Bartonellosis due to Bartonella henselae is best known as the cause of “cat scratch disease.” It is an infection that usually starts after a scratch, bite, or lick from an infected cat. The germ is a small gram-negative bacterium that lives inside red blood cells and cells that line blood vessels. It often causes swollen lymph nodes (glands), mild fever, and feeling unwell, but in some people it can affect the eyes, brain, heart, liver, or spleen. NCBI+2MSD Manuals+2
Bartonellosis due to Bartonella henselae (best known as cat-scratch disease) is a bacterial infection that can cause swollen lymph nodes, fever, eye problems, liver or spleen lesions, and even heart valve infection in severe cases. Many healthy people get better without antibiotics, but some people need strong treatment, especially if they are very sick or have a weak immune system.CDC+1
Bartonellosis due to Bartonella henselae is most commonly known as cat-scratch disease. It is a bacterial infection that you usually get after a scratch, bite, or lick on broken skin from an infected cat, especially a kitten. The bacteria live in the blood of cats and are spread between cats by fleas. In humans, the infection often starts as a small bump or blister at the site of the scratch and then causes swollen, painful lymph nodes, usually near the scratch (for example, in the armpit after a scratch on the hand). Many infections are mild and get better on their own in four to six weeks, but in some people the bacteria spread to the eye, liver, spleen, bone, brain, heart valves, or other organs and can cause serious disease such as neuroretinitis, encephalopathy, or endocarditis. People with weak immune systems are at higher risk for severe, long-lasting, or relapsing infections.
Other names
Bartonellosis due to Bartonella henselae is known by several other names:
Cat scratch disease (CSD) – The most common name. It describes the typical illness where a cat scratch leads to swollen lymph nodes and mild fever. NCBI+1
Cat-scratch fever – An older, popular term used in many patient stories and some medical reports.
Bartonella henselae infection – A broader name that covers both classic cat scratch disease and unusual forms like eye disease or heart valve infection. BMJ Best Practice+1
Bartonella lymphadenitis – Means lymph node swelling (lymphadenitis) caused by B. henselae.
Ocular bartonellosis / Bartonella neuroretinitis – When the infection mainly affects the eye and optic nerve, causing vision problems. American Journal of Case Reports+2Private Practice Infectious Disease+2
Hepatosplenic cat scratch disease – When the liver and spleen are involved with small abscesses (tiny pockets of infection). OUP Academic
All of these are different faces of the same basic problem: infection with Bartonella henselae.
Types
Doctors often group B. henselae disease into types based on where in the body it shows up.
1. Classic cat scratch disease (localized lymph node form)
This is the usual form. A small bump appears at the site of the scratch or bite after a few days. Then, after one to three weeks, the nearby lymph nodes (for example in the armpit or neck) become swollen, tender, and sometimes painful. Fever and feeling tired are common. Most healthy people get better on their own over weeks to months. NCBI+2MSD Manuals+2
2. Atypical or systemic cat scratch disease
In some people, especially children, the infection spreads beyond the local lymph nodes. It can cause long-lasting fever, weight loss, stomach pain, rashes, or many enlarged lymph nodes in different body areas. The liver, spleen, bones, joints, or nervous system can be involved. This form needs more tests and often antibiotic treatment. OUP Academic+1
3. Ocular bartonellosis – Parinaud oculoglandular syndrome
In this form, one eye becomes red, irritated, and painful. The person may feel like they have conjunctivitis (“pink eye”), but one lymph node in front of the ear or under the jaw is also swollen. This often follows a scratch near the eye or touching the eye after contact with a cat. NCBI+2BMJ Best Practice+2
4. Ocular bartonellosis – Neuroretinitis
Neuroretinitis is a special type of eye and nerve inflammation. Vision becomes blurred, often in one eye. Doctors seeing the back of the eye notice a swollen optic disc and a star-shaped pattern of yellow deposits in the retina (macular star). This type is strongly linked to B. henselae and can cause serious vision loss if not treated. American Journal of Case Reports+2Private Practice Infectious Disease+2
5. Hepatosplenic bartonellosis
In this type, the infection affects the liver and spleen. Patients often have long-lasting fever, abdominal (belly) pain, and sometimes weight loss or night sweats. Imaging tests show small abscesses or nodules in the liver and spleen. This form is more common in children and may be mistaken for cancer or other serious diseases. OUP Academic+1
6. Neurologic bartonellosis (encephalopathy and others)
Sometimes B. henselae affects the brain. Children and adults can develop headaches, confusion, behavior changes, or seizures. This is called encephalopathy. It usually shows up a few weeks after the scratch and often improves over time, but it can be frightening and needs urgent care. PubMed+1
7. Endocarditis due to Bartonella henselae
Endocarditis is infection of the inner lining of the heart and the heart valves. In some people, especially those with damaged heart valves, B. henselae can cause a slowly developing fever, shortness of breath, fatigue, and heart murmur. It can be hard to diagnose because blood cultures may be negative; special serology and PCR tests are often needed. BMJ Best Practice+1
8. Bacillary angiomatosis and vascular forms
In people with weak immune systems (like advanced HIV infection or after organ transplant), B. henselae can cause red, raised skin lesions that look like small tumors or hemangiomas. These are due to abnormal growth of blood vessels (angiomatosis). Liver and spleen may also have vascular lesions. BMJ Best Practice+1
Causes
Here, “causes” are the situations and risk factors that allow Bartonella henselae to infect a person.
1. Scratch from an infected cat
The main cause is a scratch from a cat that carries B. henselae in its blood. Fleas infect cats, and the bacteria live in the cat’s blood and claws. When claws break the skin, the bacteria enter the human body. OUP Academic+1
2. Bite from an infected cat
A bite pushes saliva containing the bacteria directly into the tissue. Cat bites are deep and narrow, so germs can become trapped inside, making infection more likely. OUP Academic+1
3. Cat licking broken skin or mucosa
If a cat licks an area of broken skin, such as a cut, or licks the eye or mouth, the bacteria can pass through the damaged surface and cause infection, even without a scratch. OUP Academic+1
4. Contact with kittens
Kittens are more likely to carry B. henselae, and they scratch and bite more during play. This makes children, who often play with kittens, more likely to get the disease. OUP Academic+2Turkish Archives of Pediatrics+2
5. Flea contamination on cat fur
Cat fleas spread B. henselae between cats. Flea dirt (flea droppings) on cat fur can contain bacteria. When a person plays with a cat and then rubs their eyes or touches broken skin, the bacteria can enter the body. OUP Academic+2BioMed Central+2
6. Poor flea control in cats
Not using flea control on cats allows fleas to multiply and keeps the infection circulating among cats and humans. Homes with many untreated cats have higher risk. BioMed Central+1
7. Stray or shelter cat exposure
Stray cats and shelter cats often live in crowded conditions with many fleas. They are more likely to be infected. People who care for these cats, such as volunteers and animal workers, have higher exposure risk. MDPI+2BioMed Central+2
8. Occupation: veterinarians and animal workers
Veterinarians, vet nurses, animal shelter staff, and groomers handle many cats daily. They have more chances to be scratched or bitten and therefore a higher risk of Bartonella infection. BMJ Best Practice+1
9. Children and young adults
Children and teenagers play more roughly with cats and often do not clean scratches or bites properly. Cat scratch disease is common in this age group. OUP Academic+1
10. Weak immune system (immunosuppression)
People with HIV, those taking chemotherapy, or those on high-dose steroids or other immunosuppressive drugs have weaker defenses. B. henselae can grow more easily, causing severe forms like bacillary angiomatosis or widespread infection. BMJ Best Practice+1
11. Pre-existing heart valve disease
Patients with damaged heart valves or artificial valves are at higher risk for Bartonella endocarditis. The bacteria can settle on abnormal valves and form infected vegetations. BMJ Best Practice+1
12. Living in warm, humid climates
Warm climates favor fleas and outdoor cats. Studies from Mediterranean and tropical regions show higher rates of B. henselae in cats and higher risk for humans. MDPI+2BioMed Central+2
13. Crowded living with many cats
Homes or shelters with many cats increase the chance that at least one cat is infected. More cats means more scratches, bites, and flea exposure for people. BioMed Central+1
14. Lack of hand-washing after playing with cats
If a person does not wash their hands after touching cats, especially before eating or touching their eyes, they can rub bacteria into small cuts or mucous membranes.
