This group of diseases are caused by intracellular Gramnegative bacilli closely related to the rickettsiae, which have been discovered to be important causes of ‘culture negative’ endocarditis. They are found in many domestic pets, such as cats, although for several the host is ill defined. The principal human pathogens are Bartonella quintana, B. henselae and B. bacilliformis.
Bartonella infections are associated with the following:
- Trench fever. This is a relapsing fever with severe leg pain and is caused by B. quintana. The disease is not fatal but is very debilitating.
- Bacteraemia and endocarditis in the homeless. Endocarditis due to B. quintana or henselae is associated with severe damage to the heart valves.
- Cat scratch disease. B. henselae causes this common benign lymphadenopathy in children and young adults. A vesicle or papule develops on the head, neck or arms after a cat scratch. The lesion resolves spontaneously but there may be regional lymphadenopathy that persists for up to 4 months before also resolving spontaneously.
- Bacillary angiomatosis. This is an HIV-associated disease caused by B. quintana or henselae.
- Oroya fever and verruga peruana (Carrion’s disease).
This is endemic in areas of Peru. It is a biphasic disease caused by B. bacilliformis and is transmitted by sandflies of the genus Phlebotomus. Fever, haemolytic anaemia and microvascular thrombosis with end-organ ischaemia are features. It is frequently fatal if untreated.
INVESTIGATIONS AND MANAGEMENT: - Bartonellae can be grown from the blood but this requires prolonged incubation using enriched media. Serum antibody detection is possible.
The medicines that can be thought of use are:-
- Veratrum album