II. Epidemiology
- Affected 1 million during World War I (1914 to 1918)
III. Pathophysiology
- Bartonella Quintana
- Small Gram Negative Rod
- Previously known as Quintana or Rochalimaea Quintana
- However, reclassified as it is not an obligate intracellular Parasite (unlike Rickettsia)
- Species name "Quintana" is derived from the fever that recurrs every 5 days
- Transmission
- Louse-Borne Illness (Body Lice)
IV. Risk Factors
-
Homelessness
- Under-recognized infections, with delayed diagnosis and treatment
- Alcoholism
- Crowded living conditions with poor sanitation practices
- Outbreaks have occurred in War (hence the name "Trench Fever")
V. Findings
-
Relapsing Fever (every 5 days)
- May present as Fever of Unknown Origin
- Headaches
- Myalgias
- Back and Leg Pain
- Splenomegaly
- Rash (variable)
VI. Labs
- Blood Cultures
- Bartonella Quintana PCR
- Indirect Immunofluorescence Assay (IFA) for Bartonella Quintana
- Cross reactivity with Bartonella Henselae
VII. Differential Diagnosis
-
Epidemic Typhus (Rickettsia prowazekii)
- Also spread via Body Lice in crowded, low sanitation conditions
VIII. Management
- Two Drug Antibiotic Regimen
- Doxycycline 100 mg orally twice daily AND
- Gentamicin 3 mg/kg IV daily for first 2 weeks
- Alternative: Rifampin 300 mg orally twice daily for first 2 weeks
IX. Complications
- Bacteremia
-
Bacterial Endocarditis
- Primary cause of mortality in Bartonella Quintana
-
Bacillary Angiomatosis
- AIDS (CD4 Count <100 cells/mm3)
- Other Immunocompromised patients
X. References
- (2023) Sanford Guide, accessed on IOS 2/14/2025
- Angelakis (2014) Int J Antimicrob Agents 44(1):16-25 +PMID: 24933445 [PubMed]
- Boodman (2024) Pathogens 13(12):1071 +PMID: 39770331 [PubMed]