How do people get Bartonellosis?
Bartonella spp. may be transmitted by contact with flea and louse feces, ticks or biting flies, or by the scratch or bite of an infected animal, most often a flea-infested cat. Bartonella spp. DNA have been found in several arthropod vectors in the United States, including cat fleas (Ctenocephalides felis) and ticks (Ixodes scapularis, Ixodes pacificus). Suspected transmission of Bartonella spp. following the bite or scratch of wild animals, such as groundhogs, squirrels, and coyotes has also been documented.
Research suggests that people who live and work with animals, especially veterinary workers, have the highest risk of Bartonella infection.
Where do most cases of Bartonellosis occur?
Bartonella infections in humans and animals have been documented throughout the United States and in countries in all major regions of the world. Geographic evidence suggests that prevalence of Bartonella spp. in arthropod vectors (fleas, ticks, lice, biting flies, etc.) is higher in warmer climates.
What are the symptoms of Bartonellosis?
Bartonella spp. induce chronic intravascular and intracellular infection resulting in a wide range of symptoms that can include pathology involving multiple organ systems. The early clinical presentation of Bartonellosis is often nonspecific with symptoms that resemble many other infectious and non-infectious diseases. Three important components of the initial clinical presentation are fever, swollen lymph nodes, and at risk exposure to arthropod vectors or bacteremic animals. None of these symptoms may be present in patients seeking medical care for chronic Bartonellosis.
Symptoms that vary in number and severity among patients may include:
- swollen lymph nodes
- skin rash or markings
- joint aches and swelling
- cardiovascular signs
- neurovascular inflammation
- abnormal sleep patterns
- memory loss
- skin lesions
- vasoproliferative tumors
Bartonellosis is associated with complex disease processes in both people and animals. It is possible to be chronically-infected with Bartonella and not have disease symptoms. The extent to which persistent infection in outwardly healthy individuals ultimately contributes to organ system pathology is unknown. Bartonellosis can range from severe life-threatening illnesses (myocarditis, endocarditis, vasculitis) to chronic intermittent and often relapsing symptoms listed above. It is possible that some individuals may become infected and not develop disease. It is not known if this is because some immune systems clear the Bartonella infection or because the infection is well tolerated.
How is Bartonellosis diagnosed?
A diagnosis of Bartonellosis is based on a combination of symptoms, physical examination findings, and specialized confirmatory laboratory tests. Detection of Bartonella is extremely challenging, as these bacteria are immune-evasive and infect at exceedingly low levels of detection. IFA serology tests are available for the detection of antibodies, but only for a few Bartonella spp. Although highly insensitive, IFA serology tests can provide evidence of exposure, but do not confirm infection. The most effective means of detecting active infection involves the combination of culture and PCR detection methods–referred to as enrichment PCR or ePCR.
Evolving evidence suggests that early detection and confirmation of Bartonella spp. infection is important for providing the best patient care.
How is Bartonellosis treated?
A number of different antibiotics have been used to treat Bartonella infection. Treatment recommendations vary on a case-by-case basis.
How can Bartonellosis be prevented?
- Avoid contact with feral animals, especially cats and rodents.
- Wear protective clothing when working or playing outdoors and when interacting with animals.
- Routinely use pest control measures for fleas, lice and ticks in your home and on your pets.
- Remove fleas, lice, and ticks promptly and properly and avoid scratching arthropod feces into wounds.
- Clean bites and scratches promptly using soap and water.
- See your doctor if you experience persistent flu-like symptoms and other adverse reactions following potential Bartonella spp exposure. Early detection is key.
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