II. Risk Factors
- AIDS (CD4 Count <100 cells/mm3)
- Immunocompromised patients on Chemotherapy or organ rejection medication
III. Causes
V. Signs
- Skin Lesions that appear similar to Kaposi's Sarcoma
- Vascular lesions in form or Papules, Nodules or pedunculated
VI. Differential Diagnosis
VII. Diagnosis
- Bartonella Antibody titer increased (or by PCR)
- Biopsy shows bacillary organisms
VIII. Management
- Risks
- Jarisch-Herxheimer Reaction (first 48 hours)
- Avoid use of TMP-SMZ, Ciprofloxacin, Penicillin, Cephalosporins
- Uncomplicated infection (skin only)
- Treat for 3 months (skin lesions may resolve as early as in 1-3 weeks)
- Doxycycline 100 mg oral or IV twice daily (preferred) OR
- Erythromycin 500 mg every 6 hours
- Other Macrolides have been used (Azithromycin, Clarithromycin)
- Disseminated infection
- Treat for at least 4 months
- Doxycycline 100 mg oral or IV twice daily AND
- Rifampin 300 mg orally twice daily
- Relapsing infection
- Repeat antibiotic course as above AND
- Extend course for suppression until CD4 Count >200 for 6 months
IX. Complications
- Disseminated infection to bone, mucous membranes, CNS
- Bacterial Endocarditis
- Bacillary Peliosis (Liver Cystic lesions)
X. References
- Spach in Bartlett (2016) Bartonella in HIV, UpToDate, ios app accessed 4/13/2016
- Angelakis (2014) Int J Antimicrob Agents 44:16–25 [PubMed]
- Goldschmidt (1999) J Am Board Fam Pract 12(1): 71-94 [PubMed]