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Bartonella (Rochalmaea) Infections
occur in immunocompromised bacillary angiomatosis (BA), peliosis hepatis
Relapsing bacteremia
in both immunocompetent and immunocompromised
first described as trench fever (World War I, B. quintana)
with or without endocarditis (culture-negative)
Granulomatous lymphadenitis
immunocompetent or early HIV infection
also known as cat scratch disease (CSD)Bartonella (Rochalimaea) Species, 2006 (nine)
small, fastidious gram-negative rod
B. quintana (causes BA, trench fever)
B. henselae (causes BA, CSD)
B. elizabethae (causes endocarditis)
B. bacilliformis (causes disease only in South America)
B. clarridgeiae (most recently identified species)
B. vinsonii (dog)
B. grahamii
B. doshiae
B. taylorii
Manifestations of Bartonella Infection in late HIV InfectionBA occurs late in HIV infection, usually when CD4 <100
BA affects skin, bone, lymph node, brain, lung
bacillary-peliosis hepatis affects spleen, liver
Cutaneous BA has diverse Presentations-vascular
may resemble KS
subcutaneous nodule
friable vascular lesion
red papule
pedunculated lesion
deep subcutaneous massOsseous Ba
extremely painful
osteolytic lesions on x-ray
bone scan positive
very vascularBacillary peliosis hepatis
vascular proliferative lesion of liver and/or spleen
may occur concomitantly with cutaneous BA/splenic peliosis
accompanied by pancytopenia, thrombocytopenia and/or ascitesBartonella can cause fever of unknown origin
Manifestations in early HIV/Immunocompetent hostwe found about 12% are Bartonella sero- or cx-positive
Cat Scratch Disease (CSD)-most common Bartonella Infection
granulomatous lymphadenitisManifestations in early OR late HIV Infectionpapule, followed by lymphadenopathymalaise/low-grade feveroccasionally severe diseasevery high feverencephalopathy with comahepatosplenic granulomatous lesionsstellate retinitisepidemiology
22,000 cases in US annually, mostly immunocompetentworldwide distributionCSD bacillus conclusively identified to be B. henselaeBH DNA present in five CSD skin test preparations found by Perkins 1992
Bartonella antibodies present in 88% of CSD patients found by Regnery 1992BH isolated from CSD lymph nodes by Dolan in 1993CSD statistically associated with traumatic cat contact (Zangwill 1992)
Bacteremia
often relapsing
relapse may occur regardless of antibiotic treatment
clusters of B. quintana bacteremia
found in homeless, alcoholics
trench fever (due to B. quintana) occurred in thousands of troops in WWIendocarditis (more common in immunocompetent)
Bartonella is a cause of "culture-negative" endocarditis
3 of 4 recent cases required valve replacement
up to 4% of endocarditis cases in Lyon, France (immunocompetent)Laboratory Diagnosis
for Lymphadenopathy in early HIV
biopsy is mainstay of diagnosis in HIV with LANneed to r/o other causes with path and cultures(NOTE: biopsy may be contraindicated in immunocompetent pts with CSD)
for late-stage HIV and cutaneous lesions
Must BX to Distinguish BA from KS, other infectionsfor multiple hypodense lesions on CT c/w peliosis hepatis
Ddx includes lymphoma, KS, MAC, P. carinii
look for other tissue to biopsy (eg, cutaneous BA, LN)
if liver biopsy, need caution due to potential for hemorrhagehistopathology