NAME: Bartonella quintana
SYNONYM OR CROSS REFERENCE: Rochalimaea quintana, trench fever Footnote 1-Footnote 4,Footnote 5, urban trench fever, volhynia fever, Meuse fever, His-Werner disease, shinbone fever, shank fever, quintan, 5-day fever, bacillary angiomatosis, chronic lymphadenopathy, bacteremia.
CHARACTERISTICS: Facultative, intracellular, fastidious, Gram-negative short rod (0.3-0.5 µm wide by 1-1.7 µm long) Footnote 1, Footnote 2, often slightly curved, belonging to the α2 subgroup of proteobacteria.
PATHOGENICITY/TOXICITY: Trench fever is characterized by sudden onset of chills, headache, relapsing fever, and maculopapular rash on the trunk and abdomen Footnote 1, Footnote 2, Footnote 4. No deaths have been reported due to trench fever. In immunocompetent persons, the disease is self-limiting and is marked by febrile episodes that occur after 15-25 days of incubation, each lasting 4-5 days, and recurring 3-5 times Footnote 2. Cases of milder or asymptomatic disease have been reported.
Bacillary angiomatosis (epithelioid angiomatosis): Neovascular proliferation of the skin, marked by blood-filled cystic structures that are partially endothelial cell-lined Footnote 2. Can also involve liver, spleen, bone, brain, lung, and bowel Footnote 1, Footnote 2, Footnote 6. When visceral parenchymal organs become involved, the disease is referred to as bacillary peliosis hapatis, splenic peliosis, or systemic bacillary angiomatosis Footnote 2. In immunocompromised patients, such as those with AIDS, symptoms can be far more severe and can be life threatening if untreated.
Endocarditis: 11.9% mortality rate seen in studies of B. quintana endocarditis despite antimicrobial drug therapy and valvular surgery Footnote 1.
EPIDEMIOLOGY: B. quintana is of worldwide prevalence Footnote 2. Trench fever is associated with poor sanitation and personal hygiene. Originally described and named based on high levels in trench soldiers of World War I, estimated >1 million people infected during World War I Footnote 1. Most recently, an epidemic of trench fever erupted in a refugee camp in Burundi Footnote 3. Bacteremia and endocarditis described in homeless, alcoholic men in France and US Footnote 3, Footnote 5, Footnote 7.
INFECTIOUS DOSE: Unknown.
INCUBATION PERIOD: The incubation period for trench fever varies from 15 – 25 days Footnote 4.
COMMUNICABILITY: Human-to-human transfer occurs through the arthropod vector, Pediculus humanus Footnote 4.
ZOONOSIS: None reported.
DRUG SUSCEPTIBILITY: Bartonella are susceptible to penicillins, cephalosporins, aminoglycosides, chloramphenicol, tetracyclines, macrolides, rifampin, fluoroquinolones, and cotrimoxazole Footnote 1, Footnote 13. Aminoglycosides has also demonstrated to be bactericidal Footnote 1, Footnote 13. Doxycycline in combination with gentamicin is effective in treating chronic bacteremia, with improved outcome in endocarditis Footnote 1. Prolonged treatment with erythromycin is effective against bacillary angiomatosis: Footnote 1, Footnote 4.
DRUG RESISTANCE: Resistance has been shown against fluoroquinolones Footnote 14. This area remains a growing concern when repeated doses are administered, especially in endemic areas.
SUSCEPTIBILITY TO DISINFECTANTS: Information specific to B. quintana is not available, but many bacteria have been shown to be susceptible to low concentration of chlorine, 70% ethanol, phenolics such as orthophenylphenol and ortho-benzyl-paua-chlorophenol, 2% aqueous glutaraldehyde, peracetic acid (0.001% to 0.2%) Footnote 15, Footnote 16.
PHYSICAL INACTIVATION: Information specific to B. quintana is not available, but many bacteria can be inactivated by moist heat (121°C for 15 min - 30 min) and dry heat (160-170°C for 1-2 hours) Footnote 17.
SURVIVAL OUTSIDE HOST: Unknown.
SURVEILLANCE: Monitor for symptoms. Serologic testing is the most widely used method to diagnose Bartonella infection. Indirect immunofluorescence is the reference method Footnote 1, Footnote 2, Footnote 4. B. quintana can be grown by direct plating onto blood agar media, blood culture in broth, and cocultivation in cell culture Footnote 1. Identification and diagnosis can be carried out using PCR, immunohistochemistry, and/or immunofluorescence Footnote 1, Footnote 2.
Note: All diagnostic methods are not necessarily available in all countries.
FIRST AID/TREATMENT: Doxycycline in combination with gentamicin is effective in treating chronic bacteremia, and improves the outcome in cases of endocarditis Footnote 1. Prolonged treatment with erythromycin is effective against bacillary angiomatosis Footnote 1, Footnote 4.
LABORATORY-ACQUIRED INFECTIONS: No documented cases.
PRIMARY HAZARDS: Accidental inoculation with infective material Footnote 11.
SPECIAL HAZARDS: None.
RISK GROUP CLASSIFICATION: Risk Group 2 Footnote 18.
CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infected materials, animals, or cultures.
PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes Footnote 19.
OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities Footnote 19.
SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up Footnote 19.
DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration.
STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled.
REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.
UPDATED: November 2010
PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada
Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.
Public Health Agency of Canada, 2010