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Overview of Bartonella Infections



Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University;

Maria T. Vazquez-Pertejo

, MD, FACP, Wellington Regional Medical Center

Last full review/revision Feb 2020| Content last modified Feb 2020
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Bartonella species are gram-negative bacteria previously classified as Rickettsiae. They are facultative intracellular organisms that typically live within red blood cells (RBCs) and endothelial cells. They cause several uncommon diseases (see table Some Bartonella Infections):

Risk is higher in immunocompromised hosts.

Bartonella infection (bartonellosis) is usually acquired by humans via an insect vector.


Some Bartonella Infections



At Risk

Insect Vector


B. henselae, B. quintana

Verrucous, fleshy skin lesions

Disseminated visceral disease



Immunocompromised patients

Lice, fleas

Doxycycline†, azithromycin, erythromycin

B. quintana

Prolonged or recurrent fever

People living in conditions of crowding or poor hygiene

Immunocompromised patients at risk of disseminated infection

Body louse

Doxycycline, erythromycin, rifampin (gentamicin IV added for 2 weeks for endocarditis)

B. henselae



Endocarditis in patients who have had a valvular heart disorder


Owners of cats

Immunocompromised patients at risk of disseminated infection

Possibly cat fleas (which also transmit the organism among cats)

Azithromycin, doxycycline, rifampin (gentamicin IV added for 2 weeks for endocarditis)†

Oroya fever, verruga peruana, Carrión disease

B. bacilliformis

Acute febrile hemolytic anemia, skin lesions similar to those in bacillary angiomatosis

Secondary infections

Residents of the Andes Mountains at elevations of 600–2400 m


Chloramphenicol, often with doxycycline, or sometimes rifampin, fluoroquinolones, macrolides, or trimethoprim/sulfamethoxazole (TMP/SMX)

* In normal host.

† Treatment is not usually required in patients with a normal immune system.

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