Bartonellosis

Bartonellosis is a group of illnesses caused by types of Bartonella bacteria. The most common types of bartonellosis include:

• Cat scratch disease (CSD): This is a Bartonella henselae infection. It most commonly causes large, swollen lymph nodes and bumps or a rash.
• Carrión’s disease: This is a Bartonella bacilliformis infection. The early stages (Oroya fever) can destroy your blood cells and lead to severe anemia. The later stage (verruga peruana) causes long-lasting bumps on your skin.
• Trench fever: This is a Bartonella quintana infection. It causes flu-like symptoms. Some complications can be serious.

Depending on the type, bartonellosis can cause mild symptoms or severe illness. You get infections from bug bites or cat scratches.

Symptoms of bartonellosis

What symptoms you have depend on the type of Bartonella you’re infected with. Some symptoms could include:

• Fever — this might come and go in some infections
• Large, painful lymph nodes
• Fatigue
• Headache
• Muscle aches
• Abdominal pain
• Bone or joint pain
• Excessive sweating
• Enlarged liver or spleen
• Bumps, cysts or growths on or under your skin

Skin growths may be red, purple or slightly darker than the skin around it.

Bartonellosis causes

Bartonella bacteria cause bartonellosis. The most common types that infect humans include B. bacilliformis, B. henselae and B. quintana. Each spreads in different ways:

• B. bacilliformis spreads through sand fly bites. It’s only found in the Andes mountains, mostly in Peru.
• You can get B. henselae from cat scratches or bites, especially from kittens. Cats get it from flea bites. It’s found worldwide.
• B. quintana spreads through body lice. It most commonly spreads in crowded living conditions without access to proper hygiene. Trench fever is more common in warm climates, but there have been outbreaks in the U.S., too.

Risk factors

B. henselae infections are most common in kids younger than 15. People experiencing homelessness or living in crowded conditions are at higher risk for B. quintana infections. You’re at higher risk for severe Bartonella infections if you have a compromised immune system.

Complications

Bartonella can spread to different organs in your body, like your heart, eyes, liver, spleen, brain and bones. Heart inflammation (endocarditis) is the most common complication of bartonellosis. Others include:

• Anemia
• Brain function issues (encephalopathy)
• Excess fluid around your heart (pericardial effusion) or in your lungs (pulmonary edema)
• Heart failure
• Liver and spleen swelling (hepatosplenomegaly)
• Inflammation of parts of your eye, including Parinaud oculoglandular syndrome

If you have a compromised immune system, you might develop bacillary angiomatosis or bacillary peliosis. Bacillary angiomatosis causes excess blood vessels to form, creating masses or cysts on your organs and bones. You might get large, raised bumps on your skin. Depending on your skin tone, they might be darker than the surrounding skin or bright red. Bacillary peliosis causes blood-filled cysts on your liver.

How doctors diagnose bartonellosis

Healthcare providers diagnose bartonellosis by testing your blood for signs of a Bartonella infection. Your provider may also take a biopsy of cysts or masses on your skin.

When you visit a provider, be sure to tell them if you:

• Have cats
• Have been around cats recently
• Have traveled recently

How is a Bartonella infection treated?

Providers treat most types of bartonellosis with one or more antibiotics. For some types of bartonellosis, like CSD, you might not need treatment. Your provider may drain large nodules.

For B. bacilliformis infections, you’ll need antibiotic treatment to prevent life-threatening complications. In some cases, you might need a blood transfusion.

When should I see my healthcare provider?

See a healthcare provider if you have symptoms of a Bartonella infection, especially if you’re at higher risk for an infection. Go to the emergency room if you have symptoms of serious illness, including:

• Severe fatigue or weakness
• Dizziness
• Shortness of breath
• Chest pain
• Severe headache
• Neck stiffness
• Confusion or other mental changes

What can I expect if I have a Bartonella infection?

What to expect if you have bartonellosis depends on what type you have. For example, CSD usually goes away on its own, without treatment. But left untreated, B. bacilliformis infections can be fatal.

Even with treatment, your symptoms might take some time to get better. Swollen lymph nodes from CSD can last two to eight weeks. Verruga peruana growths (late-stage Carrión’s disease) can last several months to a year.

Can bartonellosis be prevented?

Avoiding cat scratches and bug bites is the best way to prevent bartonellosis. You can also protect your cats from flea bites to reduce their risk of carrying Bartonella. Specific strategies include:

• Keep your cats indoors and ask your veterinarian for other ways to protect them from flea bites.
• Don’t pet or pick up stray cats or kittens.
• Adopt a cat over a year old rather than a kitten, especially if you have a weakened immune system.
• Cover any scratches or wounds with a bandage. Don’t let cats lick scratches or wounds.
• Cover as much skin as possible when outdoors. Wear long pants, tall socks and a long-sleeved shirt. Wear bug spray proven to repel sand flies or any other insects you’re trying to avoid.
• Shower or bathe your whole body with soap and warm water regularly. Change and wash your clothing at least once a week.
• Don’t share bedding, clothing, towels or personal items with others.
• If you have lice on your clothing, wash your clothes with hot water and dry them on high heat. If you can’t wash clothing in a machine, you can also kill lice by putting clothing in sealed plastic bags for two weeks.

Is Bartonella the same as Lyme disease?

No, Bartonella infections aren’t the same as Lyme disease. Borrelia bacteria, spread through a specific type of tick, cause Lyme disease.