From the Research
Yes, Bartonella can cause hemolysis, particularly the species Bartonella bacilliformis, which is responsible for Carrión's disease (also called Oroya fever in its acute phase). During infection, these bacteria attach to red blood cells and cause severe hemolytic anemia by damaging the cell membrane, leading to rupture of the red blood cells. This hemolysis can be profound, with some patients losing up to 80% of their red blood cells during acute infection. Other Bartonella species like B. henselae (cat scratch disease) and B. quintana (trench fever) typically cause less severe hemolysis. The most recent and highest quality study on the treatment of Bartonella infections is from 1, which found that current clinical practice for the treatment of bartonellosis relies mostly on expert opinion and antimicrobial susceptibility data. However, based on the available evidence, treatment for Bartonella infections usually involves antibiotics such as doxycycline (100mg twice daily for 7-14 days), ciprofloxacin, or chloramphenicol, depending on the species and severity. In cases with severe hemolysis, supportive care including blood transfusions may be necessary. The hemolysis occurs because Bartonella produces proteins that can directly damage red blood cell membranes and also because the organism can invade erythrocytes, triggering immune-mediated destruction of infected cells. Some key points to consider when treating Bartonella infections include:
- The use of gentamicin and doxycycline for chronic bacteremia, as found in 1
- The potential for antibiotic resistance, as discussed in 2
- The importance of supportive care, including blood transfusions, in cases with severe hemolysis. It is essential to note that the treatment of Bartonella infections should be guided by the severity of the disease and the species involved, and that randomized controlled trials are needed to compare different treatment options, as stated in 1.