15. Delayed cleaning of scratches or bites
Not washing a new scratch or bite with soap and water allows bacteria more time to multiply in the wound and travel to the lymph nodes.
16. Tick or other arthropod exposure (possible)
Some studies suggest ticks and other biting insects may sometimes spread Bartonella henselae, although the main proven vector is the cat flea. This possible route may explain some infections without clear cat contact. Mediterranean J. Infect. Microbes Antimicrobials+2BioMed Central+2
17. Co-infections in cats
Cats can carry Bartonella along with other germs. Sick or stressed cats may shed more bacteria, increasing the risk to people who handle them. BioMed Central+1
18. Minor skin injuries in people
People with many small skin breaks, such as from eczema, scratching, or occupational cuts, give the bacteria more entry points when in contact with cats.
19. Lack of awareness
If people do not know that cats can spread Bartonella, they may ignore scratches or bites and not seek care when they develop fever or swollen glands. This allows infection to progress.
20. Close sleeping or kissing cats
Sleeping with cats in the bed or letting them lick the face increases intimate contact and the chance of unnoticed scratches, bites, or licking of mucous membranes, which can lead to infection. BMJ Best Practice+1
Symptoms
Remember that most people with classic cat scratch disease only have a few of these symptoms and recover completely.
1. Skin bump or blister at the scratch or bite
A small red bump or blister appears where the skin was broken. This usually shows up three to ten days after contact. It may be a little tender or itchy but often is not painful and can be easily ignored. NCBI+1
2. Swollen lymph node near the scratch
A lymph node is a small “filter gland” in the neck, armpit, or groin. In cat scratch disease, the node that drains the injured area becomes swollen and firm. It may grow slowly over weeks and can reach several centimeters. NCBI+2OUP Academic+2
3. Painful lymph node
The swollen node can be tender or painful, especially when pressed or moved. The skin over it may look red or warm. Sometimes the node fills with pus and may need drainage. NCBI+1
4. Fever
Many patients have a low-grade fever. Some, especially children with systemic disease, may develop higher fevers that last days or weeks. Fever is the body’s way of fighting infection. NCBI+1
5. Fatigue and feeling unwell
People often feel tired, weak, and “under the weather.” They may want to rest more and have difficulty with normal activities, even if other symptoms are mild. NCBI+1
6. Headache
Headache can be dull and constant or come and go. In rare cases with brain involvement, headache may be severe and associated with confusion, nausea, or seizures and needs urgent medical review. PubMed+1
7. Loss of appetite and weight loss
Some people lose interest in food and may slowly lose weight, especially when fever and abdominal pain are present. This is more common in systemic or hepatosplenic disease. OUP Academic+1
8. Sore throat
A mild sore throat or upper respiratory symptoms may appear around the time of the lymph node swelling. These can mimic a common viral infection and may delay diagnosis. Journal of IMAB+1
9. Muscle and joint aches
Generalized aches in muscles and joints may occur with fever. They are usually mild but can be bothersome, especially in older children and adults. BMJ Best Practice+1
10. Eye redness and irritation
When the eye is involved, it may become red, watery, and sensitive to light. The person may feel burning or a gritty sensation. In Parinaud oculoglandular syndrome, this is often in one eye with a nearby swollen lymph node. American Journal of Case Reports+1
11. Blurred vision or dark spot in the visual field
In neuroretinitis, vision becomes blurred, or a dark patch appears in the center of sight. Straight lines may look wavy. This is due to swelling of the optic nerve and fluid leakage in the retina and needs urgent eye care. American Journal of Case Reports+2Private Practice Infectious Disease+2
12. Abdominal pain
If the liver or spleen is involved, patients may feel pain or discomfort in the upper abdomen, especially on the left (spleen) or right (liver). They may also have nausea or feel full quickly after eating. OUP Academic+1
13. Long-lasting fever of unknown origin
Sometimes the main symptom is fever that lasts for weeks without a clear reason, with only very mild lymph node swelling. This “fever of unknown origin” can be caused by hepatosplenic or systemic Bartonella infection. OUP Academic+1
14. Confusion, seizures, or behavior changes
Neurologic bartonellosis can cause sudden confusion, irritability, seizures, or unusual behavior. These symptoms suggest brain involvement (encephalopathy) and require emergency evaluation. PubMed+2Journal of IMAB+2
15. Shortness of breath or chest symptoms in endocarditis
In people with heart valve infection, symptoms may include shortness of breath, chest discomfort, swelling of ankles, and extreme tiredness. A doctor may hear a new or louder heart murmur. This form is serious and needs hospital care. BMJ Best Practice+1
Diagnostic tests
(Physical exam, manual tests, lab/pathological tests, electrodiagnostic tests, imaging)
Doctors choose tests based on symptoms and how severe the illness looks. Not every patient needs all of these.
