Also called Rochalimaea quintana, this microorganism
is an unusual rickettsia that can multiply within the gut of the body louse and
then can be transmitted to humans. Transmission to people can occur by rubbing infected
louse feces into abra ded (scuffed) skin or into the conjunctivae (whites of the
eyes).
Bartonella quintana (B. quintana) is the cause of trench fever, a disease that
was first recognized in the trenches of World War I, when it is estimated to have
affected more than a million people in Russia and on the fronts in Europe. Trench
fever was again a major problem in the military in World War II and is seen endemically
in Mexico, Africa, E. Europe, and elsewhere.
Urban trench fever occurs among the homeless people and people with alcoholism
today. Outbreaks have been documented, for example, in Seattle, Baltimore (among
injection-drug users), Marseilles (France) and Burundi.
The fever of trench fever is classically a 5-day fever ("quintan fever"). The
onset of symptoms is sudden with high fever, severe headache, back pain and leg
pain and a fleeting rash.
Recovery takes a month or more. Relapses are common.
It is now clear, that at least in its urban form among the homeless, trench fever
can cause bloodstream infection (bacteremia) associated with nonspecific symptoms
or no symptoms (New England Journal of Medicine 340: 184-189, 1999).
B. quintana also has been found responsible for a disease called bacillary angiomatosis
in people infected with HIV and for infection of the heart and great vessels (endocarditis)
with bloodstream infection (bacteremia). The full spectrum of disease caused by
B. quintana is still unfolding.
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