Key clinical aspects
1. Incubation takes approximately 3 to 8 weeks (range 10-210 days). It begins insidiously with:
2. Irregular intermittent febrile attacks with shivering
3. Rapidly worsening anaemia with tachycardia, pallor and (sub)icterus
4. Severe headache with bone and joint pain. This may persist after the fever has ended
5. Enlargement of the liver and spleen, slightly painful on palpation
6. Generalised painful swollen lymph nodes
7. Myocarditis, pulmonary oedema and anasarca (generalised oedema)
8. Haemorrhagic diathesis as a result of the endothelial lesions: petechiae and tendency to
thrombosis. Necrotic foci are found in the liver, spleen and bone marrow.
9. Neutrophilia
10. Spontaneous abortion, foetal death or transplacental transmission can occur.
11. Neurobartonellosis due to involvement of the CNS takes the form of meningo-encephalitis with or without convulsions and with high mortality. Myelitis also occurs with spastic or flaccid paraplegia with sequelae which can be permanent. There is pleiocytosis of the CSF. More focal and transient lesions of the spinal cord or of the cranial nerves are seen at the verruga stage.