Physical exam–based tests
1. General physical exam and vital signs
The doctor checks temperature, heart rate, breathing rate, and blood pressure. They also look for fever, pale skin, rashes, or weight loss. This broad exam helps decide how sick the person is and whether hospital care might be needed. NCBI+1
2. Inspection of the scratch or bite site
The doctor looks closely at the area where the cat made contact. They may see a healing scratch, a crusted sore, or a small red bump or blister. Seeing a lesion in the right location supports the diagnosis of cat scratch disease. NCBI+1
3. Lymph node region inspection
The doctor inspects typical lymph node areas (neck, under the jaw, armpits, groin) for visible swelling or redness. This visual check helps identify which nodes are involved and whether there may be skin infection or abscess over them. NCBI+1
4. Abdominal and organ inspection
The abdomen is inspected for fullness or swelling that may suggest enlarged liver or spleen. In thin patients, a big spleen or liver tip can sometimes be seen under the skin even before palpation. OUP Academic+1
Manual tests (hands-on examination)
5. Palpation of lymph nodes
The doctor gently feels (palpates) the lymph nodes to assess size, tenderness, warmth, and softness or firmness. In cat scratch disease, nodes are usually firm, tender, and localized. Very soft, fluctuant nodes may need drainage; rock-hard nodes may need biopsy to exclude cancer. NCBI+1
6. Detailed abdominal palpation
Using their hands, the doctor feels the abdomen to detect enlargement of the liver or spleen and tenderness. Tenderness in the upper abdomen in a patient with fever and cat exposure raises suspicion for hepatosplenic disease. OUP Academic+1
7. Neurological bedside examination
If there are headaches, seizures, or behavior changes, the doctor checks orientation, memory, reflexes, strength, and balance. Any abnormal findings push the doctor to order brain imaging or EEG for neurologic bartonellosis. PubMed+1
8. Eye examination with ophthalmoscope
The doctor or eye specialist looks into the back of the eye using an ophthalmoscope. They search for optic disc swelling and the “macular star” pattern typical of Bartonella neuroretinitis. This test is manual but critical when vision is affected. American Journal of Case Reports+2Private Practice Infectious Disease+2
Lab and pathological tests
9. Complete blood count (CBC)
CBC measures red cells, white cells, and platelets. Many patients have normal counts, but some may show mild anemia, raised white cells, or altered platelets, especially in systemic disease. CBC also helps rule out leukemia or other serious blood diseases that can mimic Bartonella infection. BMJ Best Practice+1
10. Inflammatory markers (ESR and CRP)
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are blood markers of inflammation. They are often mildly to moderately elevated in cat scratch disease and more elevated in severe or systemic forms. They are not specific but help monitor disease activity. BMJ Best Practice+1
11. Bartonella henselae serology (IFA or ELISA)
Serology looks for antibodies against B. henselae in blood. Indirect fluorescent antibody (IFA) test is the most widely used. A high or rising IgG titer supports recent infection, especially when combined with typical symptoms and cat exposure. However, false positives and negatives can occur, so results must be interpreted with care. Turkish Archives of Pediatrics+3PMC+3ScienceDirect+3
12. PCR for Bartonella henselae DNA
Polymerase chain reaction (PCR) detects B. henselae DNA in blood, lymph node tissue, or other samples. It is highly specific but can miss cases because the bacteria are few and difficult to detect. PCR is especially helpful in unusual or seronegative cases and in immunocompromised patients. Indian Journal of Medical Research+3PMC+3ASM Journals+3
13. Lymph node biopsy with special stains
If the diagnosis is unclear or cancer is suspected, a piece of lymph node is removed and examined under a microscope. Typical cat scratch disease shows granulomas (small clusters of immune cells) and “stellate” necrosis. Special silver stains like Warthin–Starry can sometimes highlight the tiny bacteria. MSD Manuals+2ASM Journals+2
14. Liver function tests
Blood tests for liver enzymes (ALT, AST, ALP, GGT) and bilirubin help detect liver involvement. Slight elevations may occur in systemic disease; more marked changes may point to hepatosplenic abscesses or other liver disease that needs imaging. OUP Academic+1
15. Blood cultures (especially for endocarditis)
Standard blood cultures are often negative in Bartonella infection because the bacteria are slow-growing and difficult to isolate. However, in suspected endocarditis, prolonged culture and special methods may be used, and negative cultures plus high Bartonella antibody levels strongly support the diagnosis. BMJ Best Practice+1
16. Serology for other infections
Doctors often test for other causes of lymphadenopathy or fever, such as Epstein–Barr virus, cytomegalovirus, toxoplasmosis, HIV, or tuberculosis. Negative results for these infections, together with positive Bartonella serology and the right clinical picture, help confirm the diagnosis. Turkish Archives of Pediatrics+1
Electrodiagnostic tests
17. Electroencephalogram (EEG)
EEG records the brain’s electrical activity. It is used when patients have seizures or confusion. In Bartonella encephalopathy, EEG may show diffuse slowing or other nonspecific abnormalities, supporting brain involvement and guiding treatment decisions. PubMed+2Journal of IMAB+2
18. Nerve conduction studies and EMG
If there are signs of peripheral nerve damage—such as weakness, numbness, or tingling—nerve conduction studies and electromyography (EMG) can assess how well nerves and muscles are working. These tests help identify rare peripheral neuropathies linked to Bartonella infection and rule out other causes. BMJ Best Practice+1
Imaging tests
19. Ultrasound of lymph nodes and abdomen
Ultrasound uses sound waves to create images. It can show if a lymph node is solid or filled with fluid and can guide drainage if needed. Abdominal ultrasound can reveal enlarged liver and spleen or small abscesses, especially in children with long-lasting fever and abdominal pain. OUP Academic+2SAS Publishers+2
20. CT or MRI scans (including neuroimaging and deep organ imaging)
Computed tomography (CT) and magnetic resonance imaging (MRI) provide detailed images of internal organs and the brain. CT or MRI of the abdomen can show liver and spleen lesions that suggest hepatosplenic cat scratch disease. Brain MRI can show changes in neuroretinitis or encephalopathy. These scans help distinguish Bartonella from tumors or other serious conditions. Journal of IMAB+3American Journal of Case Reports+3Private Practice Infectious Disease+3
Non-pharmacological treatments
1. Rest and energy conservation
When your body fights Bartonella henselae, it uses a lot of energy. Rest means sleeping enough and avoiding heavy work or exercise. The purpose is to let the immune system focus on killing the bacteria instead of powering muscles and brain work. Rest lowers stress hormones like cortisol and adrenaline, which can weaken the immune response if they stay high. Short naps, sitting instead of standing when possible, and avoiding late nights give the body time to repair tissues, control fever, and reduce fatigue. Good rest often makes pain, headache, and irritability less severe and supports recovery from any infection.
2. Hydration and oral fluids
Hydration means drinking enough water and other safe fluids. Fever, sweating, and poor appetite in bartonellosis can cause dehydration. The purpose of good hydration is to keep blood volume normal and help the kidneys remove bacterial toxins and drug breakdown products. Water, oral rehydration solution, clear broths, and herbal teas are usually good choices. Avoiding very sugary drinks and high-caffeine drinks prevents extra dehydration. Adequate fluids keep mucous membranes moist, support circulation to infected lymph nodes and organs, and may reduce dizziness and weakness.
3. Warm compresses for swollen lymph nodes
Many people with cat-scratch disease have tender, swollen lymph nodes, often in the armpit or neck. Warm compresses are cloths soaked in warm (not hot) water and placed over the swollen node. The purpose is to reduce pain and stiffness. Gentle heat slightly widens blood vessels (vasodilation). This can increase blood flow, help white blood cells reach the infected area, and relax tight muscles around the node. It should be used several times a day for 10–15 minutes. The compress must not be too hot, and should not be used if the skin is very red, broken, or draining pus unless a doctor says it is safe.NCBI
4. Local wound care for scratches and bites
Many infections start from a cat scratch or bite. Cleaning the wound early is a simple but powerful treatment. The purpose is to reduce the number of bacteria that enter the body. The mechanism is mechanical: rinsing the wound with running clean water, gentle soap, and sometimes saline flushes away bacteria, dirt, and saliva. After cleaning, the area is gently dried and covered with a clean dressing if needed. Harsh chemicals like strong iodine or alcohol can damage tissue if overused and may slow healing. Early wound care lowers the risk of infection spreading to lymph nodes and blood.
5. Pain control with non-drug methods
Besides medicines, physical and mind–body methods can help pain. Examples are cold packs for hot, inflamed areas, gentle stretching, relaxation breathing, and distraction (music, talking, light TV or reading). The purpose is to reduce pain signals going to the brain and lower tension. The mechanism includes cooling the skin and superficial tissues, which slows nerve signals and may limit inflammation, and activating “gate control” pathways in the spinal cord where non-pain sensations (pressure, rubbing) can block some pain signals. Relaxation techniques reduce anxiety and muscle spasm, which often worsen pain.
