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Strong et al., 1915
Strong et al., 1915
Bartonella (formerly known as Rochalimaea) is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens. Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies, and mosquitoes. At least eight Bartonella species or subspecies are known to infect humans.
Bartonella species have been infecting humans for thousands of years, as demonstrated by Bartonella quintana DNA in a 4000-year-old tooth. The genus is named for Alberto Leonardo Barton Thompson (1871 - October 26, 1950), a Peruvian scientist born in Argentina.
The currently accepted model explaining the infection cycle holds that the transmitting vectors are blood-sucking arthropods and the reservoir hosts are mammals. Immediately after infection, the bacteria colonize a primary niche, the endothelial cells. Every five days, some of the Bartonella in the endothelial cells are released into the blood stream, where they infect erythrocytes. The bacteria then invade a phagosomal membrane inside the erythrocytes, where they multiply until they reach a critical population density. At this point, the Bartonella simply wait until they are taken up with the erythrocytes by a blood-sucking arthropod.
Though some studies have found "no definitive evidence of transmission by a tick to a vertebrate host,"   Bartonella species are well-known to be transmissible to both animals and humans through various other vectors such as fleas, lice, and sand flies. Recent studies have shown a strong correlation between tick exposure and bartonellosis,  including human bartonellosis. Bartonella are the bacteria associated with cat-scratch disease, but a study in 2010 concluded, "Clinicians should be aware that . . . a history of an animal scratch or bite is not necessary for disease transmission."  All current Bartonella species identified in canines are human pathogens.
Bartonella infections are remarkable in the wide range of symptoms an infection can produce: the time course (acute or chronic) as well as the underlying pathology are highly variable.
|Bartonella pathophysiology in humans|
|Species||Human reservoir or|
|B. bacilliformis||Reservoir||Causes Carrion's disease (Oroya fever, Verruga peruana)||Peru, Ecuador, and Colombia|
|B. quintana||Reservoir||Causes Trench fever, Bacillary angiomatosis, and endocarditis||Worldwide|
|B. clarridgeiae||Incidental||Domestic cat||Cat-scratch Disease|
|B. grahamii||Incidental||Mouse||Endocarditis and Neuroretinitis|
|B. henselae||Incidental||Domestic cat||Cat-scratch Disease, Bacillary angiomatosis, Peliosis hepatis, Endocarditis, Bacteremia with fever and Neuroretinitis||Worldwide|
|B. koehlerae||Incidental||Domestic cat|
|B. vinsonii||Incidental||Mouse, Dog, Domestic Cat|
|B. rochalimae||Incidental||Unknown||Carrion's disease-like symptoms|
Treatment is dependent on which strain of Bartonella is found in a given patient. While Bartonella species are susceptible to a number of standard antibiotics in vitro — macrolides and tetracycline, for example — the efficacy of antibiotic treatment in immunocompetent individuals is uncertain. Immunocompromised patients should be treated with antibiotics because they are particularly susceptible to systemic disease and bacteremia. Drugs of particular effectiveness include trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and rifampin; B. henselae is generally resistant to penicillin, amoxicillin, and nafcillin.
Homeless IV drug users are at high risk for Bartonella infections, particularly B. elizabethae. B. elizabethae seropositivity rates in this population range from 12.5% in Los Angeles, to 33% in Baltimore, Maryland, 46% in New York, and in Sweden 39%.