Bartonella Quintana: Health Problems and Prevention

Bartonella quintana is a gram-negative bacterium (Popa, et al., 2007). Bartonella species is an intracellular bacterium that is linked with several anthropozoonoses and has widespread vertebrate hosts such as humans and mammals. Bartonella Quintana is classified as a gram-negative rod-shaped bacterium and belongs to the phylum Proteobacteria. Since these cannot multiply outside the host cell these were formally classified in the Rickettsiaceae family. Other related species of Bartonella include B. bacilliformis and B. clarrideiae. (Maurin and Raoult, 1996).

B.quintana bacterium is associated with several health problems. One of the most common diseases caused by B.quintana bacterium is trench fever. Humans are the reservoir of the bacterium. B. quintana which is located in the erythrocytes and erythroblasts cells (Rolain et al., 2002). Another disease caused by this organism is the bacillary angiomatosis infection. Since this bacterium has an affinity for endothelial cells they damage the skin that results in antiproliferative lesions (Meghari et al. 2006).

Trench fever is a blood-borne infection caused by B. quintana. Even before the name “Trench fever” became popular this disease was called five-day fever, quintan fever, shin bone fever, shank fever, His-Werner disease, and Wolhynia fever. The clinical description of the disease was first brought out during World War I (Popa, et al., 2007). The fever got this name as it was considered the most prevalent disease among Allied troops serving in the trenches. Later the disease was dormant until the World War II when it re-emerged in Eastern Europe. This disease primarily affects inner-city dwellers, chronic alcohol abusers, and political refugees. Seroprevalence data on these populations suggest that exposure is common and many infections are sub-clinical. Endocarditis is prominent in recent urban trench fever cases among the homeless, urban population (Popa, et al., 2007).

Recent research suggests that B. quintana is mainly feared to cause serious health consequences in patients with HIV infection since these people have very low immunity. It also causes a febrile disease among alcoholic individuals. In general, the disease caused by the b. quintana is popularly known as the “urban trench fever”. This bacterium can pose threat to human beings as B. quintana infections can manifest as bacillary angiomatosis, bacillary peliosis, endocarditis, and chronic bacteremia. These are life-threatening in case of concurrent occurrence (Maurin and Raoult, 1996).

Trench fever has varied clinical presentations ranging from no specific symptom or asymptomatic to a continuous and persistent fever that can last for months. Several symptoms are linked to this fever such as sudden fever, severe headache, severe leg and back pain, and recurrent fevers (Ravven, 2007). There is no human-to-human transmission of trench fever. In general, it is transmitted by inoculation of the organism in louse feces through any sort of skin injury or an open cut, or a louse bite. The only reservoir for louse is humans and the patient who is infected by B quintana can remain asymptomatic for several years. As a result of this, the disease may be diagnosed very late or even can remain underdiagnosed. There are also cases where the occurrence of epidemic and endemic infection occurs when the place of living is contaminated by lice and ticks (Relman, 1995). This can be even more common in the case of people living in less hygienic places or homeless populations especially in rehabilitation centers, camps, or during some calamities when different people have to stay together.

A blood sample analysis can help in identification of trench fever. Just because the bacterium takes a very long time to grow, the diagnosis gets delayed and can take as much as four weeks. Once confirmed the patient is treated with erythromycin and azithromycin (Maguiña and Gotuzzo, 2000; Ohl and Spach, 2000). Initially a four week course is advised by the physicians. In case the patient does not take care of their health and hygiene there can be relapses of the disease for as long as ten years. Body lice and even head lice may transport this infectious bacterium transmitting trench fever (Velho, et al. 2003). It is always good to prevent the disease by practicing good hygiene and decent living conditions. Preventing the propagation of ticks or other insects can be helpful in preventing the disease and for this purpose suitable insecticides can be used.

Other problems caused by B. quintana include Prosthetic Valve Endocarditis and Bartonella infections in HIV-infected patients. Prosthetic Valve Endocarditis is an endovascular disease and B. quintana infection occurs on parts of valve prosthesis or on reconstructed native heart valves (Piper et al. 2001). B. quintana is also known to cause infection in people with low immunity and people with HIV have problems if they are infected by this bacterium. The only way to prevent the infection of B. quintana is by maintaining hygienic surroundings and keeping the place free of lice and ticks and can be killed by using disinfectants.

References

  1. Maurin M and Raoult D. (1996) Bartonella (Rochalimaea) quintana infections. Clin Microbiol Rev. 9:273-292.
  2. Meghari S, Rolain JM, Grau GE, Platt E, Barrassi L, Mege JL, et al. (2006) Antiangiogenic effect of erythromycin: an in vitro model of Bartonella quintana infection. J Infect Dis.;193:380–386.
  3. Maguiña, C and Gotuzzo, E. (2000) Bartonellosis New and Old, Infectious Disease Clinics of North America, 14(1): 1 – 22.
  4. Ohl ME and Spach, DH (2000) Bartonella quintana and Urban Trench Fever, Clinical Infectious Diseases 31:131–135.
  5. Piper, C. et al. (2001) Prosthetic valve endocarditis, Heart 2001;85:590-593.
  6. Popa, C et al., (2007). Bartonella quintana Lipopolysaccharide Is a Natural Antagonist of Toll-Like Receptor, Infect Immun. 2007; 75(10): 4831–4837. Web.
  7. Ravven, W (2007) New bacterium discovered—related to cause of trench fever, UCSF News Office. Web.
  8. Relman, DA (1995) Has Trench Fever Returned? NEJM, 332 (7):463-464.
  9. Rolain JM, Foucault C, Guieu R, La Scola B, Brouqui P, Raoult D. (2002) Bartonella quintana in human erythrocytes. Lancet 360:226–228.
  10. Velho, P. et al. (2003) What do we (not) know about the human bartonelloses? Braz J Infect Dis vol.7 no.1 2003. Salvador.