Rochalimaea quintana

Now preferentially referred to as Bartonella quintana, this is an unusual rickettsial organism 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 abraded (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.