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Emergence of Bartonella quintana infection among homeless persons.

Centers for Disease Control
Publication Date
  • Research Article
  • Medicine


Emergence of Bartonella quintana Infection among Homeless Persons Bartonella quintana has episodically emerged as a cause of infection among distinct and diverse populations during the 20th century. The organ- ism was first identified as an important human pathogen during World War I when it caused epi- demics of louse-borne trench fever that affected an estimated 1 million troops in Europe (1, 2). Trench fever was characterized by fever, rash, bone pain, and splenomegaly and ranged in severity from a mild flulike illness to a more severe, relapsing disease. B. quintana infections were rarely recog- nized from the end of World War II until the 1980s when the organism reemerged as an opportunistic pathogen among HIV-infected persons. In this population, B. quintana has been identified as a cause of bacillary angiomatosis, endocarditis, and bacteremia (3-5) and has been isolated from AIDS patients in France (6) and the United States (3-5). In the 1990s, B. quintana has emerged among homeless persons in North America and Europe. In 1993, the organism was isolated from the blood specimens of 10 patients at a single hospital in Seattle, Washington, within a 6-month period (7). These patients had illnesses characterized by fe- ver and persistent bacteremia.Endocarditis devel- oped in two patients, one of whom required a heart valve replacement. All 10 patients had chronic alcoholism, eight were homeless, and the six who were tested for HIV infection were HIV-negative. These six were the first cases of invasive B. quin- tana infection among HIV-negative persons re- ported in the United States. Results of a case-control study indicated that the patients with Bartonella bacteremia were more likely than con- trols (other hospitalized patients from whom blood specimens were obtained at approximately the same time) to be homeless (p = 0.001), to have a history of alcohol abuse (p = 0.001), and to be nonwhite (p = 0.007). The isolates from the 10 patients were identical by polymerase chain reac- tion res

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