6. Fever comfort measures
Fever is part of the immune response, but it can be uncomfortable. Non-drug measures include wearing light clothing, using thin blankets, cool but not icy fluids, and a fan in a well-ventilated room. The purpose is comfort and prevention of overheating. The mechanism is physical cooling through evaporation of sweat and increased air flow over the skin. These measures do not block the immune system like some strong anti-inflammatory drugs can, and are useful when fever is mild and tolerated. Very high or dangerous fever still needs medical review.
7. Nutritional support and balanced meals
Good nutrition helps the immune system produce antibodies, white blood cells, and repair proteins. The purpose is to supply enough calories, proteins, vitamins, and minerals to support healing. A balanced diet with fruits, vegetables, whole grains, lean proteins (fish, eggs, legumes, poultry), and healthy fats (olive oil, nuts) gives building blocks for immune cells and inflammatory mediators. Malnutrition or crash diets can weaken defense against Bartonella henselae and other germs. Even with low appetite, small frequent meals and nutrient-dense snacks can support recovery.
8. Gentle physical activity and stretching
When fever is under control and the person feels better, very gentle activity like walking around the house or light stretching can help circulation, prevent blood clots, and reduce stiffness. The purpose is to maintain muscle strength and joint mobility without over-stressing the body. The mechanism is improved blood flow, which delivers oxygen and immune cells to tissues and prevents muscle breakdown. Activity should be increased slowly, stopping if there is dizziness, chest pain, or shortness of breath. This graded approach is especially important after prolonged illness.
9. Stress reduction and mental health support
Long-lasting infection, pain, and uncertainty can cause anxiety and low mood. Stress hormones may weaken immune function if they remain high. The purpose of stress reduction is to support both mental and physical health. Mechanisms include lowering cortisol and adrenaline, improving sleep, and encouraging healthier behaviors. Simple tools include breathing exercises, mindfulness, talking with trusted people, and possibly counseling. For some people, support from a psychologist, social worker, or spiritual advisor is part of overall care.
10. Sleep hygiene
Sleep hygiene means habits that help you sleep better. This includes regular bedtimes, a dark quiet room, no heavy meals or screens shortly before sleep, and avoiding caffeine late in the day. The purpose is deep, restorative sleep, which supports immune responses and tissue repair. During sleep, the body releases growth hormone and other substances that help cells recover from inflammation and infection. Poor sleep can increase pain sensitivity and make fatigue and brain fog worse.
11. Avoiding tobacco smoke
Smoking and exposure to second-hand smoke impair many parts of the immune system and damage blood vessels. The purpose of avoiding smoke is to improve infection control and reduce complications, especially if the lungs or heart are affected. The mechanism involves reducing oxidative stress, inflammation in blood vessels, and improving oxygen delivery to tissues. Quitting smoking also improves the effect of antibiotics and lowers the risk of other infections that could complicate Bartonella henselae disease.
12. Limiting alcohol
Alcohol in high amounts suppresses immunity and stresses the liver, which is important for processing drugs and toxins. The purpose of limiting or stopping alcohol during infection and treatment is to protect the liver and support immune function. Alcohol can also interact with some antibiotics, increasing side effects like nausea, dizziness, or liver injury. Reducing or avoiding alcohol helps the body clear both the infection and medications more safely.
13. Eye protection and hygiene
Some patients develop eye problems, such as neuroretinitis or other eye involvement from Bartonella henselae.Wikipedia The purpose of eye protection is to prevent secondary irritation and infection. Mechanisms include using prescribed eye drops correctly, avoiding rubbing the eyes, wearing sunglasses in bright light, and using clean tissues or gauze. Good eye hygiene supports local healing and prevents extra germs from entering the eye.
14. Physical therapy for weakness or joint pain
If the infection leads to long-term fatigue or muscle and joint pain, physical therapy may help. The purpose is to restore strength, balance, and function in a safe, supervised way. Therapists use graded exercises, posture training, and manual techniques. Mechanisms include improved muscle strength, better joint lubrication by movement, and neural retraining so that painful movements gradually become easier. This is more relevant in complicated or long-lasting cases.
15. Occupational therapy and activity pacing
Occupational therapists help patients adapt daily tasks while recovering, such as self-care, work, and household activities. The purpose is to prevent over-exertion and reduce disability. Mechanisms include teaching activity pacing (alternate activity and rest), energy-saving techniques, and ergonomic methods to reduce strain on tender lymph nodes or painful areas. Simple tools like better chair height or different ways to lift items can protect healing tissues.
16. Patient education and written care plans
Understanding the disease reduces fear and helps people follow treatment. The purpose of patient education is to explain the infection, expected course, warning signs, and reasons for each treatment. Mechanisms include improved adherence to antibiotics, better wound care, and timely medical review when symptoms change. Written instructions in simple language also help family members support the patient correctly.
17. Infection-control practices at home
Basic infection control includes handwashing, not sharing towels that touch open wounds, and proper disposal of dressings. The purpose is to limit spread of bacteria to others and prevent additional infections in the same person. Mechanisms include physically removing germs from hands and surfaces and reducing contact between open skin and contaminated objects. Alcohol hand rubs, regular cleaning of frequently touched surfaces, and careful handling of cat scratches are practical steps.
18. Flea and pet management (for cat-scratch disease)
Bartonella henselae often spreads between cats through fleas, then to humans by scratches or bites.Wikipedia The purpose of managing pets is to reduce future infections. Mechanisms include regular flea control treatments for cats, keeping cats indoors when possible, trimming their nails, and avoiding rough play that leads to scratches. Veterinarians can suggest safe flea medications and check cats that seem ill.
19. Supportive care in hospital (oxygen, IV fluids)
In severe cases (for example, endocarditis or liver involvement), hospital supportive care may be needed.ClinicalInfo+1 The purpose is to stabilize vital signs while antibiotics work. Mechanisms include intravenous fluids to maintain blood pressure and kidney function, oxygen therapy for respiratory distress, and careful monitoring of heart and liver function. This supportive care does not kill bacteria directly but keeps organs working while targeted treatments act.
20. Management of underlying conditions (HIV, cancer, etc.)
Severe Bartonella infections are more common in people with HIV/AIDS or other strong immune problems.ClinicalInfo+1 The purpose of managing these conditions (for example, with antiretroviral therapy for HIV) is to boost natural defense against the bacteria. Mechanisms include increasing CD4 T-cell counts, improving macrophage function, and reducing chronic inflammation. When underlying diseases are better controlled, Bartonella infection often responds more reliably to antibiotics and is less likely to relapse.
Drug treatments
Very important:
These drugs are usually prescribed and adjusted by infectious-disease or other specialists.
Many are FDA-approved broad-spectrum antibiotics for other infections but used off-label for Bartonella henselae based on clinical evidence and expert guidelines.BioMed Central+3ClinicalInfo+3Medscape+3
Labels and safety information come from FDA documents and references on accessdata.fda.gov for the drug, not specifically for Bartonella henselae.FDA Access Data+3FDA Access Data+3FDA Access Data+3
Doses below are typical adult examples and may differ for children, pregnancy, kidney or liver disease, and combined regimens.
