### Microbiology A *Pseudomonadota* (synonym *Proteobacteria*). *B.* *bacilliformis*, *[[Bartonella]]* *elizabethae*, *B.* henselae, *B.* *quintana*, *[[Bartonella]]* *mayotimonensis*, *B.* *vinsonii*,  *B.* *rattimassiliensis*, *[[Bartonella]]* *rousetti*. and *B.* *tribocorum*. Disease causing *[[Bartonella]]* are being discovered at a brisk rate due to the use of diagnostic PCR. [^1] [^2] *[[Bartonella]]* are intracellular pathogens. They cannot be grown in routine cultures, but can be diagnosed with serology or PCR, although the two are complementary for cat scratch disease. ### Epidemiologic Risks *B.* bacilliformis: sand flies at 1 - 3 km up in the Andes. Really. *B.* henselae: cat scratches and probably cat fleas. It is seasonal as well, peaking in the winter when the vermin come indoors to avoid the rain. [^3] Feral pigs in the US SW, [^4] feral cats, and raccoons can have *B* *henselae* and other *[[Bartonella]]*. [^5] Bacteremia from a variety of *[[Bartonella]]* is common in veterinarians and veterinary technicians [^6] and is detectable in transfused blood. [^7] *B.* quintana: worldwide, spread by the human body louse. 33% of the homeless in San Francisco are [[Lice]]-infested [^9] with *B.* quintana as are those in France. [^8] And probably it is true worldwide. Also found in in captive and free-ranging Japanese macaques. *B.* rochalimae: previously described as a *B.* clarridgeiaelike organism, has been isolated from rural domestic dogs, gray foxes, 1 red fox near Paris, France, and from 11 raccoons and 2 coyotes from California. [^10] Also urban rats (not studio executives) in Los Angeles). [^11] *[[Bartonella]]* *elizabethae*: the rat. *[[Bartonella]]* *rousetti*: Fruit bats. [^12] I was unaware that bats were made of fruit, *[[Bartonella]]* *mayotimonensis*: Bats. [^13] *B.* *tribocorum*: Rats. *B.* *australis*: kangaroos. No human disease reported yet, mate. *B.* *vinsonii*: transmission is suspected among dogs and wild canines, which are the primary reservoir. Maybe feral pigs in the US SW . [^14] Exotic small mammals (gerbils, squirrels, various rodents) are a source for innumerable *[[Bartonella]]* species. [^15] Mmmmmm. Small rodents. In Africa, *[[Bartonella]]* can be found in rodents and ectoparasites. [^16] *[[Bartonella]]* can be found in fleas parasitizing common voles (*Microtus* arvalis) *from* northwestern Spain . [^17] 3 *[[Bartonella]]* species can be found in wild rabbit fleas from Colorado: *B.* *vinsonii* subsp. *berkhoffii*, *B.* *alsatica*, and *B.* *rochalimae*. [^18] Human have always been infected with [[Bartonella]]: > [[Bartonella]] quintana was detected by suicide PCR in 4000-year-old human remains, thus representing the oldest evidence to date of an arthropod ­transmitted infection to human beings. This species has also been detected in human specimens from the 11th to 15th, 18th and 19th centuries. In addition, [[Bartonella]] henselae, a cat and flea associated pathogen, was detected in cat specimens from the 13th to 18th centuries, therefore demonstrating an association of the bacterium and its reservoir for over 800 years. [^19] Maybe the Kattenstoet was not such a bad idea after all. [^20] The bottom line is there are a wide variety of *[[Bartonella]]* that can infect more than one animal. So if you really need to know, search for [[Bartonella]] in the animal of concern. Part of the problem is preventative autoclaving pets is counterproductive. ### Syndromes ***B.