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Chapter 153. Bartonella Infections, Including CatScratch Disease

Bartonella species are gram-negative bacteria that can cause an array of infectious diseases, including cat-scratch disease (CSD), bacillary angiomatosis, bacteremia, culture-negative endocarditis, trench fever, and bartonellosis (Table 153-1). Three Bartonella species play a major role in causing human disease: B. bacilliformis, B. quintana, and B. henselae. Recent advances in molecular diagnostics have expanded the list of diseases known to be caused by Bartonella species. | Chapter 153. Bartonella Infections Including CatScratch Disease Bartonella species are gram-negative bacteria that can cause an array of infectious diseases including cat-scratch disease CSD bacillary angiomatosis bacteremia culture-negative endocarditis trench fever and bartonellosis Table 153-1 . Three Bartonella species play a major role in causing human disease B. bacilliformis B. quintana and B. henselae. Recent advances in molecular diagnostics have expanded the list of diseases known to be caused by Bartonella species. Table 153-1 Major Diseases Caused by Bartonella Species Disease Organism Risk Factor Cat-scratch B. henselae Cat scratch or bite disease Bacillary B. quintana B. henselae Cat scratch or bite angiomatosis Bacillary peliosis B. henselae Cat scratch or bite Trench fever B. quintana Homelessness body louse infestation alcoholism Endocarditis B. quintana B. henselae As for cat-scratch disease and B. elizabethae trench fever Bartonellosis B. bacilliformis Sandfly bite Cat-Scratch Disease Definition and Etiology CSD is typically a self-limited illness characterized by regional lymphadenopathy lasting weeks to months. B. henselae is the primary causative agent. Infrequently patients with CSD develop disseminated B. henselae infection. Epidemiology CSD has a global distribution. In the United States the annual incidence is 4-9 cases per 100 000 persons with 40 of cases involving adults. Cats are the primary host for B. henselae and transmit the infection to humans via a scratch bite or lick. In cats particularly kittens the incidence of asymptomatic B. henselae bacteremia is high. The cat flea Ctenocephalides felis serves as the vector for transmission between animals. Rarely CSD occurs after exposure to dogs. Clinical Presentation The initial clinical manifestation the primary inoculation lesion consists of a 0.5- to 1-cm papule vesicle or nodule that appears at the site where B. henselae is introduced and persists for 1-3 weeks. Adenopathy typically