BARTONELLA INFECTIONS is a topic covered in the Harrison's Manual of Medicine.

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  • Bartonella species are fastidious, facultative intracellular, gram-negative bacteria that cause an array of infectious disease syndromes in humans.
  • Most Bartonella species have successfully adapted to survival in specific domestic or wild mammals, creating a reservoir for human infection. The exceptions are B. bacilliformis and B. quintana, which are not zoonotic.
  • Clinical presentation generally depends on both the infecting Bartonella species and the immune status of the infected individual.
  • Therapy for syndromes caused by Bartonella is summarized in Table 91-2.
DiseaseAntimicrobial Therapy
Typical cat-scratch diseaseNot routinely indicated; for pts with extensive lymphadenopathy, consider azithromycin (500 mg PO on day 1, then 250 mg PO qd for 4 days)
Cat-scratch disease retinitisDoxycycline (100 mg PO bid) plus rifampin (300 mg PO bid) for 4–6 weeks
Other atypical cat-scratch disease manifestationsaAs per retinitis; treatment duration should be individualized
Trench fever or chronic bacteremia with B. quintanaGentamicin (3 mg/kg IV qd for 14 days) plus doxycycline (200 mg PO qd or 100 mg PO bid for 6 weeks)
Suspected Bartonella endocarditisGentamicinb (1 mg/kg IV q8h for ≥14 days) plus doxycycline (100 mg PO/IV bid for 6 weeksc) plus ceftriaxone (2 g IV qd for 6 weeks)
Confirmed Bartonella endocarditisAs for suspected Bartonella endocarditis minus ceftriaxone
Bacillary angiomatosisErythromycind (500 mg PO qid for 3 months)
 Doxycycline (100 mg PO bid for 3 months)
Bacillary peliosisErythromycind (500 mg PO qid for 4 months)
 Doxycycline (100 mg PO bid for 4 months)
Carrión’s disease 
 Oroya feverChloramphenicol (500 mg PO/IV qid for 14 days) plus another antibiotic (β-lactam preferred)
 Ciprofloxacin (500 mg PO bid for 10 days)
 Verruga peruanaRifampin (10 mg/kg PO qd, to a maximum of 600 mg, for 14 days)
 Streptomycin (15–20 mg/kg IM qd for 10 days)
aData on treatment efficacy for encephalitis and hepatosplenic cat-scratch disease are lacking. Therapy similar to that given for retinitis is reasonable.
bSome experts recommend gentamicin at 3 mg/kg IV qd. If gentamicin is contraindicated, rifampin (300 mg PO bid) can be added to doxycycline for documented Bartonella endocarditis.
cSome experts recommend extending oral doxycycline therapy for 3–6 months.
dOther macrolides are probably effective and may be substituted for erythromycin or doxycycline.
Source: Recommendations are modified from JM Rolain et al: Antimicrob Agents Chemother 48:1921, 2004.

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