1. Azithromycin (macrolide antibiotic)
Class: Macrolide antibacterial.FDA Access Data
Typical use and dose: For uncomplicated cat-scratch disease in adults, a common regimen is 500 mg by mouth on day 1, then 250 mg once daily on days 2–5, as suggested by CDC guidance.CDC
Purpose: Shorten the duration of lymph node swelling and systemic symptoms in mild to moderate cat-scratch disease.
Mechanism: Azithromycin binds to the 50S subunit of the bacterial ribosome and blocks protein synthesis, so Bartonella henselae cannot grow and multiply. It concentrates inside cells, which is important because Bartonella lives partly inside human cells.FDA Access Data+1
Side effects: Common effects are nausea, diarrhea, mild stomach pain, and headache. Rare but serious problems include allergic reactions, liver injury, and changes in heart rhythm (QT prolongation), especially in people with heart disease or who take certain other drugs.FDA Access Data+1
2. Doxycycline (tetracycline-class antibiotic)
Class: Tetracycline-class broad-spectrum antibacterial.FDA Access Data+1
Typical dose: Often 100 mg by mouth twice daily in adults for serious Bartonella infections, usually in combination with another antibiotic like rifampin for 4–6 weeks or longer, especially for endocarditis or severe disease.ClinicalInfo+1
Purpose: Treat more severe or complicated Bartonella disease, including endocarditis and bacillary angiomatosis.
Mechanism: Doxycycline binds to the 30S ribosomal subunit in bacteria, blocking protein synthesis. Its good tissue penetration and long half-life help reach infected cells and organs. Doxycycline is FDA-approved for several infections, including Bartonellosis caused by Bartonella bacilliformis.FDA Access Data+1
Side effects: Stomach upset, photosensitivity (easy sunburn), esophageal irritation if taken without water, and, rarely, liver toxicity. It is generally avoided in pregnancy and in children under 8 years because of tooth discoloration.
3. Erythromycin
Class: Macrolide antibiotic.
Typical dose: For bacillary angiomatosis, 500 mg by mouth four times a day for several weeks to months has been used.DermNet®+1
Purpose: First-line drug for bacillary angiomatosis and some other severe Bartonella infections, especially in HIV-infected patients.
Mechanism: Like other macrolides, erythromycin inhibits protein synthesis by binding to the bacterial 50S ribosome. It is active against many gram-negative and intracellular bacteria.
Side effects: Stomach cramps, nausea, diarrhea, and, less often, liver enzyme elevation or heart rhythm changes. It interacts with many other drugs via the liver enzyme CYP3A4.
4. Clarithromycin
Class: Macrolide antibiotic.
Typical dose: Often 500 mg by mouth twice daily in adults when used, though regimens vary and it is not always first-line.MSD Manuals
Purpose: Alternative macrolide for Bartonella infections, especially when azithromycin is not suitable or when treating more severe disease in combination with other agents.
Mechanism: Same general macrolide mechanism: inhibition of protein synthesis at the 50S ribosomal subunit. It also has immunomodulatory effects that may reduce inflammation in tissues.
Side effects: Similar to erythromycin: GI upset, bitter taste, potential liver problems, and drug–drug interactions through CYP3A4.
5. Rifampin (rifamycin-class antibiotic)
Class: Rifamycin antibacterial.
Typical dose: 300 mg to 600 mg by mouth twice daily in adults, commonly combined with doxycycline for severe Bartonella infections such as endocarditis.ClinicalInfo+1
Purpose: Used in combination therapy to improve bacterial killing and prevent resistance in deep or serious Bartonella infections.
Mechanism: Rifampin blocks bacterial DNA-dependent RNA polymerase, stopping RNA and protein production. It penetrates cells and biofilms, which may make it useful against intracellular and persistent forms of Bartonella.BioMed Central
Side effects: Orange discoloration of urine and tears, liver toxicity, many drug interactions (especially with HIV medicines, anticoagulants, and birth control pills), and flu-like symptoms in some cases.
6. Gentamicin
Class: Aminoglycoside antibiotic.
Typical dose: Usually given intravenously, often 3 mg/kg/day divided every 8 hours for about 2 weeks, combined with doxycycline for severe Bartonella endocarditis.ClinicalInfo+1
Purpose: Rapid bactericidal effect in life-threatening infections such as Bartonella endocarditis.
Mechanism: Binds irreversibly to the 30S ribosomal subunit, causing misreading of mRNA and bacterial death.
Side effects: Kidney injury (nephrotoxicity) and hearing or balance damage (ototoxicity), so levels and kidney function must be carefully monitored.
7. Trimethoprim–sulfamethoxazole (TMP–SMX)
Class: Combination folate-antagonist antibacterial.
Typical dose: Common adult dose is 160/800 mg (one “double-strength” tablet) twice daily, but regimens vary.
Purpose: Alternative or adjunct option in some Bartonella infections, including bacillary angiomatosis, when first-line macrolides or doxycycline cannot be used.DermNet®+1
Mechanism: TMP and SMX block two steps in bacterial folate synthesis, which bacteria need to make DNA and proteins.
Side effects: Rash, GI upset, photosensitivity, and rarely severe reactions like Stevens–Johnson syndrome, bone marrow suppression, or kidney injury.
8. Ciprofloxacin
Class: Fluoroquinolone antibiotic.
Typical dose: For various infections, often 500–750 mg twice daily orally; dosing is tailored and fluoroquinolones are usually second-line for Bartonella.MSD Manuals
Purpose: Alternative in certain complicated Bartonella infections when other options are not possible.
Mechanism: Inhibits bacterial DNA gyrase and topoisomerase IV, enzymes needed for DNA replication.
Side effects: Tendon problems, neuropathy, CNS effects (like agitation), and QT prolongation. Because of safety concerns, fluoroquinolones are used with caution.
9. Levofloxacin
Class: Fluoroquinolone antibiotic.
Typical dose: Often 500–750 mg once daily in adults for other infections; occasionally considered in Bartonella as an alternative.
Purpose: Broad-spectrum option if first-line drugs are not appropriate, though not typically first choice for Bartonella henselae.MSD Manuals
Mechanism: Similar to ciprofloxacin, blocking DNA gyrase and topoisomerase IV.
Side effects: Similar to other fluoroquinolones: tendon rupture risk, CNS effects, and heart rhythm issues.
10. Amoxicillin–clavulanate
Class: Beta-lactam antibiotic plus beta-lactamase inhibitor.
Typical dose: For bite-related mixed infections, often 875/125 mg twice daily in adults.
Purpose: Often used after animal bites to cover mixed mouth bacteria; it does not directly target Bartonella well but may treat co-infections from cat bites.
Mechanism: Amoxicillin blocks bacterial cell wall synthesis, while clavulanate protects amoxicillin from beta-lactamase enzymes.
Side effects: Diarrhea, allergic reactions, liver enzyme elevations.
11. Ceftriaxone
Class: Third-generation cephalosporin.
Typical dose: Often 1–2 g once daily IV for serious infections; in Bartonella endocarditis, it may be used with doxycycline in selected cases.Medscape+1
Purpose: Broad-spectrum coverage when initial diagnosis is uncertain or when other organisms might be present in endocarditis.
Mechanism: Blocks bacterial cell wall synthesis, leading to cell death.
Side effects: Allergic reactions, biliary sludge, diarrhea, and rare blood disorders.
12. Vancomycin (initial empiric therapy, not specific to Bartonella)
Class: Glycopeptide antibiotic.