* *bacilliformis*** Oroya [[Fever]] aka South American bartonellosis aka Carrion's disease,: fevers after sand fly bite with headache and severe [[anemia]] from red cell destruction. Verruga Peruanna: nodular lesions after the bacteremic phase; may ulcerate and bleed. > Although disease manifestations vary, two disparate syndromes can occur independently or sequentially. The first, Oroya [[Fever]], occurs approximately 60 days following the bite of an infected sandfly, in which infection of nearly all erythrocytes results in an acute hemolytic [[anemia]] with attendant symptoms of [[Fever]], jaundice, and myalgia. This phase of Carrión's disease often includes secondary infections and is fatal in up to 88% of patients without antimicrobial intervention. The second syndrome, referred to as verruga peruana, describes the endothelial cell-derived, blood-filled tumors that develop on the surface of the skin. [^21] ***B.* *henselae*** Cat Scratch [[Fever]] aka Ted Nugent's disease: fevers and adenopathy. Pathology will show stellate necrotizing granuloma. The disease, like Tularmemia, can be ocular glandular (Parinauds syndrome with [[Conjunctivitis]]). The majority of patients after a scratch will have symptoms (fatigue, arthralgias, and myalgias, half of patients will seroconvert and maybe a quarter will have evidence of a bloodstream infection. [^22] To maximize the diagnosis, use BOTH PCR and serology; 8% of seronegative patients will be PCR positive. [^23] It is a cause of "SENLAT" (scalp eschar and neck lymph-adenopathy) after a tick bite. [^24] [[Endocarditis]], usually culture negative. > "/...a positive PCR result from a cardiac valve or blood specimen, an IgG titer ≥800 using IFA or a positive western blot may be considered as major Duke criteria for [[Bartonella]] [[endocarditis]]." [^25] There are a pair of cases of prosthetic valve [[endocarditis]] cured medically. [^26] That's a surprise. [[Bacillary Angiomatosis]] in [[AIDS]], Bacillary Peliosis (holes in the liver) in [[AIDS]] and the occasional normal host. [^27] Acute violent [[encephalitis]] leading rapidly to a reversible coma and transverse myelitis. [^28] So good to have vermin like cats for a pet. Musculoskeletal involvement occurs in 10%: > "Myalgia (5.8%) often severe, with a median duration of 4 weeks. Arthropathy (arthralgia and/or [[arthritis]] (5.5%) occurred mainly in the medium and large joints and was classified as moderate or severe in 26 patients, with a median duration of 5.5 weeks. In 7 patients, symptoms persisted for > 1 year; 5 developed chronic disease. Tendinitis, neuralgia, and [[osteomyelitis]] occurred in 7, 4, and 2 patients, respectively". [^29] Atypical manifestations include [[Retinitis]]/neuroretinitis, [[Conjunctivitis]], neuritis, [[encephalitis]], hepatosplenic disease, [[osteomyelitis]], erythema nodosum, and [[endocarditis]] and occur in about 1.5% of the time. [[Fever]] of unknown origin in cat sctatch disease may be a unique process, or so the title says. > "Relapsing [[Fever]] pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal [[osteomyelitis]] (6%) were the most common" and often mistaken for malignancy. [^30] *B.* *quintana*: Trench [[Fever]]. [[Bacillary Angiomatosis]] in [[AIDS]], Bacillary Peliosis (holes in the liver) in [[AIDS]], [[endocarditis]]. And [[endocarditis]] in Ethiopian children. [^31] *[[Bartonella]]* *mayotimonensis*: [[endocarditis]]. *B.* *rochalimae*: Bacteremia, [[Fever]], and splenomegaly. Only a handful of cases reported, and I have small hands. Don't tell Trump. *[[Bartonella]]* *elizabethae*: [[endocarditis]] in homeless injection drug users. *B.* *vinsonii*: [[endocarditis]], [[arthritis]], and neurological disease. *[[Rickettsia]]* *slovaca* and *[[Rickettsia]]* *raoultii*. SENLAT ### Treatment *B.* bacilliformis: [[chloramphenicol]] or oral [[tetracycline]]. Resistant to quinolones. [^32] *B.