- Bartonellosis is a bacterial infection common in certain valleys in the Andes Mountains of South America, acquired through the bite of an infected sand fly.
- 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 sand fly bites.
- No vaccine or preventive drugs are currently available.
Bartonellosis is a potentially fatal bacterial infection of red blood cells transmitted by the bite of a sand fly 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.
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.
Bartonellosis is transmitted through the bite of infected sand flies in affected areas, where transmission seems to occur throughout the year. Most of the sand flies' biting activity is at dusk, at night, or before sunrise. The bite is usually painless but can become very itchy shortly after it occurs.
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 sand fly biting times are not adhered to.
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.
Wear long sleeves and long pants and observe daytime and nighttime personal protective measures against sand fly bites. Observe standard insect precautions, but remember that the tiny sand flies can penetrate typical mosquito nets. DEET-based insect repellents are generally effective.