Bartonellosis is an infectious disease produced by bacteria of the genus Bartonella . Bartonella species cause diseases, such as Carrion´s disease, Trench fever, and Cat scratch disease, and other recognized diseases, such as (Bacillary Angiomatosis), peliosis hepatis, chronic bacteremia, endocarditis, chronic lymphadenopathy, and neurological disorders.


The disease was named after a medical student Daniel Alcides Carrión of Cerro de Pasco, Peru. Carrion described the disease after being inoculated on his request by Doctor Evaristo M. Chávez, a close friend and coworker in Dos de Mayo National Hospital. Carrion kept a meticulous clinical history until the disease rendered him incapable of so doing. Carrion proved that "Oroya fever" and "Verruga Peruana" were two stages of the same disease, not two different ones as thought at the time.

Carrion was inoculated with the pus of the purple lesion from a patient (Carmen Paredes) in 1885. He developed the disease 3 weeks after the inoculation and died several weeks later. Bartonella bacilliformis is considered the most deadly bartonella to date, with a death rate of up to 90% during the acute phase. His sacrifice demonstrated the connection between the 2 phases of the disease. Subsequently, 23 subspecies of bartonella were discovered. His work did not result in a cure at that time, but his research started the process. Peru named October 5th as Peruvian Medicine day in his honor.

The causative bacterial agent of bartonellosis was discovered by the Peruvian microbiologist Alberto Barton in 1905, but his results were not published until 1909. Barton originally identified them as endoglobular structures, bacteria living inside red blood cells. Until 1993, the Bartonella genus contained only one species; there are now 23 identified species, all of them within family Bartonellaceae.

In 1988, English and col isolated and cultured a becterium that was named Afipia felis in 1992. This agent was considered the etiologic agent of Cat Scratch Disease (CSD) but further studies failed to support this conclusion. Serologic studies associated CSD with Bartonella henselae, reported in 1992. In 1993 Dolan and col isolated Rochalimae henselae (now called Bartonella henselae) from the lymph nodes of patients with CSD. Also, Bartonella henselae was associated bacteremia, bacillary angiomatosis, and peliosis hepatis in HIV patients, and bacteremia and endocarditis in immunocompetent and immunocompromised patients.

Detailed descriptions of the disease were reported in soldiers during the World War I. Also known as 5-day fever or quintan fever or Wolhinie fever. Actually this disease is known as "urban trench fever" because is described in homeless and alcoholic people.


Carrion's disease, or Oroya fever, or Peruvian Wart is a rare infectious disease found only in Peru, Ecuador, and Colombia. It is Endemic in some areas of Peru, and is caused by infection with the bacterium Bartonella bacilliformis and transmitted by sandflies of genus Lutzomyia.

Cat scratch disease is a worldwide disease. Cats are the main reservoir of Bartonella henselae (etiologic agent), and the bacterium is transmitted to cats by the cat flea Ctenocephalides felis.

Trench fever is produced by the infection of Bartonella quintana, and the bacterium is transmitted by the human body louse Pediculus humanus corporis and humans are the only known reservoir.


Members of the genus Bartonella are facultative intracellular bacteria, alpha 2 subgroup Proteobacteria. The genus comprises:

Bartonella species Reservoir Disease
Bartonella bacilliformis human Carrion´s disease/Verruga peruana
Bartonella quintana human Trench fever, bacteremia, bacillary angiomatosis, endocarditis
Bartonella henselae cats Cat scratch disease, bacillary angiomatosis, bacteremia, endocarditis
Bartonella elizabethae rats Endocarditis
Bartonella grahamii Retinitis
Bartonella vinsoni dogs Endocarditis, bacteremia
Bartonella washonsis rodents Myocarditis
Bartonella clarridgiae cats Bacteremia
Bartonella rochalimae human Carrion´s disease like syndrome


In mammals, each Bartonella species is highly adapted to its reservoir host as the result of intracellular parasitism and can persist in the bloodstream of the host. Intraerythrocytic parasitism is only observed in the acute phase of Carrion´s disease. Bartonella also have a tropism for endothelial cells, observed in the chronic phase of Carrion´s disease (also known as Verruga peruana) and bacillary angiomatosis. Pathological response can varies with the immune status of the host. Infection with Bartonella henselae can result in a focal suppurative reaction (CSD in immunocompetent patients), a multifocal angioproliferative response (bacillary angiomatosis in immunocompromised patients), endocarditis or meningitis. Some of the diseases can resolve spontaneously without treatment.

