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Bartonella quintana, the bacterial pathogen that caused trench fever in soldiers during World War I, has been identified in 15% of people made homeless during a recent Denver outbreak, researchers reported.
David McCormick
The finding, published in the Open Forum Infectious Diseases, suggests that people who are homeless “may have a significant risk of infection” from B. quintana, which is transmitted by human body lice. David McCormick, MD, MPH, Healio said, an Epidemic Intelligence Service official in the CDC’s vector-borne disease division.
Source: McCormick DW et al. Open the Infect Dis forum. 2021; doi: 10.1093 / ofid / ofab230.
“Physicians should maintain a high index of suspicion for B. quintana as a possible cause of fever or endocarditis in the homeless,” McCormick said. “When ordering blood cultures for patients suspected of having B. quintana, clinicians should inform the microbiology laboratory that Bartonella is a potential diagnosis so that culture techniques can be optimized and the incubation period extended by at least 21 days.”
According to McCormick, PCR testing of blood and tissue samples can also be useful in diagnosing Bartonella-associated infections. Doctors should identify and treat body lice and improve access to hygiene services for homeless patients.
McCormick and colleagues tested samples from 241 homeless patients in Denver who presented for SARS-CoV-2 testing for B. quintana. They collected samples between June and July 2020 and examined information about the age, gender, collection situation, race, ethnicity, and SARS-CoV-2 test results of each patient.
Of the patients, 15% were seroreactive for Bartonella. Patients who were seroreactive for Bartonella were significantly older (mean age = 50.5; interquartile range) [IQR] = 40-57 years) than non-reactive people (mean age = 43 years; IQR = 35-54 years; P = 0.04).
McCormick said the limitations of the study included cross-reactivity in antibody tests and the inability to link the prevalence of Bartonella seropositivity in the study to an outbreak of B. quintana endocarditis in Denver.
“Without a comparison group from the general population who are not homeless, it cannot be said whether that population is disproportionately affected or what other risk factors are for infection,” said McCormick. “Further studies comparing diagnostic methods for B. quintana and clarifying the natural course of antibody persistence after infection would be helpful.”
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