Clinical features, diagnosis, and treatment of Bartonella quintana infections
- David H Spach, MD
David H Spach, MD
- Professor of Medicine
- Division of Infectious Diseases
- University of Washington
Bartonella quintana is a species of Bartonella, which historically caused "trench fever", but more recently has been associated with a variety of infections including bacteremia, endocarditis, and bacillary angiomatosis.
The clinical features, diagnosis, and treatment of B. quintana infection will be reviewed here. Endocarditis due to Bartonella spp, Bartonella infection in HIV-infected patients, bacillary angiomatosis, and bartonellosis (or Carrion's disease) are discussed separately. (See "Endocarditis caused by Bartonella" and "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients" and "South American bartonellosis: Oroya fever and verruga peruana".)
B. quintana is a small, fastidious, gram-negative rod formerly known as Rochalimaea quintana, Rickettsia quintana, Rickettsia weigli, Rickettsia volhynia, and Rickettsia pediculi .
Early in the 20th century, B. quintana infection emerged as a major source of morbidity and mortality among soldiers and was commonly known as trench fever. During World War I, an estimated one million soldiers developed trench fever, and military physicians reported on the wide range of clinical manifestations . They identified the human body louse Pediculus humanus variety corporis as the vector. During World War II, a significant, but less extensive, trench fever epidemic occurred. Subsequently, endemic and sporadic outbreaks of trench fever occurred in the middle part of the century in multiple regions of the world, including Ethiopia (1946), Poland (1949), Mexico (1954), USSR (1960), and Tunisia (1961) .
Since the 1990s, sporadic B. quintana infections have reemerged in the United States and Europe, most often manifesting as bacteremia [4,5], endocarditis [6-8], or bacillary angiomatosis [9,10]. Contemporary B. quintana infections have disproportionately affected indigent or homeless persons who often have chronic alcoholism [4-6]. One study from France noted intraerythrocytic organisms in a small proportion of erythrocytes from 9 of 18 homeless individuals with B. quintana bacteremia; the authors speculate that infection of erythrocytes could allow body lice to efficiently transmit B. quintana .
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