Bartonella Species and Vascular Pathology

Abstract In recent years, an increasing number of Bartonella species have been identified as zoonotic pathogens that are transmitted by animal bites or scratches, needle sticks, blood transfusions, or by arthropods. Potentially, because Bartonella spp. can infect erythrocytes, endothelial cells, pericytes, and various macrophage-type cells, cardiac and vascular pathologies appear to be very diverse in human patients and animals. Due to current limitations associated with diagnostic testing for bartonellosis, a high index of suspicion is required, particularly in patients with persistent bacteremia, small-vessel disease, and nonspecific symptoms, such as fatigue, weakness, muscle, and joint pain. Because of the rapid discovery of new, pathogenic Bartonella spp., the expanding number of arthropods proven or suspected in transmission, the large numbers of infected animal reservoir hosts in nature, and the broad spectrum of cardiovascular abnormalities reported in recent years, bartonellosis may be a much more prevalent cause of cardiovascular disease in immunocompetent and immunocompromised patients throughout the world than is currently recognized.