Clinical manifestations

Patients can develop two clinical phases: an acute (hematic) stage and a chronic (eruptive) phase associated with skin eruptions. In the acute phase (also known as Oroya fever or Fiebre de la Oroya), Bartonella bacilliformis infection is a sudden, potentially life-threatening infection associated with high fever and decreased levels of circulating red blood cells (i.e., hemolytic anemia)and transient immunosupression. The acute phase typically lasts two-to-four weeks. Peripheral blood smears shows anisomacrocytosis with many bacilli adherent to red blood cells. Thrombocytopenia is also seen and can be very severe. Neurologic involvement is sometimes seen (neurobartonellosis) and the prognosis in this case is very guarded. It can present as spinal meningitis or as paralysis. In the acute stage, the most feared complication is overwhelming infections by mainly enterobacteriasSalmonella,and other parasites such as Toxoplasmosis. The chronic manifestation—Verruga Peruana—consists of a benign skin eruption with raised, reddish-purple nodules (angiomatous tumours). Visualization of the bacterium is possible using a silver stain (the Warthin–Starry method) of biopsy .

Cat scratch disease is manifested by gradual regional lymph nodes enlargement (axilla, groin, neck) and a distal scratch and/or red-brown skin papule (not always seen at the time of the disease). The enlarged lymph node is painful and tender. The Bartonella henselae infection is self-limited and the lymph nodes compromise last 2-3 months or longer. The lymph nodes may suppurate and most patients can remain afebrile or asymptomatic. Atypical presentations include Unknown Origin Fever, Parinaud's oculoglandular syndrome, encephalopathy and neuroretinitis.

Trench fever, also known as 5-day fever or quintan fever is the initial manifestation of Bartonella quintana infection. Clinical manifestations range from asymptomatic infection to severe illness. Classical presentation include a febrile illness of acute onset, headache, dizziness, and shin pain. Chronic infection manifestation include attacks of fever and aching in some cases and persistent bacteremia in soldiers and homeless people.

Bacillary Angiomatosis is a vascular proliferative disease involving mainly the skin, and other organs. The disease was first described in Human Immunodificiency Virus (HIV)patients and organ transplant recipients. Severe, progressive and disseminated disease may occur in HIV patients. Differential diagnosis include Kaposi´s sarcoma, pyogenic granuloma, hemangioma, Verruga peruana, subcutanous tumors. Lesions can affect bone marrow, liver, spleen or lymph nodes. Bartonella henselae y Bartonella quintana can cause bacillary angiomatosis.

Peliosis hepatis is defined as a vascular proliferation of sinusoid hepatic capillaries resulting in blood-filled spaces in the liver. Bartonella henselae is recognized as the etiologic agent in HIV patients and organ transplant recipients. Peliosis hepatis can be associated by peliosis of the spleen, as well as bacillary angiomatosis of the skin in HIV patients.


Treatment of infections caused by Bartonella species.
Disease Adults Children
Cat scratch disease no recommendation no recommendation
Retinitis Doxicycline + Rifampin unknown
Trench fever or chronic bacteremia by B.quintana Doxicycline + Gentamicin unknown
Bacillary angiomatosis Erythromycin or Doxycycline Erythromycin
Peliosis hepatis Erythromycin or Doxycycline Erythromycin
Endocarditis Doxycycline + Gentamicin + Rifampin or Ceftriaxone + Gentamicin
Carrion´s disease (acute phase) Ciprofloxacin or Chloramphenicol Chloramphenicol + beta-lactam
Carrion´s disease (chronic phase:Verruga peruana) Rifampin or macrolides Rifampin or macrolides


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