Use: Sometimes started empirically for suspected endocarditis while awaiting tests; stopped if cultures and investigations point toward Bartonella and more targeted therapy is chosen.
Mechanism: Inhibits cell wall synthesis in gram-positive bacteria.
Side effects: Kidney injury, infusion reactions (“red man” syndrome), hearing issues.
13. Linezolid (selected resistant cases)
Class: Oxazolidinone antibiotic.
Use: Rarely, may be used when other options are not possible and severe gram-positive coinfections exist.
Mechanism: Inhibits protein synthesis by binding to the 50S ribosomal subunit at a unique site.
Side effects: Bone marrow suppression, neuropathy, serotonin syndrome with some antidepressants.
14. Clindamycin (for associated soft tissue infection)
Class: Lincosamide antibiotic.
Use: May be used when soft tissue infection from other bacteria is present around the cat bite or scratch.
Mechanism: Blocks protein synthesis at the 50S subunit.
Side effects: Diarrhea and high risk of Clostridioides difficile colitis.
15. Daptomycin (for resistant gram-positive co-infection)
Class: Lipopeptide antibiotic.
Use: Not specific to Bartonella; used when resistant gram-positive bacteria complicate the picture, especially in severe endocarditis.
Mechanism: Causes rapid depolarization of bacterial cell membranes, leading to death.
Side effects: Muscle toxicity, requires CK monitoring.
16. Antipyretic analgesics (paracetamol / acetaminophen)
Class: Analgesic and antipyretic.
Use: Reduce pain and fever in Bartonella infection; typical adult dose is 500–1000 mg every 4–6 hours, not exceeding the daily maximum.
Mechanism: Inhibits prostaglandin production in the brain, lowering fever set-point and pain perception.
Side effects: Generally safe at correct doses; overdose can cause severe liver damage.
17. NSAIDs (ibuprofen and similar)
Class: Non-steroidal anti-inflammatory drugs.
Use: Short-term relief of pain and inflammation in lymph nodes or joints.
Mechanism: Block COX enzymes, reducing prostaglandins that cause pain and swelling.
Side effects: Stomach irritation, kidney strain, and increased bleeding risk if used long-term or in high doses.
18. Antiemetic drugs (e.g., ondansetron)
Class: 5-HT3 receptor antagonist.
Use: Control nausea and vomiting caused by fever, antibiotics, or the infection itself, improving ability to eat and take medicines.
Mechanism: Blocks serotonin receptors in the gut and brain’s vomiting center.
Side effects: Constipation, headache, and rare heart rhythm effects.
19. Proton-pump inhibitors (PPIs)
Class: Gastric acid-suppressing drugs.
Use: Protect the stomach in patients who need NSAIDs or have reflux worsened by stress and antibiotics.
Mechanism: Block the proton pump in stomach cells, reducing acid production.
Side effects: Long-term use may raise risk of certain infections and nutrient deficiencies; use only when clearly needed.
20. Antihistamines (for itching and allergic symptoms)
Class: H1-receptor antagonists.
Use: Relieve itch or mild allergic reactions from drugs or skin lesions.
Mechanism: Block histamine receptors, reducing itch and redness.
Side effects: Drowsiness (for older agents), dry mouth, sometimes blurred vision.
Dietary molecular supplements
Note: Supplements do not cure Bartonella and cannot replace antibiotics when needed. Evidence is usually indirect (general immune or anti-inflammatory support), not specific to Bartonella henselae.
1. Vitamin C (ascorbic acid)
A common dose for immune support is 250–500 mg once or twice daily, but higher doses should only be used under medical advice, especially in kidney disease. Vitamin C functions as a strong antioxidant and supports immune cells such as neutrophils and lymphocytes. It helps white blood cells generate reactive oxygen species to kill bacteria, then protects them from self-damage by neutralizing free radicals. It also supports collagen formation, which helps maintain healthy skin and blood vessels that act as barriers against infection.
2. Vitamin D
Many adults take 800–2000 IU of vitamin D3 (cholecalciferol) per day, adjusted by blood levels. Vitamin D modulates both innate and adaptive immunity. It helps monocytes and macrophages produce antimicrobial peptides like cathelicidin, which can kill various bacteria. Adequate vitamin D status is linked with better infection outcomes in general, though direct data in Bartonella is limited. Supplementation should follow blood testing and medical advice to avoid toxicity.
3. Zinc
Typical short-term immune-support doses are 10–25 mg elemental zinc per day, counting all sources (diet and supplements). Zinc is essential for many enzymes and transcription factors in immune cells. It supports normal development and function of neutrophils, natural killer cells, and lymphocytes. Deficiency can weaken both barrier defenses and antibody responses. Too much zinc, however, can cause nausea and copper deficiency, so it should not be taken in high doses for long periods without monitoring.
4. Selenium
Selenium is often given at about 50–100 micrograms per day as a supplement when intake is low. It is a key part of antioxidant enzymes like glutathione peroxidase, which protect cells from oxidative stress during infection. Selenium also influences T-cell function and antibody production. Correcting selenium deficiency may help the immune system respond more effectively to bacterial and viral infections, but doses above recommended levels can be toxic, causing hair loss and nail changes.
5. Omega-3 fatty acids (EPA/DHA)
Fish oil supplements often provide 500–1000 mg combined EPA and DHA daily, though higher doses are used for specific conditions under medical care. Omega-3 fatty acids help regulate inflammation by being converted into anti-inflammatory lipid mediators (resolvins, protectins). They can reduce excessive inflammatory responses that damage tissues while allowing the immune system to continue fighting infection. They may also support heart and blood vessel health, important in people with endocarditis or other vascular issues.
6. Probiotics
Probiotics are live microorganisms, often Lactobacillus or Bifidobacterium strains, taken as capsules or fermented foods. Typical doses range from billions of colony forming units (CFU) per day, chosen based on product and strain. Their function is to support a healthy gut microbiome, which plays a major role in immune function. Mechanisms include competition with harmful bacteria, strengthening the gut barrier, and modulating immune signaling. They may help reduce antibiotic-associated diarrhea and improve tolerance of long antibiotic courses.
7. Curcumin (turmeric extract)
Curcumin supplements often give 500–1000 mg per day, sometimes with piperine (black pepper extract) to improve absorption, though dosing and safety should be discussed with a doctor, especially if taking blood thinners. Curcumin has anti-inflammatory and antioxidant effects, modulating pathways such as NF-κB. It may reduce overactive inflammation in tissues affected by infection. However, it does not directly kill Bartonella at usual dietary doses and should be considered supportive only.
8. N-acetylcysteine (NAC)
Common supplemental doses are 600–1200 mg per day. NAC is a precursor to glutathione, one of the body’s main antioxidants. It helps replenish glutathione in cells under oxidative stress from infection and drugs. NAC can also help thin mucus in the lungs and has mild anti-inflammatory effects. It may protect the liver from some drug-related stress. High doses should be supervised due to possible GI upset and rare allergic reactions.
9. Coenzyme Q10 (CoQ10)
Doses of 100–200 mg per day are often used for mitochondrial and heart support. CoQ10 is part of the electron transport chain in mitochondria and acts as an antioxidant in cell membranes. In chronic or severe infections, energy production in cells may be stressed; CoQ10 can help support cellular energy and reduce fatigue. It may also benefit heart muscle function, which is relevant if the infection or antibiotics affect the cardiovascular system.
