Symptoms

Enlarged lymph node resulting from cat scratch disease. Used with permission of NEJM.

Cat scratch disease (CSD), Bartonella henselae

• Fever
• Enlarged, tender lymph nodes that develop 1–3 weeks after exposure
• A papule or pustule at the inoculation site

Rarely, unusual manifestations such as eye infections, severe muscle pain, or encephalitis may occur.

Trench fever, Bartonella quintana

• Fever (may present as a single bout of fever or bouts of recurrent fever)
• Headache
• Rash
• Bone pain, mainly in the shins, neck, and back

Carrión's disease, Bartonella bacilliformis

Verruga peruana, mular form. Used with permission of NEJM.

This disease has 2 distinct phases:

• Oroya fever: During this phase, patients may present with fever, headache, muscle aches, abdominal pain, and severe anemia.
• Verruga peruana: During this later phase, lesions appear under the skin as nodular growths, then emerge from the skin as red-to-purple vascular lesions that are prone to ulceration and bleeding.

Other complications

Bacillary angiomatosis

Bacillary angiomatosis (caused by B. henselae or B. quintana) and bacillary peliosis (caused by B. henselae) occur primarily in immunocompromised people, such as those with advanced HIV infection. Bacillary angiomatosis may present as lesions in the skin, subcutaneous tissue, bone, or other organs. Bacillary peliosis causes vascular lesions in the liver and spleen.

Bacillary angiomatosis. Used with permission of NEJM.

Subacute endocarditis

Many Bartonella species can cause subacute endocarditis (infection of the heart valves), which is often culture negative.