January 10, 2024
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Key takeaways:
- Bartonella quintana is a louse-borne bacteria.
- It meets WHO criteria to be considered a neglected tropical disease.
Bartonella quintana, the louse-borne bacterium known for causing trench fever in World War I, meets the criteria of being a neglected tropical disease in Africa, researchers suggested.
However, research to “confidently define” it as a neglected tropical disease is lacking, they argued.
Bartonella
quintana is a gram-negative bacillus primarily transmitted via infected body louse feces. Image: Adobe Stock.
Carl Boodman
“We believe that a few modest measures may substantially improve awareness of this neglected disease,” Carl Boodman, MD, a PhD candidate at the Institute of Tropical Medicine in Antwerp, Belgium, and clinical investigator program candidate at the University of Manitoba, and colleagues wrote.
Boodman and colleagues advocated for several public health measures to be taken, including making B. quintana a national notifiable disease “to ensure that data on existing cases are reported.”
We spoke with Boodman about what it would mean to classify B. quintana as a neglected tropical disease.
Healio: What is B. quintana infection, and what is the disease burden in Africa?
Boodman: B. quintana infection is a bacterial infection caused by Bartonella quintana, a louse-borne bacteria. B. quintana can cause bloodstream infection of long duration — months to even years — despite minimal symptoms but then may cause fatal manifestations such as heart valve infection known as infective endocarditis. B. quintana endocarditis may lead to stroke. We, unfortunately, do not know the true disease burden in Africa due to lack of data.
Healio: What prompted this paper?
Boodman: After seeing a patient with B. quintana infective endocarditis diagnosed in Canada but who acquired the infection in Ethiopia, I started noticing increasing numbers of reports of B. quintana infective endocarditis acquired in Africa but diagnosed in a high-income country in Europe of North America. Then I read [the work of co-author AlfonsoJ.Pecoraro, MBChB,] on B. quintana as the second most common cause of endocarditis in South Africa. I then was finding more and more insect or xenodiagnoses studies showing that B. quintana was the predominant pathogen of African lice in many publications throughout different areas of the African continent. We wanted to write this paper to draw attention to this neglected disease because we suspect that many cases go undiagnosed.
Healio: What qualifies it as a neglected tropical disease?
Boodman: The disease meets most WHO criteria to be considered a neglected tropical disease. B. quintana disproportionately affects populations experiencing poverty. B. quintana primarily affects populations living in tropical and subtropical areas — not due to climate per se, but due to risk factors such as overcrowding and lack of access to running water. B. quintana is amenable to broad control because lice infestations are preventable and B. quintana is treatable with antimicrobials. And research on B. quintana is neglected.
Healio: What would calling it a neglected tropical disease do? Does it open funding avenues?
Boodman: We hope it may draw more attention to this disease and eventually lead to more research funding and more support for national or regional labs to test for this organism.
Healio: What is the main takeaway of this paper?
Boodman: That B. quintana is an underdiagnosed infection with a likely large undescribed burden on the African continent. Research is desperately needed because early detection and treatment of subclinical B. quintana infection may prevent avoidable morbidity and mortality.
References:
Boodman C, et al. Open Forum Infect Dis. 2023;doi:10.1093/ofid/ofad672.
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