10. L-glutamine
Glutamine supplements often provide 5–10 g per day in divided doses. Glutamine is a key fuel for rapidly dividing cells such as intestinal epithelial cells and certain immune cells. During severe illness, glutamine levels can fall, and supplementation may help support gut barrier function and immune responses. It should be used cautiously in people with certain metabolic or liver problems and always under medical guidance.
Immune-supportive / “regenerative” therapies
There are no specific “stem-cell drugs” approved to treat Bartonella henselae infection itself. However, in very complex cases doctors may use treatments that help the immune system or damaged organs recover. These are specialist-level decisions.
1. Antiretroviral therapy (ART) for HIV
In people with HIV who develop severe Bartonella infections, effective ART is essential.ClinicalInfo+1 Typical ART uses a combination of drugs (for example, two nucleoside reverse transcriptase inhibitors plus an integrase inhibitor) taken once or twice daily. The function is to suppress HIV replication, raise CD4 cell counts, and restore immune function. Mechanistically, ART reduces the virus load so the immune system can better fight Bartonella and other infections, lowering relapse risk.
2. Granulocyte colony-stimulating factor (G-CSF, e.g., filgrastim)
G-CSF is an injectable medicine that stimulates the bone marrow to produce more neutrophils. It is used at doses like 5 mcg/kg per day in people with severe neutropenia, according to specialist protocols. Its function is to boost the number of white blood cells needed to fight bacteria. Mechanistically, it binds to receptors on bone marrow precursors, increasing proliferation and differentiation into functioning neutrophils. It may be used if a patient with Bartonellosis has very low neutrophils from another condition or chemotherapy.
3. Intravenous immunoglobulin (IVIG)
IVIG is a blood-derived product containing pooled antibodies from many donors. It is given as an infusion over several hours, with dose based on body weight and reason for use. Its function is to support or modulate immunity in some immune deficiencies or autoimmune complications. Mechanisms include providing passive antibodies, blocking harmful antibody actions, and modulating cytokine networks. It is not routine for Bartonella but may be used when immune dysfunction is severe.
4. Corticosteroid-sparing immunomodulators (very selective cases)
In some situations where severe inflammation threatens vision or other organs, doctors may consider carefully balanced immunosuppressive or immunomodulating drugs alongside antibiotics. This is highly individualized. The function is to control damaging inflammation while antibiotics clear the infection. Mechanisms vary by drug, but often involve reducing specific immune cell activation. These medicines carry significant risk and must be used only by experienced specialists.
5. Hematopoietic stem cell transplantation (HSCT) – rare context
HSCT is not a treatment for Bartonella itself but may be part of therapy for underlying cancers or marrow diseases that also predispose to severe infections. It involves giving high-dose chemotherapy then infusing blood-forming stem cells. The function is to rebuild the bone marrow. Mechanistically, transplanted stem cells repopulate the marrow with healthy blood cell precursors, including immune cells. Infection risk is high around the procedure, so Bartonella and other infections must be carefully prevented and treated.
6. Nutritional rehabilitation in severe malnutrition
In people with severe malnutrition, structured nutritional plans (sometimes including tube feeding) act in a “regenerative” way for the immune system. Adequate protein, vitamins, and minerals allow bone marrow and lymphoid tissues to regenerate. Mechanistically, this restores the building blocks needed for antibodies, cytokines, and immune cell membranes, indirectly improving resistance to Bartonella and many other infections.
Surgeries and procedures
1. Needle aspiration of lymph nodes
If a lymph node is very large, tense, and painful, doctors may insert a sterile needle to remove pus (aspiration). The purpose is to relieve pain, reduce pressure, and get material for lab tests to confirm the diagnosis and exclude other causes like cancer. Mechanistically, draining pus reduces bacterial load and improves blood flow in the area, helping antibiotics work better. It is a minor procedure done under local anesthesia.
2. Incision and drainage of abscesses
Sometimes, a lymph node or soft tissue forms a true abscess with thick pus that cannot drain through a needle. In this case, a small surgical cut (incision) may be made to open and drain the abscess. The purpose is to fully remove trapped pus and dead tissue. Mechanistically, this reduces pressure, pain, and bacterial numbers, and allows healthy tissue to grow. The wound is often left partially open with packing to let more fluid drain over time.
3. Biopsy of lymph nodes or organs
A biopsy is removal of a small piece of tissue for microscopic and molecular testing. In Bartonella, biopsy of a lymph node, liver lesion, or skin lesion may be needed when the diagnosis is unclear. The purpose is to look for features of cat-scratch disease, rule out cancer, and detect Bartonella DNA or organisms. Mechanistically, this gives direct tissue samples to pathologists and labs, guiding accurate treatment.
4. Cardiac valve surgery for Bartonella endocarditis
Bartonella can cause endocarditis, a serious infection of heart valves.ClinicalInfo If the valve is badly damaged or heart failure develops, surgery to repair or replace the valve may be required. The purpose is to remove infected tissue and restore normal blood flow through the heart. Mechanistically, surgery physically eliminates a major bacterial “nest” and reduces the risk of emboli (infected clots) traveling to the brain or other organs, while antibiotics continue to treat remaining bacteria.
5. Ophthalmic surgery (eye procedures)
If Bartonella causes severe eye complications such as retinal detachment, vitreous hemorrhage, or structural problems, specialized eye surgery may be needed. Procedures may include vitrectomy (removal of the gel inside the eye) or repair of detached retina. The purpose is to preserve or restore vision. Mechanistically, surgery removes blood, scar tissue, or infected material that interferes with normal eye structure, giving medicines better access and preventing permanent sight loss.
Prevention
Avoid rough play with cats, especially kittens, as they are more likely to carry Bartonella and to scratch or bite.
Wash cat scratches and bites immediately with soap and running water, and seek medical advice for deep or high-risk wounds.
Use flea control on pets as recommended by a veterinarian, since fleas spread Bartonella henselae between cats.Wikipedia
Do not let cats lick open wounds or broken skin, because their saliva can carry bacteria.
Wear gloves when gardening, especially if cats use the garden as a litter area, to avoid contact with contaminated soil.
Teach children gentle handling of pets, and show them how to wash scratches right away.
Immunocompromised people (HIV, chemotherapy, transplant) should discuss with their doctors whether to avoid young or stray cats and what precautions to take.ClinicalInfo+1
Control stray cat populations in your area through humane programs, which lowers overall infection risk.
Maintain general health with vaccines (such as tetanus updates), exercise, diet, and sleep, which strengthens the immune system.
Seek early medical care if you develop unexplained swollen lymph nodes, fever, or eye problems after contact with a cat, especially if you have a weak immune system.
When to see a doctor
You should see a doctor as soon as possible if:
You have swollen lymph nodes near a cat scratch or bite that last more than 1–2 weeks, especially with fever or fatigue.NCBI+1
You notice high fever, chills, night sweats, or weight loss.
You develop eye pain, blurred vision, double vision, or loss of part of your visual field.
You feel shortness of breath, chest pain, new or louder heart murmur, or signs of heart failure (such as ankle swelling or severe fatigue), which may indicate endocarditis.ClinicalInfo+1
You have severe headache, confusion, seizures, or weakness, which may suggest brain involvement.
You are pregnant, have HIV, are on chemotherapy, take strong immunosuppressive drugs, or have had an organ transplant and you develop any signs of infection after cat contact.
