Bartonella

Question 1

What is bartonellosis?

Answer 1

Zoonotic Disease caused by Bartonella species
Gram negative bacilli
More than 30 species
Carrions disease - Bartonella Bacciliformis
Most important/common Bartonella Henselae (cat scratch disease)

Question 2

How may bartonella present?

Answer 2

bacteremia, endocarditis or bacillary angiomatosis.

Question 3

What is the diagnosis?

Answer 3

Bartonella

Question 4

What causes cat scratch disease?

Answer 4

B.Henselae

• Bacillary angiomatosis
• Bacillary peliosis hepatis
• Bacteremia/Fever
• Endocarditis
• Necroinflammatory parenchymal nodules HIV dementia (?)
• Neuroretinitis (CSD)

Question 5

How is B.Henselae transmitted?

Answer 5

Cat scratch or bite
Fleas from cat

Question 6

How does cat scratch disease present?

Answer 6

It starts with a cutaneous lesion at the
inoculation site (primary lesion).
REGIONAL ADENOPATHY

Progresses - key features:
- Endocarditis
- Bacillary angiomatosis
- Bacillary peliosis hepatic - hepato and splenomegaly

Question 7

Best diagnostic test for bartonella bacilliformis?

Answer 7

Gram stain - intra erythrocytic bacilliformis

Question 8

Other manifestations of cat scratch disease?

Answer 8

CSD retinitis
CSD meningitis

Question 9

Treatment of Cat Scratch Disease?

Answer 9

Azithromycin

Alternatives:
Clarithromycin, Cotrimoxazole, Rifampin,
Ciprofloxacin, Doxycycline

Question 10

What causes Carrions disease?

Answer 10

Carrions disease - Bartonella Bacciliformis
Endemic in Peru at high altitude

Question 11

What is the vector for Carrions disease?

Answer 11

Lutzomyia verrucarum - phlebotamine sand flies (same as leish)
Or L.peruvenis

Question 12

Symptoms of Carrions disease?

Answer 12

Fever, jaundice, anaemia (key feature, develops quickly), malaise
Often get superimposed infections

Question 13

Complications of Carrions disease?

Answer 13

Cardiac involvement - heart failure, pericardial eff, myocarditis, endocarditis.

Question 14

Diagnosis of Carrions disease?

Answer 14

Gimsea stain
Culture takes weeks

Question 15

Treatment of acute Carrions disease?

Answer 15

Ciprofloxacin

Question 16

Which strain of bartonella affects homeless/alcoholics in USA and presents with fever, endocarditis and bacillary angiomatosis?

Answer 16

B.Quintana

Question 17

Which bartonella strains cause Bacillary angiomatosis?

Answer 17

B.Henslae and B.Qunitana

Question 18

Star shaped macular exudate - cause?

Answer 18

B.Henslae

Question 19

Diagnosis of Bartonella Henslae?

Answer 19

Serology
Culture may take a while

Question 20

Vector for Carrions disease, and species?

Answer 20

Lutzomyia fly
Bartonella Bacilliformis

Question 21

Where do you find Carrions disease?

Answer 21

High altitude

Question 22

Symptoms of Carrions disease?

Answer 22

Fever, abdo pain, HSM
Jaundice
ANAEMIA

Question 23

What complications can occur in Carrions?

Answer 23

Cardiac - heart failure, endocarditis, myocarditis

Question 24

What is the ∆?

Answer 24

Bartonella Bacilliformis

Intra erythrocytic on smear

Question 25

Diagnosis of Bartonella?

Answer 25

Smear - intra erythrocytic
Serology
Culture

Question 26

Treatment of B.Bacilliformis acute and name?

Answer 26

Oroya fever
Ciprofloxacin

Question 27

What is this? ∆∆?

Answer 27

Chronic eruptive phase of carrions disease
Also called Peruvian wart

Differentials: Bacillary angiomatosis, angioma, KS, molluscum, cutaneous lymphoma

Question 28

Treatment of chronic Bartonella infection?

Answer 28

Azithromycin