* henselae: [[Azithromycin]], [[erythromycin]], [[doxycycline]], a quinolone. In severe disease add [[rifampin]]. *B.* quintana: [[Azithromycin]], [[erythromycin]], [[doxycycline]], a quinolone. ### Notes There is an interesting argument that the data to support the spread of *[[Bartonella]]* by ticks basically stinks on ice. [^33] *B.* *quintana* has been found in dental pulp up of humans from 4000 years ago, mostly in soldiers. [^34] Living in trenches, oddly, is a risk for trench [[Fever]]. ### Puswhisperers I had one uninsured guy who went into a coma for 3 days from CSD, and when he awoke with an enormous bill, he went home and had his girlfriends 3 cats put to death. I wonder if they are still together. [Is Insanity Infectious?](http://www.pusware.com/PW1/IsInsanityInfectious.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop32.mp3) [Red Bump Disease](http://www.pusware.com/PW2/RedBumpDisease.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1085.mp3) [Red Bumps Redux](http://www.pusware.com/PW3/RedBumpsRedux.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop368.mp3) [Captain, I Canna Get a Cure. I\'m Givin\' Her All I\'ve Got.](http://www.pusware.com/PW4/Captain.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop483.mp3) [Mystery](http://www.pusware.com/PW4/Mystery.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop346.mp3) [Wrong. Big Time.](http://www.pusware.com/PW4/WrongBigTime.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop532.mp3) [Vermin Bumps](http://www.pusware.com/PW4/VerminBumps.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop531.mp3) [Great Ideas Disproved by Reality Yet Again](http://www.pusware.com/PW?/.2a5bb97e!) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop757.mp) [Quick Questions](http://www.pusware.com/PW6/QuickQuestionsSlowAnswers.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop753.mp3) ### Rationalizations [^1]: Breitschwerdt EB, Maggi RG, Duncan AW, Nicholson WL, Hegarty BC, Woods CW. [[Bartonella]] species in blood of immunocompetent persons with animal and arthropod contact. Emerg Infect Dis. 2007 Jun;13(6):938-41. doi: 10.3201/eid1306.061337. PMID: 17553243; PMCID: PMC2792845. [^2]: Eremeeva ME, Gerns HL, Lydy SL, Goo JS, Ryan ET, Mathew SS, Ferraro MJ, Holden JM, Nicholson WL, Dasch GA, Koehler JE. Bacteremia, [[Fever]], and splenomegaly caused by a newly recognized bartonella species. N Engl J Med. 2007 Jun 7;356(23):2381-7. doi: 10.1056/NEJMoa065987. PMID: 17554119. [^3]: Sanguinetti-Morelli D, Angelakis E, Richet H, Davoust B, Rolain JM, Raoult D. Seasonality of cat-scratch disease, France, 1999-2009. Emerg Infect Dis. 2011 Apr;17(4):705-7. doi: 10.3201/eid1704.100825. PMID: 21470466; PMCID: PMC3377394. [^4]: Beard AW, Maggi RG, Kennedy-Stoskopf S, Cherry NA, Sandfoss MR, DePerno CS, Breitschwerdt EB. [[Bartonella]] spp. in feral pigs, southeastern United States. Emerg Infect Dis. 2011 May;17(5):893-5. doi: 10.3201/eid1705.100141. PMID: 21529405; PMCID: PMC3321751. [^5]: Hwang, J., & Gottdenker, N. L. (2013). [[Bartonella]] Species in Raccoons and Feral Cats, Georgia, USA. _Emerging Infectious Diseases_, _19_(7), 1167-1168. https://doi.org/10.3201/eid1907.130010. [^6]: Lantos PM, Maggi RG, Ferguson B, Varkey J, Park LP, Breitschwerdt EB, Woods CW. Detection of [[Bartonella]] species in the blood of veterinarians and veterinary technicians: a newly recognized occupational hazard? Vector Borne Zoonotic Dis. 2014 Aug;14(8):563-70. doi: 10.1089/vbz.2013.1512. PMID: 25072986; PMCID: PMC4117269. [^7]: Pitassi LH, de Paiva Diniz PP, Scorpio DG, Drummond MR, Lania BG, Barjas-Castro ML, Gilioli R, Colombo S, Sowy S, Breitschwerdt EB, Nicholson WL, Velho PE. [[Bartonella]] spp. bacteremia