Diagnosis and treatment of Bartonella henselae infections.

There are four Bartonella species known to be pathogenic for humans (Table 1). Carrion’s disease (Bartonella bacilliformis) is endemic to certain areas of South America and has a clinical course that varies widely. It may occur as a subclinical latent disease, an acute fulminant and fatal febrile illness, or an insidious disease of the skin. Trench fever (Bartonella quintana) is transmitted by the human louse and appears to be endemic in Poland, Eastern Europe, North Africa, and Russia. Patients usually have a single acute febrile illness that lasts 3–6 days, but prolonged or relapsing fevers may also occur. Bartonella elizabethae has caused endocarditis in at least one patient. The most important of these species, however, is Bartonella henselae. As more information is obtained about this species of Bartonella, it becomes necessary for the clinician to have a working knowledge of the typical and atypical presentations of clinical disease, methods of diagnosis, and acceptable treatment options for this organism.