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NAME: Bartonella bacilliformis

SYNONYM OR CROSS REFERENCE: Oroya fever Footnote 1, verruga peruana, Lutzomyia verrucarum, Bartonellosis, Carrion’s disease.

CHARACTERISTICS: Aerobic, Gram-negative, motile rods with polar flagellaFootnote 2, Footnote 3; 0.3-1.5 µm long by 0.2-0.5 µm wide; fastidious, hemotrophic organism Footnote 3, Footnote 4. B. bacilliformis occurs mainly in the form of short rods arranged singly, in pairs, in chains, or in clumps Footnote 2. This organism grows best at about from 25°C to 28°C, prefers a pH of 7.8, does not ferment sugar, forms no haemolysin, and survives in semisolid medium at -70°C for years and at 25°C to 28°C for weeks.


PATHOGENICITY/TOXICITY: Causes biphasic disease in humans with two distinct clinical forms: Oroya fever (frequently fatal form characterized by haemolytic syndrome) and verruga peruana (non-fatal form characterized by wart-like growths) Footnote 2, Footnote 5. The bacteria may reside in host in asymptomatic form or progress to disease.

In the acute form of Oroya fever, the disease is rapidly progressive, marked by febrile anemia with high parasitaemia, and is characterized by fever, haemolytic anemia, headache, and pallor Footnote 2, Footnote 6. Destruction of red blood cells in organs may ensue with associated lymphadenopathy, severe thrombocytopenia, myalgias, arthralgias, and associated hypoxic complications of delirium or coma. Mortality rates of Oroya fever can be as high as 40%-85% Footnote 5, Footnote 7. An asymptomatic period of latency is generally noted and many patients develop chronic eruptive, verruga peruana stage Footnote 2. Verrugous lesions are wart- or hemangioma-like, nodular outgrowths that vary in size and number, may persist for months to years, and can be accompanied by severe muscle and joint pain Footnote 6, Footnote 8. Mucosal and internal lesions may also occur. Although Oroya fever and verruga peruana generally occur sequentially, each phase is a distinct syndrome in the absence of the other Footnote 2.

EPIDEMIOLOGY: Infections seen only in South America at intermediate altitudes (Peru, Equador, Columbia) Footnote 2, Footnote 7.

HOST RANGE: Humans, monkeys Footnote 2, Footnote 5.


MODE OF TRANSMISSION: Transmitted by the bite of the sand fly Lutzomyia verrucarum Footnote 1, Footnote 2.

INCUBATION PERIOD: Oroya fever may develop in 1-3 weeks post infection, and verruga peruana may occur 2 weeks to years after recovery from bartonellosis Footnote 2, Footnote 6.

COMMUNICABILITY: B. bacilliformis is transmitted from human to human via vectors (Lutzomyia verrucarum) Footnote 1.


RESERVOIR: Humans (dormant and asymptomatic stage of disorder in humans believed to be natural reservoir) Footnote 2, Footnote 5.


VECTORS: Sand fly, Lutzomyia spp. Footnote 1.


DRUG SUSCEPTIBILITY/RESISTANCE: Susceptible to chloramphenicol, penicillin, gentamicin, doxycycline, beta-lactams, rifampin, macrolides, cotrimoxazole, fluoroquinolones, streptomycin, and tetracycline Footnote 2, Footnote 9, Footnote 10.

DRUG RESISTANCE: Resistant to nalidixic acid, vancomycin, clindamycin, ciprofloxacin, rifampicin, erythromycin, and aminoglycosides Footnote 9, Footnote 11. Resistance to quinolones has been reported Footnote 12.

SUSCEPTIBILITY TO DISINFECTANTS: Information specific to B. bacilliformis is not available, but most bacteria have been shown to be susceptible to low concentration of chlorine, 1% sodium hypochlorite, 2% formaldehyde, 70% ethanol, phenolics such as orthophenylphenol and ortho-benzyl-paua-chlorophenol, 2% aqueous glutaraldehyde, peracetic acid (0.001% to 0.2%) Footnote 13, Footnote 15.