in blood donors from Campinas, Brazil. PLoS Negl Trop Dis. 2015 Jan 15;9(1):e0003467. doi: 10.1371/journal.pntd.0003467. PMID: 25590435; PMCID: PMC4295888. [^8]: Drali R, Sangaré AK, Boutellis A, Angelakis E, Veracx A, Socolovschi C, Brouqui P, Raoult D. [[Bartonella]] quintana in body [[Lice]] from scalp hair of homeless persons, France. Emerg Infect Dis. 2014 May;20(5):907-8. doi: 10.3201/eid2005.131242. PMID: 24751237; PMCID: PMC4012801. [^9]: Bonilla DL, Kabeya H, Henn J, Kramer VL, Kosoy MY. [[Bartonella]] quintana in body [[Lice]] and head [[Lice]] from homeless persons, San Francisco, California, USA. Emerg Infect Dis. 2009 Jun;15(6):912-5. doi: 10.3201/eid1506.090054. PMID: 19523290; PMCID: PMC2727331. [^10]: Henn JB, Chomel BB, Boulouis HJ, Kasten RW, Murray WJ, Bar-Gal GK, King R, Courreau JF, Baneth G. [[Bartonella]] rochalimae in raccoons, coyotes, and red foxes. Emerg Infect Dis. 2009 Dec;15(12):1984-7. doi: 10.3201/eid1512.081692. PMID: 19961681; PMCID: PMC3044513. [^11]: Gundi VA, Billeter SA, Rood MP, Kosoy MY. [[Bartonella]] spp. in rats and zoonoses, Los Angeles, California, USA. Emerg Infect Dis. 2012 Apr;18(4):631-3. doi: 10.3201/eid1804.110816. PMID: 22469313; PMCID: PMC3309692. [^12]: Gundi VA, Billeter SA, Rood MP, Kosoy MY. [[Bartonella]] spp. in rats and zoonoses, Los Angeles, California, USA. Emerg Infect Dis. 2012 Apr;18(4):631-3. doi: 10.3201/eid1804.110816. PMID: 22469313; PMCID: PMC3309692. [^13]: Veikkolainen, V., Vesterinen, E. J., Lilley, T. M., & Pulliainen, A. T. (2014). Bats as Reservoir Hosts of Human Bacterial Pathogen, [[Bartonella]] mayotimonensis. _Emerging Infectious Diseases_, _20_(6), 960-967. https://doi.org/10.3201/eid2006.130956. [^14]: Beard AW, Maggi RG, Kennedy-Stoskopf S, Cherry NA, Sandfoss MR, DePerno CS, Breitschwerdt EB. [[Bartonella]] spp. in feral pigs, southeastern United States. Emerg Infect Dis. 2011 May;17(5):893-5. doi: 10.3201/eid1705.100141. PMID: 21529405; PMCID: PMC3321751. [^15]: Inoue K, Maruyama S, Kabeya H, Hagiya K, Izumi Y, Une Y, Yoshikawa Y. Exotic small mammals as potential reservoirs of zoonotic [[Bartonella]] spp. Emerg Infect Dis. 2009 Apr;15(4):526-32. doi: 10.3201/eid1504.081223. PMID: 19331727; PMCID: PMC2671452. [^16]: Kamani J, Morick D, Mumcuoglu KY, Harrus S. Prevalence and diversity of [[Bartonella]] species in commensal rodents and ectoparasites from Nigeria, West Africa. PLoS Negl Trop Dis. 2013 May 30;7(5):e2246. doi: 10.1371/journal.pntd.0002246. PMID: 23738028; PMCID: PMC3667778. [^17]: Rodríguez-Pastor, R., Mougeot, F., Vidal, M., Jado, I., González-Martín-Niño, R. M., Escudero, R....Luque-Larena, J. (2019). Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain. _Emerging Infectious Diseases_, _25_(7), 1423-1425. https://doi.org/10.3201/eid2507.181646. [^18]: Sato, S., Brinkerhoff, R., Hollis, E., Funada, S., Shannon, A. B., & Maruyama, S. (2020). Detection of Zoonotic [[Bartonella]] Pathogens in Rabbit Fleas, Colorado, USA. _Emerging Infectious Diseases_, _26_(4), 778-781. https://doi.org/10.3201/eid2604.191161. [^19]: Fournier PE, Drancourt M, Aboudharam G, Raoult D. Paleomicrobiology of [[Bartonella]] infections. Microbes Infect. 