66) Bartonella bacilliformis: Oroya fever and Verruga peruana. Bartonella henselae and Bartonella quintana: Cat-Scratch Disease, Bacillary Angiomatosis and Trench Fever.

Question 1

Bartonella bacilliformis: Oroya fever

Answer 1

Bartonella bacilliformis is a gram-negative bacterium that causes Oroya fever, a severe febrile illness with anemia and leukopenia. The bacterium is transmitted by sandflies and is endemic in the Andean regions of South America. Infected individuals experience an acute phase with high fever, fatigue, and pallor due to hemolytic anemia. The bacteria infect red blood cells, causing a drop in hemoglobin. If untreated, the disease can be fatal. Treatment includes antibiotics such as doxycycline or azithromycin.

Question 2

Bartonella bacilliformis: Verruga peruana

Answer 2

Verruga peruana is a cutaneous manifestation of Bartonella bacilliformis infection, occurring after the acute phase of Oroya fever. It is characterized by the development of raised, reddish-purple lesions on the skin, primarily on the face and extremities. These lesions are composed of proliferating blood vessels, leading to the term ‘angiomatosis.’ The condition can persist for months or years but is typically less severe than Oroya fever. Treatment with doxycycline or azithromycin is effective.

Question 3

Bartonella henselae: Cat-Scratch Disease

Answer 3

Bartonella henselae is a gram-negative bacterium responsible for cat-scratch disease, transmitted by scratches or bites from infected cats, often young cats. Clinical features include a localized papule or pustule at the site of inoculation, followed by regional lymphadenopathy, fever, and malaise. The infection is usually self-limiting, but in immunocompromised individuals, it can cause more severe systemic manifestations. Diagnosis is based on clinical findings and serology. Treatment includes azithromycin or doxycycline.

Question 4

Bartonella henselae: Bacillary Angiomatosis

Answer 4

Bacillary angiomatosis is a proliferative vascular disease caused by Bartonella henselae, typically seen in immunocompromised individuals, such as those with HIV/AIDS. It presents with vascular lesions (similar to Verruga peruana) that can involve the skin, liver, spleen, and other organs. Lesions appear as raised, red-to-purple nodules and can be mistaken for Kaposi’s sarcoma. Diagnosis is made through biopsy and PCR. Treatment includes erythromycin, doxycycline, or azithromycin.

Question 5

Bartonella quintana: Trench Fever

Answer 5

Bartonella quintana is a gram-negative bacterium responsible for trench fever, historically affecting soldiers during World War I. It is transmitted by body lice. Symptoms include relapsing episodes of fever, headache, muscle pain, and weakness. The disease can last for weeks to months and may be complicated by endocarditis or other systemic issues. Trench fever can be treated with doxycycline or azithromycin. In immunocompromised patients, treatment is more complicated, and prolonged antibiotic therapy may be needed.