PHYSICAL INACTIVATION: Information specific to B. bacilliformis is not available, but most bacteria can be inactivated by moist heat (121°C for 15 min - 30 min) and dry heat (160-170°C for 1-2 hours) Footnote 16.

SURVIVAL OUTSIDE HOST: B. bacilliformis survives in semisolid media stored at -70°C for years, 25-28°C for several weeks Footnote 2.


SURVEILLANCE: Monitor for symptoms. Infection can be confirmed by isolation of infective agent using culture methods such as peripheral blood smear, Giemsa stain and identification of bacilli, PCR, and/or indirect immunofluorescence assay (IFA) Footnote 11, Footnote 17. Improved assays can be based on detection of novel antigens or by sequencing relevant genes by phylogenetic analysis Footnote 17-Footnote 19.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Administer appropriate drug therapy. Acute Phase: Administration of appropriate antibiotic regime Footnote 11. Blood transfusion in cases of severe anaemia.

Eruptive Phase: Recommended treatment is rifampin for 14 to 21 days or, alternatively, azithromycin, ciprofloxacin, or erythromycin can be given for 7 to 14 days Footnote 11. Chloramphenicol or penicillin treatments are not useful in this phase.




LABORATORY-ACQUIRED INFECTIONS: One case of laboratory-acquired infection with B. bacilliformis has been reported and was published in 1976 Footnote 20.

SOURCES/SPECIMENS: Blood, Skin lesion, infected vector Footnote 1-Footnote 3.

PRIMARY HAZARDS: Accidental parenteral inoculation, contact with infected laboratory sandflies Footnote 1-Footnote 3, Footnote 4.



RISK GROUP CLASSIFICATION: Risk Group 2 Footnote 21.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes Footnote 22.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities Footnote 22.


SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up Footnote 22.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration Footnote 22.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled Footnote 22.


REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: November 2010

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada

Although the information, opinions and recommendations contained in this Pathogen Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©
Public Health Agency of Canada, 2010


