ABSTRACT
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.
Subject(s)
Disease Outbreaks/history , Endocarditis/epidemiology , Fever/epidemiology , Lice Infestations/epidemiology , Trench Fever/epidemiology , Animals , Bartonella quintana/pathogenicity , Bartonella quintana/physiology , Endocarditis/history , Endocarditis/physiopathology , Europe/epidemiology , Fever/history , Fever/physiopathology , History, 20th Century , Humans , Insect Vectors/microbiology , Lice Infestations/history , Pediculus/microbiology , Recurrence , Trench Fever/history , Trench Fever/physiopathology , World War IABSTRACT
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.
Subject(s)
Bartonella quintana/classification , Communicable Diseases, Emerging , Trench Fever , Adult , Animals , Bartonella quintana/genetics , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/microbiology , Communicable Diseases, Emerging/physiopathology , Communicable Diseases, Emerging/therapy , Female , Humans , Pediculus/microbiology , Trench Fever/epidemiology , Trench Fever/microbiology , Trench Fever/physiopathology , Trench Fever/therapyABSTRACT
We report an observational case of Bartonella quintana-associated neuroretinitis. The patient had a positive IgM IFA titer for Bartonella quintana early in the disease. After treatment, the neuroretinitis and IgM resolved. Given the patient's history, symptoms, response to treatment, and IgM course, we believe his neuroretinitis was secondary to Bartonella quintana.
Subject(s)
Bartonella quintana/pathogenicity , Retinitis/etiology , Trench Fever/complications , Adult , Humans , Life Style , Male , Retinitis/pathology , Trench Fever/physiopathologyABSTRACT
Chronic asymptomatic bacteremia caused by Bartonella quintana occurs in homeless people, but its pathophysiology is unknown. We investigated homeless people with bacteremia to determine whether the persistence of B. quintana is associated with a specific immune profile. Homeless people without B. quintana infection exhibited an inflammatory profile--levels of circulating markers of leukocyte activation (soluble interleukin [IL]-2 receptor and neopterin) and cytokines released by mononuclear cells (tumor necrosis factor, IL-1beta, IL-6, and IL-10) were significantly higher than levels in healthy control subjects. In contrast, homeless people with B. quintana bacteremia exhibited specific increases in IL-10 secretion by mononuclear cells. This overproduction of IL-10 was associated with an attenuated inflammatory profile. The depressed inflammatory response was specific of bacteremia, because patients with specific antibodies and without bacteremia had responses similar to those of homeless people. The overproduction of IL-10 and attenuated inflammatory response may account for the persistence of B. quintana in homeless people.
Subject(s)
Bacteremia/immunology , Bartonella quintana/physiology , Ill-Housed Persons , Interleukin-10/biosynthesis , Trench Fever/immunology , Adult , Aged , Bacteremia/microbiology , Bacteremia/physiopathology , Chronic Disease , Cytokines/biosynthesis , Female , Humans , Leukocytes, Mononuclear/metabolism , Male , Middle Aged , Trench Fever/microbiology , Trench Fever/physiopathologyABSTRACT
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.
