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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.
|Typical cat-scratch disease||Not 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 retinitis||Doxycycline (100 mg PO bid) plus rifampin (300 mg PO bid) for 4–6 weeks|
|Other atypical cat-scratch disease manifestationsa||As per retinitis; treatment duration should be individualized|
|Trench fever or chronic bacteremia with B. quintana||Gentamicin (3 mg/kg IV qd for 14 days) plus doxycycline (200 mg PO qd or 100 mg PO bid for 6 weeks)|
|Suspected Bartonella endocarditis||Gentamicinb (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 endocarditis||As for suspected Bartonella endocarditis minus ceftriaxone|
|Bacillary angiomatosis||Erythromycind (500 mg PO qid for 3 months)|
|Doxycycline (100 mg PO bid for 3 months)|
|Bacillary peliosis||Erythromycind (500 mg PO qid for 4 months)|
|Doxycycline (100 mg PO bid for 4 months)|
|Oroya fever||Chloramphenicol (500 mg PO/IV qid for 14 days) plus another antibiotic (β-lactam preferred)|
|Ciprofloxacin (500 mg PO bid for 10 days)|
|Verruga peruana||Rifampin (10 mg/kg PO qd, to a maximum of 600 mg, for 14 days)|
|Streptomycin (15–20 mg/kg IM qd for 10 days)|