Your symptoms worsen or do not improve after a few days, even if you are already on treatment.
You notice yellowing of the skin or eyes, severe abdominal pain, or very dark urine, which may show drug-related liver problems.
Always call emergency services if symptoms are suddenly severe or life-threatening.
Diet: what to eat and what to avoid
Fluids:
Eat/drink: Water, oral rehydration solutions, clear soups, herbal teas.
Avoid: Very sugary sodas and high-caffeine energy drinks that can worsen dehydration.
Proteins:
Eat: Lean meats, fish, eggs, tofu, lentils, beans, and yogurt to support tissue repair and immune cells.
Avoid: Large amounts of processed meats high in salt and preservatives, which may stress the heart and blood pressure.
Fruits and vegetables:
Eat: Colorful fruits and vegetables rich in vitamins C, A, and antioxidants, such as berries, citrus, leafy greens, carrots, and peppers.
Avoid: Very sugary fruit juices in large amounts; whole fruits are better.
Whole grains vs refined grains:
Eat: Whole-grain bread, brown rice, oats, quinoa, which provide steady energy and fiber.
Avoid: Excess white bread, pastries, and sweets that cause blood sugar spikes and crashes.
Healthy fats:
Eat: Nuts, seeds, avocado, olive oil, and fatty fish for omega-3 fats.
Avoid: Trans fats and large amounts of deep-fried foods that increase inflammation.
Dairy or alternatives:
Eat: Milk, yogurt, or fortified plant milks that provide protein and calcium if tolerated.
Avoid: Very high-sugar flavored yogurts and milkshakes; choose low-sugar versions.
Gut-friendly foods:
Eat: Probiotic foods such as yogurt with live cultures, kefir, and fermented vegetables to support gut bacteria during antibiotic therapy.
Avoid: Excess alcohol and heavily processed foods that can upset the gut.
Salt intake:
Eat: Moderate salt only, especially if there are heart or kidney concerns.
Avoid: Very salty snacks and instant foods that may worsen fluid retention or blood pressure in people with cardiac complications.
Food safety:
Eat: Well-cooked meats and properly washed raw produce.
Avoid: Raw or undercooked meat, unpasteurized dairy, or foods stored at unsafe temperatures, especially if you are immunocompromised.
Stimulants and irritants:
Eat/drink: If you drink coffee or tea, keep it moderate and not late at night.
Avoid: Excess caffeine, energy drinks, and nicotine, which can worsen sleep, heart rhythm, and stress responses.
Frequently asked questions
1. Is Bartonella henselae infection always serious?
No. In many healthy people, especially children, cat-scratch disease from Bartonella henselae is mild and goes away on its own over weeks to months.NCBI+1 However, a minority of people develop complications, and the infection can be serious in those with weak immunity, involving the liver, spleen, eye, brain, or heart. This is why medical assessment is important.
2. Do all cases need antibiotics?
No. There is debate about antibiotic use in typical, mild cat-scratch disease because many cases resolve without them.CDC+1 Azithromycin has been shown to shorten lymph node swelling in some studies, and antibiotics are clearly advised for severe disease, eye involvement, endocarditis, or in immunocompromised patients. The decision is individual and should be made with a doctor.
3. Can I catch Bartonella henselae from people?
Person-to-person spread is rare. The usual pathway is from a cat (especially a kitten) to a human through a scratch or bite, after the cat has been infected via fleas.Wikipedia+1 Good wound care and cat management greatly reduce risk.
4. If my cat has Bartonella, must I get rid of it?
Not usually. Veterinarians and CDC guidance generally focus on flea control, gentle handling, and avoiding rough play, rather than removing pets from the home.CDC+1 Immunocompromised people should discuss specific recommendations with their doctors and vets, but many can safely keep their pets with precautions.
5. How long does treatment last for severe Bartonella infections?
For mild lymph node disease, a short course of azithromycin (often 5 days) is common.CDC For serious infections like endocarditis, guidelines recommend combination therapy (for example, doxycycline plus rifampin) for at least 6 weeks, sometimes longer.ClinicalInfo+1 The exact duration depends on site of infection, response to therapy, and underlying health.
6. Are Bartonella antibiotics FDA-approved for this specific disease?
Most antibiotics used (azithromycin, doxycycline, erythromycin, rifampin, etc.) are FDA-approved for many bacterial infections, but their use in Bartonella henselae infection is often off-label, based on expert guidelines, studies, and clinical experience.BioMed Central+4FDA Access Data+4FDA Access Data+4 This is common in infectious diseases, but treatments must be directed by a qualified clinician.
7. Can Bartonella cause chronic fatigue or long-term symptoms?
Some patients report prolonged fatigue, pain, or neurologic symptoms after Bartonella infection, especially if the disease was severe. Evidence is still developing, and many factors (including other conditions or stress) can contribute. A thorough medical evaluation is needed to understand ongoing symptoms and to rule out other causes.
8. Is there a vaccine for Bartonella henselae?
At present, there is no human vaccine against Bartonella henselae. Prevention focuses on cat and flea management, wound care, and protecting vulnerable people from high-risk exposures.
9. Is Bartonella dangerous in pregnancy?
Any significant infection during pregnancy can carry risks. Data for Bartonella are limited, but fever and systemic illness can affect both mother and fetus. Azithromycin is often preferred in pregnancy when an antibiotic is needed because doxycycline is avoided due to possible effects on fetal bones and teeth.Wikipedia+1 Pregnant patients should always seek specialist obstetric and infectious-disease advice.
10. Can I breastfeed if I have Bartonella infection?
In many cases, breastfeeding can continue, but decisions depend on the mother’s health, severity of infection, and medications used. Some antibiotics are considered compatible with breastfeeding, while others may need caution. The doctor and pediatrician should review each case.
11. Will my lymph nodes go back to normal size?
In most people, swollen lymph nodes slowly shrink over weeks to months as the infection clears.NCBI+1 Some nodes may stay slightly larger or firmer than before but are usually painless. Persistent, very large, or hard nodes must be checked to rule out other conditions.
12. Can Bartonella cause eye damage?
Yes. Bartonella can cause eye problems such as neuroretinitis and other inflammatory conditions.Wikipedia With proper antibiotic treatment and, when needed, anti-inflammatory therapy, many patients improve. However, severe or delayed cases can lead to permanent vision changes, so any eye symptom should be checked quickly by an eye specialist.
13. What tests confirm Bartonella henselae infection?
Doctors may use blood tests for Bartonella antibodies or DNA (PCR), imaging for liver or spleen lesions, and sometimes biopsy of lymph nodes or skin lesions. No single test is perfect, so history (cat exposure) and typical symptoms are also important.PMC+1
14. Can diet alone cure Bartonella henselae infection?
No. Diet and supplements can support the immune system and overall healing, but they cannot replace appropriate antibiotics and medical care when these are needed. Ignoring medical treatment and relying only on “natural” methods can allow the infection to spread and cause serious complications.
15. What is the most important thing I should remember?
The most important points are:
Take cat contact and unexplained swollen nodes or fever seriously.
See a doctor early, especially if you are immunocompromised, pregnant, or very unwell.
Follow prescribed antibiotic regimens exactly, and never start or stop antibiotics without medical advice.
Support recovery with rest, fluids, nutrition, stress control, and good hygiene.
Take steps to prevent future infections through cat care, flea control, and safe handling.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: November 13, 2025.
