The name given to infections caused by Bartonella species. The infections usually cause sudden fever, anemia, chronic skin eruptions, cat scratch disease, or diseases that are distributed over various areas of the body in hosts who are less resistant to disease.

The Bartonella are a small group of gram-negative bacteria. The three species which are of concern to humans are as follows:

• B. quintana enters the body by the body louse. The condition can lead to trench fever.

• B. henselae (formerly Rochalimaea henselae) possibly enters the body by fleas. It causes cat scratch disease, and widespread infections in persons who are less resistant to infection (immnuocompromised).

• B. bacilliformis enters the body by the phlebotomus sandfly. B. bacilliformis organisms enter the bloodstream and attach themselves to white blood cells, causing anemia. They also enter the capillary flat cells that line the blood and lymphatic vessels (endothelial cells), causing the vessels to occlude.

Oroya fever is the first clinical sign and stage of bartonellosis. It causes sudden fever, weakness, paleness, muscle and joint pain, and severe headache. In addition, neurological manifestations include delirium and coma. The second stage is verruga peruana. This stage is characterized by skin eruptions that occur mainly on the limbs and face. This stage lasts for months to years, and may be associated with pain and fever.

Peripheral blood smears can readily reveal the organism on a stained slide during the acute stage. When the infection progresses to the cutaneous stage, the organism can be identified via the skin eruptions. Blood cultures during the cutaneous stage also demonstrate the organism.

Treatment for these three species causing bartonellosis is as follows:

• B. quintana - Treatment may not be required in persons with normal immune systems. Otherwise, antibiotics are indicated.

• B. henselae - Treatment may not be required in persons with normal immune systems. Otherwise, antibiotics are indicated.

• B. bascilloformis - Antibiotics are indicated. Insecticides control the sandfly. Antimicrobial treatment is indicated in the acute stage. Antimicrobial therapy rapidly discontinues this stage, and prevents the eruption of skin lesions. In addition, since salmonella bacteria can complicate bartonellosis, the treatment of choice is chloramphenicol; a broad-spectrum antibiotic used in the treatment of salmonella.

Mortality rates can be 50% or more in untreated cases.

1. May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% and/or other requirements/qualifications under 38 CFR §3.350 [Special monthly compensation ratings]. Also reference 38 CFR 3.155(d)(2).

Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, endocarditis or skin lesions. (38 CFR §4.88b [Schedule of ratings-infectious diseases, immune disorders and nutritional deficiencies])