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Bartonella quintana infections

Background

Bartonella quintana was first described as the agent responsible for trench fever, an acute febrile illness that caused large epidemics among soldiers during World Wars I and II. More recently, B. quintana infection has been found among homeless people in Europe, the United States and Japan. Studies among homeless populations have reported seroprevalences up to 54%. B. quintana infection is generally associated with bad hygiene and poor living conditions.

Transmission

B. quintana is transmitted from human to human via infected body lice ( Pediculus humanus corporis). The bacterium multiplies in the louse gut and is excreted in the faeces. It penetrates human skin through small lesions resulting from the scratching of lice bites.

Diseases and symptoms

B. quintana is responsible for a variety of clinical conditions:

  • Trench fever: There is sudden onset of fever, often accompanied by headache and severe pain in the shins. Patients may experience one or several episodes of fever recurring approximately every five days. Following the febrile stage of the disease, some patients recover completely while others remain infected and carry the organism in their blood for a long time without showing any clinical signs. As a result, relapses may occur many months or years after the initial episode

  • Endocarditis: Chronic bacteraemia may be associated with the development of endocarditis, an inflammation of the lining of the heart that commonly affects heart valves. Endocarditis caused by B.quintana may present in patients with no previous history of heart disease. Some studies have identified homelessness, alcoholism and body lice infestation as predisposing factors for B. quinatana endocarditis. Other Bartonella species such as B. henselae, the agent of Cat Scratch Disease (CSD), can also cause endocarditis, but less frequently. In total, Bartonella species are estimated to account for approximately 3% of all cases of bacterial endocarditis.

  • Bacillary angiomatosis: this is a condition where blood vessels proliferate and form tumour-like lesions. The skin is often affected with the appearance of red-purple nodules and papules. The infection may spread to other organs and may lead to life-threatening complications. This condition affects mostly immunocompromised patients, especially those who are HIV-positive. Both B. quintana and B. henselae can cause bacillary angiomatosis.

Diagnosis

Diagnosis is based on the clinical presentation and laboratory tests. Serology, molecular techniques and culture can be used. See here for laboratory services.

Treatment

Trench fever, chronic bacteraemia and bacillary angiomatosis can be treated with antibiotics. Endocarditis is a more serious condition that often requires valve replacement and that may be associated with high mortality when not detected early.

Prevention

Prevention involves good personal hygiene to avoid contact with body lice.


Last reviewed: 30 July 2009