2015 Nov-Dec;17(11-12):879-83. doi: 10.1016/j.micinf.2015.09.002. Epub 2015 Sep 11. PMID: 26369716. [^20]: https://en.wikipedia.org/wiki/Kattenstoet [^21]: Minnick MF, Anderson BE, Lima A, Battisti JM, Lawyer PG, Birtles RJ. Oroya [[Fever]] and verruga peruana: bartonelloses unique to South America. PLoS Negl Trop Dis. 2014 Jul 17;8(7):e2919. doi: 10.1371/journal.pntd.0002919. PMID: 25032975; PMCID: PMC4102455. [^22]: Maggi RG, Mascarelli PE, Pultorak EL, Hegarty BC, Bradley JM, Mozayeni BR, Breitschwerdt EB. [[Bartonella]] spp. bacteremia in high-risk immunocompetent patients. Diagn Microbiol Infect Dis. 2011 Dec;71(4):430-7. doi: 10.1016/j.diagmicrobio.2011.09.001. Epub 2011 Oct 13. PMID: 21996096. [^23]: Yanagihara, M., Tsuneoka, H., Tanimoto, A., Otsuyama, K., Nishikawa, J., Matsui, T....Ichihara, K. (2018). [[Bartonella]] henselae DNA in Seronegative Patients with Cat-Scratch Disease. _Emerging Infectious Diseases_, _24_(5), 924-925. https://doi.org/10.3201/eid2405.152033. [^24]: Angelakis E, Pulcini C, Waton J, Imbert P, Socolovschi C, Edouard S, Dellamonica P, Raoult D. Scalp eschar and neck lymphadenopathy caused by [[Bartonella]] henselae after Tick Bite. Clin Infect Dis. 2010 Feb 15;50(4):549-51. doi: 10.1086/650172. PMID: 20070235. [^25]: Edouard S, Nabet C, Lepidi H, Fournier PE, Raoult D. [[Bartonella]], a common cause of [[endocarditis]]: a report on 106 cases and review. J Clin Microbiol. 2015 Mar;53(3):824-9. doi: 10.1128/JCM.02827-14. Epub 2014 Dec 24. PMID: 25540398; PMCID: PMC4390654. [^26]: Papineni, P., Carroll, A., Radvan, J., Hemsley, C., Chambers, J., Cortes, N....Klein, J. L. (2017). Management of [[Bartonella]] Prosthetic Valve [[Endocarditis]] without Cardiac Surgery. _Emerging Infectious Diseases_, _23_(5), 861-863. https://doi.org/10.3201/eid2305.161238. [^27]: Berteau, F., Mahieu, R., Le Turnier, P. _et al.* Hepatosplenic bartonellosis in immunocompetent adults: a case series and literature review. _Eur J Clin Microbiol Infect Dis_ **39**, 1789–1792 (2020). https://doi.org/10.1007/s10096-020-03906-8 [^28]: Baylor P, Garoufi A, Karpathios T, Lutz J, Mogelof J, Moseley D. Transverse myelitis in 2 patients with [[Bartonella]] henselae infection (cat scratch disease). Clin Infect Dis. 2007 Aug 15;45(4):e42-5. doi: 10.1086/519998. Epub 2007 Jul 5. PMID: 17638185. [^29]: Maman E, Bickels J, Ephros M, Paran D, Comaneshter D, Metzkor-Cotter E, Avidor B, Varon-Graidy M, Wientroub S, Giladi M. Musculoskeletal manifestations of cat scratch disease. Clin Infect Dis. 2007 Dec 15;45(12):1535-40. doi: 10.1086/523587. PMID: 18190312. [^30]: Landes M, Maor Y, Mercer D, Habot-Wilner Z, Bilavsky E, Chazan B, Cohen R, Glikman D, Strahilevitz J, Katzir M, Litachevsky V, Melamed R, Guri A, Shaked H, Perets O, Wiener-Well Y, Stren A, Paul M, Zimhony O, Srugo I, Rahav G, Bishara J, Kuperman AA, Ben-Ami R, Ephros M, Giladi M. Cat Scratch Disease Presenting as [[Fever]] of Unknown Origin Is a Unique Clinical Syndrome. Clin Infect Dis. 2020 Dec 31;71(11):2818-2824. doi: 10.1093/cid/ciz1137. PMID: 31758684. [^31]: Tasher, D., Raucher-Sternfeld, A., Tamir, A., Giladi, M., & Somekh, E. (2017). [[Bartonella]] quintana, an Unrecognized Cause of Infective [[Endocarditis]] in Children in Ethiopia. _Emerging Infectious Diseases_, _23_(8), 1246-1252. https://doi.org/10.3201/eid2308.161037. [^32]: del Valle LJ, Flores L, Vargas M, García-de-la-Guarda R, Quispe RL, Ibañez ZB, Alvarado D, Ramírez P, Ruiz J. [[Bartonella]] bacilliformis, endemic pathogen of the Andean region, is intrinsically resistant to quinolones. Int J Infect Dis. 2010 Jun;14(6):e506-10. doi: 10.1016/j.ijid.2009.07.025. Epub 2009 Dec 6. PMID: 19969497. [^33]: Telford SR 3rd, Wormser GP. [[Bartonella]] spp. transmission by ticks not established. Emerg Infect Dis. 2010 Mar;16(3):379-84. doi: 10.3201/eid1603.090443. PMID: 20202410; PMCID: PMC3322007. [^34]: Mai BH, Barbieri R, Chenal T, Castex D, Jonvel R, Tanasi D, Georges-Zimmermann P, Dutour O, Peressinotto D, Demangeot C, Drancourt M, Aboudharam G. Five millennia of [[Bartonella]] quintana bacteraemia. PLoS One. 2020 Nov 4;15(11):e0239526. doi: 10.1371/journal.pone.0239526. PMID: 33147255; PMCID: PMC7641340.