Bartonella quintana Characteristics and Clinical Management

Cédric Foucault; Philippe Brouqui; Didier Raoult


Emerging Infectious Diseases. 2006;12(3) 

In This Article

Abstract and Introduction

Bartonella quintana, a pathogen that is restricted to human hosts and louse vectors, was first characterized as the agent of trench fever. The disease was described in 1915 on the basis of natural and experimental infections in soldiers. It is now recognized as a reemerging pathogen among homeless populations in cities in the United States and Europe and is responsible for a wide spectrum of conditions, including chronic bacteremia, endocarditis, and bacillary angiomatosis. Diagnosis is based on serologic analysis, culture, and molecular biology. Recent characterization of its genome allowed the development of modern diagnosis and typing methods. Guidelines for the treatment of B. quintana infections are presented.

Trench fever, the first clinical manifestation attributed to Bartonella quintana, affected an estimated > 1 million people during World War I.[1,2] The name "trench fever" was mentioned for the first time in 1915.[3,4] In 1916, McNee et al. described 2 types of the disease.[5] The first was characterized by a sudden onset of headache, dizziness, pain in the shins, and elevated temperature (39°C-40°C). Between days 3 and 7, temperature would suddenly drop to normal or subnormal. Thereafter, temperature rose sharply before falling again. The second manifestation of the disease was characterized by a shorter initial period and frequent relapses. In 1919, 200 consecutive cases were recorded by Byam et al., and transmission by human body lice was demonstrated, but the nature of the trench fever agent was still unknown.[4]

Trench fever was precisely described based on experimental infections in volunteer soldiers.[4] The first experiments consisted of transmitting whole blood from typical cases to volunteers, which reproduced natural infection. Byam confirmed in 1919 the others' work, showing that "rickettsia bodies" were present in lice, their excreta, and their guts when they were collected from trench fever patients. In 1949, Kostrzewski precisely described trench fever after an accidental epidemic spread among louse-feeders in laboratories that produced typhus vaccine.[6] Of 104 persons who worked with lice, 90 contracted symptomatic trench fever, and 5 were asymptomatic carriers. Three different courses of trench fever were described by Kostrzewski: the classic relapsing form associated with shin pain, headaches, and dizziness; the typhoidal form characterized by a prolonged fever, splenomegaly, and rash; and the abortive form, characterized by a brief, less intense course.

After World War I, the incidence of trench fever decreased dramatically, but during World War II, epidemics were again reported.[6] More recently, reports have indicated the reemergence of B. quintana infections among the homeless population in cities in both Europe and the United States.[7,8] Major predisposing factors for new B. quintana infections include poor living conditions and chronic alcoholism.[8] Epidemics of trench fever were also recently reported in particular conditions, such as in refugee camps in Burundi in 1997, where pediculosis was prevalent.[1]