lambert-Fair MA, Tappero J, Hunter SB et al.. Identification of Bartonella species directly in clinical specimens by PCR-restriction fragment length polymorphism analysis of a 16S rRNA gene fragment. Journal of clinical microbiology 1999. link 9 Loutit JS. Bartonella infections: diverse and elusive. Hospital practice (1995) 1998. link 10 Wong R, Tappero J, Cockerell CJ. Bacillary angiomatosis and other Bartonella species infections. Seminars in cutaneous medicine and surgery 1997. link80042-9) 11 Maurin M, Raoult D. Bartonella (Rochalimaea) quintana infections. Clinical microbiology reviews 1996. link 12 Tierno PM, Inglima K, Parisi MT. Detection of Bartonella (Rochalimaea) henselae bacteremia using BacT/Alert blood culture system. American journal of clinical pathology 1995. link 13 Koehler JE, Cederberg L. Intra-abdominal mass associated with gastrointestinal hemorrhage: a new manifestation of bacillary angiomatosis. Gastroenterology 1995. link90770-x) 14 Cockerell CJ, Tierno PM, Friedman-Kien AE, Kim KS. Clinical, histologic, microbiologic, and biochemical characterization of the causative agent of bacillary (epithelioid) angiomatosis: a rickettsial illness with features of bartonellosis. The Journal of investigative dermatology 1991. link 15 Mitchell PD, Slack JM. Hyper-reactivity of rabbits sensitized with Bartonella bacilliformis. Journal of bacteriology 1966. link

Bartonellosis