From the Guidelines
Bartonella infection affecting the liver and spleen typically presents with non-specific symptoms such as fever, fatigue, abdominal pain, and hepatosplenomegaly, and should be treated with azithromycin as the first-line antibiotic therapy. The symptoms of Bartonella liver and spleen infection can be varied and non-specific, making diagnosis challenging. 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, extranodal disease, including liver and spleen involvement, occurs in less than 2% of cases. Patients may experience:
- Fever
- Fatigue
- Abdominal pain, particularly in the upper right and left quadrants
- Hepatosplenomegaly (enlarged liver and spleen)
- Night sweats
- Weight loss
- Decreased appetite
- General malaise
- Lymph node enlargement
- Rash
- Joint pain Blood tests may show elevated liver enzymes, anemia, and abnormal white blood cell counts. The recommended treatment for Bartonella infections, including those affecting the liver and spleen, is azithromycin, with a recommended 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. It is essential to seek medical attention promptly if a Bartonella infection is suspected, as proper diagnosis through blood cultures, PCR testing, or serology is crucial for appropriate treatment.
From the Research
Symptoms of Bartonella Liver Spleen Infection
- The symptoms of Bartonella liver spleen infection can range from benign and self-limited to severe and life-threatening disease 2.
- Clinical conditions associated with Bartonella spp. include local lymphadenopathy, bacteraemia, endocarditis, and tissue colonisation resulting in bacillary angiomatosis and peliosis hepatis 2.
- Granulomatous hepatitis and necrotizing splenitis are also manifestations of Bartonella henselae infection, particularly in immunocompromised persons 3.
- In immunocompetent adults, systemic Bartonella henselae infections are unusual, but can present with fever and multinodular splenomegaly 4.
- The severity of Bartonella infection correlates with the patient's immune status, and without treatment, Bartonella infection can cause high mortality 2.
Treatment of Bartonella Liver Spleen Infection
- Treatment decisions for Bartonella infections are based on case reports, and no single treatment is effective for all Bartonella-associated diseases 2, 5.
- For patients with Bartonella spp. bacteraemia, treatment with gentamicin and doxycycline is recommended, while chloramphenicol has been proposed for the treatment of B. bacilliformis bacteraemia 2.
- Gentamicin in combination with doxycycline is considered the best treatment regimen for endocarditis, and erythromycin is the first-line antibiotic therapy for the treatment of angioproliferative lesions 2.
- In the case of visceral infection by B. henselae, treatment with doxycycline and rifampin has been effective 3.