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Traveler Summary

Key Points

  • Bartonellosis is a bacterial infection common in certain valleys in the Andes Mountains of South America, acquired through the bite of an infected sandfly.
  • Risk occurs in travelers going to affected areas who will have evening and nighttime outdoor exposure.
  • Symptoms include fever, malaise, headaches, weakness, muscle aches, and exhaustion.
  • Consequences of infection include enlarged kidney and spleen, swollen lymph glands, mental status changes, and fluid retention.
  • Prevention includes wearing long sleeves and long pants as well as observing personal protective measures against sandfly bites.
  • No vaccine or preventive drugs are currently available.

Introduction

Bartonellosis is a potentially fatal bacterial infection of red blood cells transmitted by the bite of a sandfly carrying the Bartonella bacteria. The acute phase of the disease causes high fever and anemia; a later, chronic phase is characterized by distinctive skin sores that look like warts.

Risk Areas

Bartonellosis occurs in many valleys of the South American Andes, primarily in Peru and in some parts of Ecuador, at altitudes ranging from 500 to 3200 m (1,600-10,500 ft) above sea level. Infected areas include popular destinations in the Sacred Valley of the Incas.

Transmission

Bartonellosis is transmitted through the bite of infected sandflies in affected areas, where transmission seems to occur throughout the year. Most of the sandflies' biting activity is at dusk, at night, or before sunrise. The bite is usually painless but can become very itchy shortly after it occurs.

Risk Factors

The risk for short-term travelers is low, but the recent increase in adventure travel and eco-tourism to endemic areas may increase the possibility of transmission to travelers, especially if insect precautions during sandfly biting times are not adhered to.

Symptoms

Bartonellosis typically involves 2 stages: acute and chronic.

The acute phase typically develops 3 to 4 weeks after infection, but can take as long as 16 weeks to appear. Symptoms include fever, malaise, headaches, weakness, muscle aches, and exhaustion due to extreme anemia.

Consequences of Infection

Consequences of acute infection include enlarged kidney and spleen, swollen lymph glands, and mental status changes. Seizures and fluid retention can occur in some patients. Death occurs in about 90% of untreated cases.

The chronic phase begins 2 to 8 weeks after recovery from the acute phase (or sometimes without a previously recognizable acute phase) and is characterized by distinctive skin sores that look like warts.

Need for Medical Assistance

Travelers who develop fever, dark urine, or pale skin (due to anemia) should seek urgent medical attention. Travelers should mention bartonellosis to treating physicians, who often think of malaria in a traveler exposed in Peru. Acute bartonellosis is a very serious, potentially fatal illness, but early diagnosis and treatment with common antibiotics can drastically reduce the potential for a fatal outcome.

Prevention

Nonvaccine

Wear long sleeves and long pants and observe daytime and nighttime personal protective measures against sandfly bites. Observe standard insect precautions, but remember that the tiny sandflies can penetrate standard mosquito nets. DEET-based insect repellents are generally effective.