From the Guidelines
A Bartonella rash can cause symptoms beyond just the skin manifestation, including lymphadenopathy, fever, and systemic symptoms. According to the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1, the disease course varies, but lymphadenopathy generally resolves within 1–6 months. In about 10% of cases, the nodes suppurate, and extranodal disease can develop in ≤2% of cases.
Key Symptoms
- Lymphadenopathy
- Fever
- Systemic symptoms
- Lymph node suppuration in some cases
- Extranodal disease in rare cases
The diagnosis of Bartonella infections may be difficult because the organism is fastidious and difficult to grow in culture, but serological testing and PCR can support the diagnosis 1.
Treatment
- Azithromycin is recommended for the treatment of cat scratch disease, with a dose of 500 mg on day 1, then 250 mg once daily for 4 additional days for patients weighing ≥45.5 kg (100 lb) 1
- For patients weighing <45.5 kg, the dose is 10 mg/kg orally on day 1, then 5 mg/kg on days 2–5 1
It is essential to seek medical evaluation promptly if a Bartonella infection is suspected, as proper diagnosis through blood tests or PCR is important for appropriate management. Treatment with antimicrobial agents, such as azithromycin, can help reduce lymph node size and alleviate symptoms.
From the Research
Bartonella Infection Symptoms
- Bartonella infections can cause a range of symptoms, including local lymphadenopathy and more serious systemic disease such as persistent bacteremia and endocarditis 2.
- Cutaneous manifestations of bartonellosis can include maculo-papular rash, papules or nodules, vasculitis, febrile morbilliform rash, purpura, urticaria, erythema nodosum, erythema multiforme, erythema marginatus, granuloma annularis, leukocytoclastic vasculitis, granulomatous reactions, and angioproliferative reactions 3.
- Cat-scratch disease, caused by Bartonella henselae, can result in symptoms such as agitation, panic disorder, and treatment-resistant depression 4.
Rash Symptoms
- A maculo-papular rash can occur in trench fever, which is caused by Bartonella quintana 3.
- Papules or nodules can occur in cat scratch disease, which is caused by Bartonella henselae 3.
- A febrile morbilliform rash can also occur in bartonellosis 3.