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The Journal of Infectious Diseases Oct 2022Bartonella quintana is an important cause of infection amongst people experiencing homelessness that is underdiagnosed due to its nonspecific clinical manifestations. We... (Review)
Review
BACKGROUND
Bartonella quintana is an important cause of infection amongst people experiencing homelessness that is underdiagnosed due to its nonspecific clinical manifestations. We reviewed cases identified in the Denver metropolitan area in 2016-2021.
METHODS
The electronic medical records from 2 large academic medical centers in Colorado were reviewed for demographic, clinical, and laboratory features of patients with B. quintana infection confirmed by blood culture, serologies, and/or molecular testing from July 2016 to December 2021.
RESULTS
Fourteen patients with B. quintana infection were identified. The mean age was 49.5 years (SD 12.7 years) and 92.9% of patients were male. Twelve patients had history of homelessness (85.7%) and 11 were experiencing homelessness at the time of diagnosis (78.6%). Most frequent comorbidities included substance use (78.6%), of which 42.9% had alcohol use disorder. The average time to blood culture positivity was 12.1 days (SD 6.2 days). Three patients with bacteremia had negative B. quintana IgG, and 6 of 14 (42.8%) patients had evidence of endocarditis on echocardiography.
CONCLUSIONS
B. quintana is an underrecognized cause of serious infection in individuals experiencing homelessness. Serologic and microbiologic testing, including prolonged culture incubation, should be considered in at-risk patients due to ongoing transmission in homeless populations.
Topics: Bartonella quintana; Endocarditis; Female; Ill-Housed Persons; Humans; Immunoglobulin G; Male; Middle Aged; Trench Fever
PubMed: 35749315
DOI: 10.1093/infdis/jiac238 -
APMIS : Acta Pathologica,... Nov 2018During World War I, a mysterious new disease affected soldiers on both sides of battle field. The first reports described a relapsing fever of unknown origin with body... (Review)
Review
During World War I, a mysterious new disease affected soldiers on both sides of battle field. The first reports described a relapsing fever of unknown origin with body lice being suggested as the vector. The outbreak affected >1 000 000 people, mostly soldiers fighting in front-line trenches. Shortly afterward, the illness was known as Trench fever, of which the causal infectious agent is currently classified as Bartonella quintana.
Topics: Animals; Bartonella quintana; Disease Outbreaks; Endocarditis; Europe; Fever; History, 20th Century; Humans; Insect Vectors; Lice Infestations; Pediculus; Recurrence; Trench Fever; World War I
PubMed: 30357961
DOI: 10.1111/apm.12895 -
Clinical Microbiology Reviews Jul 1996Bartonella (formerly Rochalimaea) quintana is the etiological agent of trench fever, a disease extensively reported during the World Wars. Recent molecular biology... (Review)
Review
Bartonella (formerly Rochalimaea) quintana is the etiological agent of trench fever, a disease extensively reported during the World Wars. Recent molecular biology approaches have allowed dramatic extension of the spectrum of Bartonella infections. B. quintana is now also recognized as an etiological agent of fever and bacteremia, endocarditis, bacillary angiomatosis, and chronic lymphadenopathy. Human immunodeficiency virus-infected patients and/or homeless people are the most vulnerable to infection. Poverty and louse infestation were the main epidemiological factors associated with B. quintana infections during wartime. Although poverty and chronic alcoholism have been associated with modern cases of trench fever and bacteremia due to B. quintana in Europe and the United States, vectors for B. quintana have not been clearly identified and B. quintana has not been isolated from modern-day lice. Microscopic bacillary angiomatosis lesions are characterized by tumor-like capillary lobules, with proliferating endothelial cells. In vitro experiments have shown that B. quintana survives within endothelial cells and stimulates cell proliferation. These observations, together with the finding that lesions may regress when antibiotic therapy is administered, strongly suggest that B. quintana itself stimulates angiogenesis. Bartonella infections are characterized by a high frequency of relapses after brief courses of antibiotic therapy. It is to be noted that in vitro, although Bartonella species are highly susceptible to antibiotics, only the aminoglycosides have proved to be bactericidal. However, the most effective antibiotic regimen for Bartonella infections remains to be established.
