Bartonella Quintana Infection
Contact Precautions
Bartonella quintana, a gram-negative rod belonging to the Rickettsiaceae family, restricts itself to human hosts. Typically transmitted by the human body louse (a small, wingless insect), B. quintana is associated with poverty, lack of hygiene, crowded and unhygienic conditions, and cold weather.
During World War I, more than 1 million people became infected with what is now known as “trench fever”—the first clinical manifestation of B. quintana. Following the war, the incidence of trench fever dropped dramatically, only to rise again during World War II. (See Trench fever.)
In the 1980s, B. quintana appeared again as an opportunistic pathogen among those infected with human immunodeficiency virus (HIV). More recently, it has reemerged among indigent populations in the United States and Europe.
Causes
B. quintana multiplies in the intestine of the louse and is excreted in its feces, which then infects the human host through breaks in the skin—either by biting or other means. Infected lice excrete infectious feces 5 to 12 days after ingesting infected blood. Recently, B. quintana has been found in cat fleas and cat teeth, which is suggestive of bacteremia in cats. Recent research has found B. quintana in ticks.
Poor living conditions and a history of alcoholism are the two main predisposing factors for B. quintana infection.
Complications
B. quintana is responsible for a long list of complications. Chronic bacteremia has been reported in patients as many as 8 years after initial infection. Other complications include endocarditis, often requiring valve surgery; lymphadenopathy; peliosis; and bacillary angiomatosis (more common in those who are HIV positive).
Trench FeverTrench fever is known by a variety of names, including Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever, and His-Werner disease. It was first described in 1915, when more than 1 million people were affected during World War I. However, recent DNA studies have shown that B. quintana infected many soldiers in Napoleon’s Grand Army at Vilnius in 1812. The infection is characterized by headache and dizziness, shin and joint pain, and fever. Muscle aches, truncal rashes and, later in the course of disease, hepatosplenomegaly are also common.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
