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      Drugs & Diseases > Infectious Diseases

      Bartonellosis (Bartonella Infection) Treatment & Management

      Updated: Mar 09, 2022
      • Author: Kassem A Hammoud, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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      Treatment

      Medical Care

      Cat scratch disease

      Several therapies have been successful. Whether therapy should be provided at all is unclear because cat scratch disease is ordinarily a self-limited condition that lasts weeks to months. Therapy is typically provided because of patient concerns about tender nodes and because early treatment is believed to reduce the possibility of disseminated complications.

      Cost-effective pharmaceutical choices include erythromycin or doxycycline. Azithromycin has been shown to be more effective than placebo in resolving lymphadenopathy; some consider azithromycin to be the drug of choice.

      If the initial therapeutic choice appears unsuccessful after 2-3 weeks, consider switching to azithromycin, co-trimoxazole, or a quinolone antibiotic. Rifampin in combination with another drug, or the use of gentamicin, may be considered in some situations.

      The usual duration of therapy is 3-6 weeks. Patients who are bacteremic require at least 4 weeks of therapy. Patients with HIV and other immunocompromising diseases require more prolonged therapy. Patients who have vegetations due to bartonellosis often require valve replacement. An aminoglycoside for at least 14 days should be included in the treatment of Bartonella endocarditis. [49] in combination with doxycycline for at least 6 weeks.

      No definitive therapeutic study of CNS bartonellosis or neuroretinitis has been performed, but treating these patients seems prudent. Agents that penetrate the CNS or eye are favored, including doxycycline or azithromycin possibly with rifampin, clarithromycin, or a newer fluoroquinolone antibiotic. A combination of two drugs is favored because this may speed healing and because no single agent has been found to cure all cases in which it was used. Data from the literature do not support the use of corticosteroids.

      A meta-analysis found two studies; one was a randomized controlled study and the other was an observational study. No antibiotic regimen was shown to be beneficial in improving the cure rate or time to achieve cure. [50]

      B quintana infection

      For bacteremia or trench fever, patients should be administered a trial of doxycycline 100 mg orally twice daily for at least 4 weeks. A longer duration of therapy should be considered in immunocompromised patients. In addition, when the liver or other organs are involved, the duration of therapy is typically longer.

      Bacillary angiomatosis

      In persons with AIDS and bacillary angiomatosis, the primary pharmaceutical choices include erythromycin, doxycycline, or more expensive drugs such as azithromycin, clarithromycin, or a fluoroquinolone.

      Doxycycline combined with rifampin is effective in patients with severe disease. Such patients often require extended treatment (≥3 mo).

      Antiretroviral therapy is essential in patient with AIDS in order to improve the immune response and prevent relapses.

      B bacilliformis infection

      Chloramphenicol has been established as therapy in developing countries, but ciprofloxacin or doxycycline could be used.

      If the initial phase (Oroya fever) is not treated, mortality can be higher than 40%. [51]

      Duration of therapy should be at least 1 week, and longer courses may be required.

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      Surgical Care

      In an editorial entitled "Bartonellosis: light and shadows in diagnostic and therapeutic issues" in Clinical Microbiology and Infection (2005), Manfredi et al wrote, "The role of surgical debridement and the unpredictable activity of antimicrobial agents warrant further investigation." The authors go on to point out that "The need for, selection and duration of antimicrobial therapy for CSD remain contentious. Suppurative nodes that become tense and painful should be drained, but incision of non-suppurative lesions should be avoided, as chronic draining fistulae or compromised healing may result." [52]

      In a retrospective study of 101 patients with bartonella endocarditis by Raoult et al., 55% of patients needed valvular surgery.  [53]

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      Consultations

      Consultations include the following:

      • Infectious diseases specialist

      • Possible consultation with a surgeon or interventional radiology for biopsy or drainage

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      Prevention

      B bacilliformis and B quintana infections: Prevention is best achieved by avoiding the circumstances in which exposure to their arthropod vectors occur. B bacilliformis transmission is limited to the Andes Mountains at elevations of 1000-3000 meters because of the habitat of the sand fly Phlebotomus, now called Lutzomyia. Outbreaks occur only in the Andes. B quintana is found worldwide and causes febrile outbreaks. Poor sanitation and lack of personal hygiene strongly correlate with transmission by the body louse Pediculus humanus.

      B henselae infection: B henselae is found throughout the world in association with both domestic and feral cats. Prevention is achieved by avoiding interactions with cats that might result in scratches, bites, or licks, especially kittens, cats with fleas, and cats that are allowed outdoors.

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