II. Risk Factors

  1. AIDS (CD4 Count <100 cells/mm3)
  2. Immunocompromised patients on Chemotherapy or organ rejection medication

IV. Symptoms

  1. Fever
  2. Chills
  3. Anorexia
  4. Weight loss
  5. Gastrointestinal symptoms

V. Signs

  1. Skin Lesions that appear similar to Kaposi's Sarcoma
  2. Vascular lesions in form or Papules, Nodules or pedunculated

VI. Differential Diagnosis

VII. Diagnosis

  1. Bartonella Antibody titer increased (or by PCR)
  2. Biopsy shows bacillary organisms

VIII. Management

  1. Risks
    1. Jarisch-Herxheimer Reaction (first 48 hours)
    2. Avoid use of TMP-SMZ, Ciprofloxacin, Penicillin, Cephalosporins
  2. Uncomplicated infection (skin only)
    1. Treat for 3 months (skin lesions may resolve as early as in 1-3 weeks)
    2. Doxycycline 100 mg oral or IV twice daily (preferred) OR
    3. Erythromycin 500 mg every 6 hours
      1. Other Macrolides have been used (Azithromycin, Clarithromycin)
  3. Disseminated infection
    1. Treat for at least 4 months
    2. Doxycycline 100 mg oral or IV twice daily AND
    3. Rifampin 300 mg orally twice daily
  4. Relapsing infection
    1. Repeat antibiotic course as above AND
    2. Extend course for suppression until CD4 Count >200 for 6 months

IX. Complications

  1. Disseminated infection to bone, mucous membranes, CNS
  2. Bacterial Endocarditis
  3. Bacillary Peliosis (Liver Cystic lesions)

X. References

Images: Related links to external sites (from Bing)

Related Studies