RT Book, Section
A1 Giladi, Michael
A1 Ephros, Moshe
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1155967905
T1 Bartonella Infections, Including Cat-Scratch Disease
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accessmedicine.mhmedical.com/content.aspx?aid=1155967905
RD 2024/04/23
AB Bartonella  species  are  fastidious,  facultative  intracellular,  slow-growing,  gram-negative  bacteria  that  cause  a  broad  spectrum  of  diseases  in  humans.  This  genus  includes  ~40  distinct  species  or  subspecies,  of  which  at  least  16  have  been  recognized  as  confirmed  or  potential  human  pathogens;  Bartonella  bacilliformis,  Bartonella  quintana,  and  Bartonella  henselae  are  most  commonly  identified  (Table  167-1).  Most  Bartonella  species  have  successfully  adapted  to  survival  in  specific  domestic  or  wild  mammals.  Prolonged  intraerythrocytic  infection  in  these  animals  creates  a  niche  where  the  bacteria  are  protected  from  both  innate  and  adaptive  immunity  and  which  serves  as  a  reservoir  for  human  infections.  Bartonella  characteristically  evades  the  host  immune  system  by  modification  of  its  virulence  factors  (e.g.,  lipopolysaccharides  or  flagella)  and  by  attenuation  of  the  immune  response.  B.  bacilliformis  and  B.  quintana,  which  are  not  zoonotic,  are  exceptions.  Arthropod  vectors  are  often  involved.  Isolation  and  characterization  of  Bartonella  species  are  difficult  and  require  special  techniques.  Clinical  presentation  generally  depends  on  both  the  infecting  Bartonella  species  and  the  immune  status  of  the  infected  individual.  Bartonella  species  are  susceptible  to  many  antibiotics  in  vitro;  however,  clinical  responses  to  therapy  and  studies  in  animal  models  suggest  that  the  minimal  inhibitory  concentrations  of  many  antimicrobial  agents  correlate  poorly  with  the  drugs’  in  vivo  efficacies  in  patients  with  Bartonella  infections.