Topics: Angiomatosis, Bacillary; Animals; Anti-Bacterial Agents; Arthropod Vectors; Bacteremia; Bacteriological Techniques; Bartonella quintana; Cats; DNA, Bacterial; Disease Reservoirs; Endocarditis; Humans; Lymphadenitis; Microbial Sensitivity Tests; Risk Factors; Serology; Trench Fever
PubMed: 8809460
DOI: 10.1128/CMR.9.3.273 -
Tropical Biomedicine Sep 2022Limited information is available on human exposure to Bartonella infection, i.e., Bartonella henselae (causative agent of cat scratch disease) and Bartonella quintana... (Review)
Review
Limited information is available on human exposure to Bartonella infection, i.e., Bartonella henselae (causative agent of cat scratch disease) and Bartonella quintana (causative agent of trench fever) in West Malaysia. This study reports a review of serological findings obtained from patients attending to a teaching hospital in Klang Valley, Malaysia. An indirect immunofluorescence assay (IFA) was used to determine IgG and IgM antibody titers against B. henselae and B. quintana. In a pilot study conducted between 2013-2015, IgG antibodies against Bartonella spp. (either B. quintana and B. henselae) were detected in 14 (36.8%) of 38 patients who were clinically suspected of rickettsial infections, while IgM antibody was detected in 4 (10.5%) patients. This has prompted us to investigate the serologic responses of patients who were clinically suspected of other febrile causes besides rickettsial infection. Of the 59 serum samples analysed in a follow-up investigation, Bartonella IgG antibodies were detected from 7 (11.9%) patients, of which 5 (27.8%) and 2 (18.2%) patients were clinically suspected of rickettsial infection (n=18) and dengue (n=11), respectively. None of the sera obtained from the leptospirosis (n=10), legionellosis (n=10) and mycoplasma infection (n=10) groups were seropositive to Bartonella spp. The review of Bartonella serological findings in this study highlights that Bartonella infection is not uncommon and should be considered as one of the causes for febrile illness in Malaysia.
Topics: Antibodies, Bacterial; Bartonella Infections; Bartonella henselae; Humans; Immunoglobulin G; Immunoglobulin M; Pilot Projects; Trench Fever
PubMed: 36214431
DOI: 10.47665/tb.39.3.004 -
Clinical Infectious Diseases : An... Jul 2000Contemporary Bartonella quintana infections have emerged in diverse regions of the world, predominantly involving socially disadvantaged persons. Available data suggest... (Review)
Review
Contemporary Bartonella quintana infections have emerged in diverse regions of the world, predominantly involving socially disadvantaged persons. Available data suggest that the human body louse Pediculus humanus is the vector for transmission of B. quintana. Descriptions of the clinical manifestations associated with contemporary B. quintana infections have varied considerably and include asymptomatic infection, a relapsing febrile illness, headache, leg pain, "culture-negative" endocarditis, and, in human immunodeficiency virus-infected persons, bacillary angiomatosis. Laboratory diagnosis is most convincing when B. quintana is isolated in blood culture, but growth often takes 20-40 days; problems exist with both sensitivity and specificity of serological assays. On the basis of available information, use of doxycycline, erythromycin, or azithromycin to treat B. quintana infections is recommended. Treatment of uncomplicated B. quintana bacteremia for 4-6 weeks and treatment of B. quintana endocarditis (in a person who does not undergo valve surgery) for 4-6 months are recommended, with the addition of a bactericidal agent (such as a third-generation cephalosporin or an aminoglycoside) during the initial 2-3 weeks of therapy for endocarditis.
Topics: Animals; Bacteremia; Bartonella quintana; Endocarditis, Bacterial; Forecasting; Humans; Immunocompetence; Trench Fever; Urban Population
PubMed: 10913410
DOI: 10.1086/313890 -
Journal of Global Infectious Diseases 2022is an anaerobic bacillus whose main target is the erythrocyte. This bacterium transmitted by the body louse notably infected the soldiers of the First World War from...
INTRODUCTION
is an anaerobic bacillus whose main target is the erythrocyte. This bacterium transmitted by the body louse notably infected the soldiers of the First World War from where the name of this disease: fever of the trenches. The 90s marked the return of this bacterial infection. infection in the homeless was reported in the literature with a high incidence in these populations worldwide. This upsurge of cases justified this study for a better understanding of infections.
METHODS
We conducted a systematic review to evaluate the seroprevalence of infection by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to collect scientific papers from PubMed and Google Scholar based on combining keywords.
RESULTS
The review included 45 articles published from April 1996 to March 2020 with 84 subpopulations of 21 countries from 4 continents; among them, 61 subpopulations had a positive rate from 0.2% to 65%. These subpopulations were divided into four main groups: homeless people, healthy people, blood donors, and symptoms/diseases. Homeless people were the main target of this infection, and three factors related to susceptibility were homeless period, age, and alcoholism. 6/11, 12/20, and 32/41 subpopulations of healthy people, blood donors, symptoms/diseases, respectively, had a positive percentage. However, factors of exposure in these three groups were not mentioned. Other reservoirs, vectors, and transmitted routes were identified to partially explain the worldwide spread of the infection, and it is important to have more further investigations to identify potential risk factors. This will help to limit contamination and prevent effectively.
CONCLUSIONS
This serological overview indicated the importance of infection that has emerged in multiple regions, touched worldwide populations.
PubMed: 35910824
DOI: 10.4103/jgid.jgid_220_21 -
Emerging Infectious Diseases Feb 2006Bartonella 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... (Review)
Review
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.
