Diagnosis, treatment, and prevention of Bartonella infections in HIV-infected patients
- David H Spach, MD
David H Spach, MD
- Professor of Medicine
- Division of Infectious Diseases
- University of Washington
Bartonella infections can cause serious morbidity and mortality in HIV-infected patients, particularly those with advanced immunosuppression.
This topic will address the diagnosis, treatment, and prevention of Bartonella infections in HIV-infected patients. The epidemiology and clinical manifestations of disease are discussed elsewhere. (See "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients".)
General background — The diagnosis of Bartonella infections can be made through histopathologic examination of biopsy tissue . Lesions are characterized by vascular proliferation; Warthin-Starry stain usually demonstrates numerous bacilli.
Although isolation of this organism makes a definitive diagnosis, this is infrequently accomplished due to the fastidious nature of this organism. Serologic testing is often used as supportive, but not definitive, evidence for infection.
Culture — Bartonella species are fastidious gram-negative bacteria that require specific laboratory conditions to enhance the yield. The likelihood of isolating of the organism increases if blood is cultured in pediatric or adult isolator tubes (Wampole, Cranbury, NJ) or in tubes containing EDTA. Bartonella species have occasionally been isolated from BACTEC (Becton Dickinson Diagnostic Instrument Systems, Sparks, MD) bottles.
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