Bartonella

Pediatricians are often familiar with cat-scratch disease (CSD), but many are not familiar with the other manifestations of Bartonella infection. The Bartonella genus of bacteria are fastidious and slow-growing gram-negative bacilli. From 1889 to the present, 8 different Bartonella species have been identified, with differing manifestations. This In Brief reviews the illnesses caused by 3 of the more common Bartonella strains: henselae, quintana, and bacilliformis.

CSD, caused by Bartonella henselae, is the most common Bartonella infection, but it is also a “newer” manifestation. CSD was first reported clinically in 1950, yet B henselae was not identified as the etiologic agent until 1983.

In immunocompetent patients, typical (uncomplicated) CSD is characterized by regional lymphadenopathy, the most common manifestation of B henselae infection, along with a history of cat exposure. For most patients with CSD, regional lymphadenopathy is the only symptom. In approximately 30% of patients with CSD, mild systemic symptoms are also present, including low-grade fever, fatigue, and headache. A skin papule, vesicle, or pustule may be present at the presumed site of inoculation, which is often a bite or scratch from an infected cat. Regional lymphadenopathy develops approximately 1 to 2 weeks after the inoculation. The affected nodes are most frequently in the axillary, cervical, and inguinal areas, and the skin overlying the affected lymph nodes is often tender, warm, erythematous, and indurated, consistent with a bacterial lymphadenitis. Approximately 10% of affected nodes suppurate spontaneously.

Atypical (complicated) CSD is a disseminated infection that develops in 5% to 14% of immunocompetent patients and may involve almost any organ system. Ocular manifestations of B henselae occur in 5% to 10% …