Topics: Adult; Animals; Bartonella quintana; Communicable Diseases, Emerging; Female; Humans; Pediculus; Trench Fever
PubMed: 16494745
DOI: 10.3201/eid1202.050874 -
PloS One 2020During the two World Wars, Bartonella quintana was responsible for trench fever and is now recognised as an agent of re-emerging infection. Many reports have indicated...
During the two World Wars, Bartonella quintana was responsible for trench fever and is now recognised as an agent of re-emerging infection. Many reports have indicated widespread B. quintana exposure since the 1990s. In order to evaluate its prevalence in ancient populations, we used real-time PCR to detect B. quintana DNA in 400 teeth collected from 145 individuals dating from the 1st to 19th centuries in nine archaeological sites, with the presence of negative controls. Fisher's exact test was used to compare the prevalence of B. quintana in civil and military populations. B. quintana DNA was confirmed in a total of 28/145 (19.3%) individuals, comprising 78 citizens and 67 soldiers, 20.1% and 17.9% of which were positive for B. quintana bacteraemia, respectively. This study analysed previous studies on these ancient samples and showed that the presence of B. quintana infection followed the course of time in human history; a total of 14/15 sites from five European countries had a positive prevalence. The positive rate in soldiers was higher than those of civilians, with 20% and 18.8%, respectively, in the 18th and 19th centuries, but the difference in frequency was not significant. These results confirmed the role of dental pulp in diagnosing B. quintana bacteraemia in ancient populations and showed the incidence of B. quintana in both civilians and soldiers.
Topics: Bacteremia; Bartonella quintana; DNA, Bacterial; Dental Pulp; Europe; Fossils; Humans; Military Personnel; Paleodontology; Prevalence; Real-Time Polymerase Chain Reaction; Sequence Analysis, DNA; Tooth; Trench Fever
PubMed: 33147255
DOI: 10.1371/journal.pone.0239526 -
Open Forum Infectious Diseases Jul 2021We present the first case described in the literature of leucocytoclastic vasculitis due to infection. A 73-year-old woman presented to the hospital with persistent...
We present the first case described in the literature of leucocytoclastic vasculitis due to infection. A 73-year-old woman presented to the hospital with persistent fevers, retro-orbital headache, generalized weakness, and left lower thigh pain for 1 week. She was found to have truncal and proximal lower extremity papules and small plaques. Serology revealed immunoglobulin M (IgM) titer of 1:256 with undetectable immunoglobulin G (IgG) and undetectable IgG and IgM. Skin biopsy of an abdominal lesion revealed fibrinoid necrosis of vessel walls in the superficial and mid-dermis consistent with leucocytoclastic vasculitis. Doxycycline 100 mg orally twice daily was initiated, after which she had defervescence within 36 hours and rapid improvement of other presenting symptoms.
PubMed: 34307730
DOI: 10.1093/ofid/ofab333 -
Clinical Infectious Diseases : An... Mar 2024Bartonella quintana is a louse-borne bacterium that remains a neglected cause of endocarditis in low-resource settings. Our understanding of risk factors, clinical...
BACKGROUND
Bartonella quintana is a louse-borne bacterium that remains a neglected cause of endocarditis in low-resource settings. Our understanding of risk factors, clinical manifestations, and treatment of B. quintana endocarditis are biased by older studies from high-income countries.
METHODS
We searched Pubmed Central, Medline, Scopus, Embase, EBSCO (CABI) Global Health, Web of Science and international trial registers for articles published before March 2023 with terms related to Bartonella quintana endocarditis. We included articles containing case-level information on B. quintana endocarditis and extracted data related to patient demographics, clinical features, diagnostic testing, treatment, and outcome.
RESULTS
A total of 975 records were identified, of which 569 duplicates were removed prior to screening. In total, 84 articles were eligible for inclusion, describing a total of 167 cases. Infections were acquired in 40 different countries; 62 cases (37.1%) were acquired in low- and middle-income countries (LMICs). Disproportionately more female and pediatric patients were from LMICs. More patients presented with heart failure (n = 70/167 [41.9%]) than fever (n = 65/167 [38.9%]). Mean time from symptom onset to presentation was 5.1 months. Also, 25.7% of cases (n = 43/167) were associated with embolization, most commonly to the spleen and brain; 65.5% of antimicrobial regimens included doxycycline. The vast majority of cases underwent valve replacement surgery (n = 154/167, [98.0%]). Overall case fatality rate was 9.6% (n = 16/167).
CONCLUSIONS
B. quintana endocarditis has a global distribution, and long delays between symptom onset and presentation frequently occur. Improved clinician education and diagnostic capacity are needed to screen at-risk populations and identify infection before endocarditis develops.
Topics: Humans; Female; Child; Bartonella quintana; Trench Fever; Endocarditis; Doxycycline; Endocarditis, Bacterial
PubMed: 37976173
DOI: 10.1093/cid/ciad706