Footnote 1
Krauss, H., Weber, A., Appel, M., Enders, B., Isenberg, H. D., Schiefer, H. G., Slenczka, W., von Graevenitz, A., & Zahner, H. (2003). Bacterial Zoonoses. In H. Krauss, A. Weber, M. Appel, B. Enders, H. D. Isenberg, H. G. Schiefer, W. Slenczka, A. von Graevenitz & H. Zahner (Eds.), Zoonoses: Infectious Diseases Transmissible from Animals to Humans (3rd ed., pp. 173-252). Washington, D.C.: ASM Press.
Footnote 2
Jerris, R. C. (1998). Tropheryma, Afipia and Bartonella. In A. Balows, & B. I. Duerden (Eds.), Topley & Wilson's Microbiology and Microbial Infections (9th ed., pp. 1365-1374). New York: Oxford University Press.
Footnote 3
Minnick, M. F., Mitchell, S. J., & McAllister, S. J. (1996). Cell entry and the pathogenesis of Bartonella infections. Trends in Microbiology, 4(9), 343-347.
Footnote 4
Minnick, M. F., & Battisti, J. M. (2009). Pestilence, persistence and pathogenicity: Infection strategies of Bartonella. Future Microbiology, 4(6), 743-758.
Footnote 5
Ihler, G. M. (1996). Bartonella bacilliformis: Dangerous pathogen slowly emerging from deep background. FEMS Microbiology Letters, 144(1), 1-11.
Footnote 6
Kosek, M., Lavarello, R., Gilman, R. H., Delgado, J., Maguina, C., Verastegui, M., Lescano, A. G., Mallqui, V., Kosek, J. C., Recavarren, S., & Cabrera, L. (2000). Natural history of infection with Bartonella bacilliformis in a nonendemic population. The Journal of Infectious Diseases, 182(3), 865-872. doi:10.1086/315797
Footnote 7
Alexander, B. (1995). A review of bartonellosis in Ecuador and Colombia. American Journal of Tropical Medicine and Hygiene, 52(4), 354-359.
Footnote 8
Cerimele, F., Brown, L. F., Bravo, F., Ihler, G. M., Kouadio, P., & Arbiser, J. L. (2003). Infectious angiogenesis: Bartonella bacilliformis infection results in endothelial production of angiopoetin-2 and epidermal production of vascular endothelial growth factor. The American Journal of Pathology, 163(4), 1321-1327.
Footnote 9
Biswas, S., Raoult, D., & Rolain, J. M. (2007). Molecular mechanisms of resistance to antibiotics in Bartonella bacilliformis. The Journal of Antimicrobial Chemotherapy, 59(6), 1065-1070. doi:10.1093/jac/dkm105
Footnote 10
Sobraques, M., Maurin, M., Birtles, R. J., & Raoult, D. (1999). In vitro susceptibilities of four Bartonella bacilliformis strains to 30 antibiotic compounds. Antimicrobial Agents and Chemotherapy, 43(8), 2090-2092.
Footnote 11
Huarcaya, E., Maguiña, C., Torres, R., Rupay, J., & Fuentes, L. (2004). Bartonelosis (Carrion's Disease) in the pediatric population of Peru: an overview and update. The Brazilian Journal of Infectious Diseases : An Official Publication of the Brazilian Society of Infectious Diseases, 8(5), 331-339.
Footnote 12
del Valle, L. J., Flores, L., Vargas, M., García-de-la-Guarda, R., Quispe, R. L., Ibañez, Z. B., Alvarado, D., Ramírez, P., & Ruiz, J. (2009). Bartonella bacilliformis, endemic pathogen of the Andean region, is intrinsically resistant to quinolones. International Journal of Infectious Diseases,
Footnote 13
Laboratory Safety Manual (1993). (2nd ed.). Geneva: World Health Organization.
Footnote 14
Rutala, W. A. (1996). APIC guideline for selection and use of disinfectants. American Journal of Infection Control, 24(4), 313-342.
Footnote 15
Rutala, W. A., Cole, E. C., Thomann, C. A., & Weber, D. J. (1998). Stability and bactericidal activity of chlorine solutions. Infection Control and Hospital Epidemiology, 19(5), 323-327.
Footnote 16
Pflug, I. J., Holcomb, R. G., & Gomez, M. M. (2001). Principles of the Thermal Destruction of Microorganisms. In S. S. Block (Ed.), Disinfection, Sterilization, and Preservation (5th ed., pp. 79-129). Philadelphia, USA: Lippincott Williams & Wilkins.
Footnote 17
Taye, A., Chen, H., Duncan, K., Zhang, Z., Hendrix, L., Gonzalez, J., & Ching, W. (2005). Production of recombinant protein Pap31 and its application for the diagnosis of Bartonella bacilliformis infection. Annals of the New York Academy of Sciences, 1063, 280-285.
Footnote 18
Zeaiter, Z., Fournier, P. -., Greub, G., & Raoult, D. (2003). Diagnosis of Bartonella endocarditis by a real-time nested PCR assay using serum. Journal of Clinical Microbiology, 41(3), 919-925.
Footnote 19
Lydy, S. L., Eremeeva, M. E., Asnis, D., Paddock, C. D., Nicholson, W. L., Silverman, D. J., & Dasch, G. A. (2008). Isolation and characterization of Bartonella bacilliformis from an expatriate Ecuadorian. Journal of Clinical Microbiology, 46(2), 627-637. doi:10.1128/JCM.01207-07
Footnote 20
Pike, R. M. (1979). Laboratory-associated infections: incidence, fatalities, causes, and prevention. Annual Review of Microbiology, 33, 41-66. doi:10.1146/annurev.mi.33.100179.000353
Footnote 21
Human pathogens and toxins act. S.C. 2009, c. 24, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009. (2009).
Footnote 22
Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.