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Previous Volume 332:419-423 February 16, 1995 Number 7 Next

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ABSTRACT

Background Bartonella (Rochalimaea) quintana is the agent of trench fever and is transmitted by the body louse. We searched for this organism in three alcoholic homeless men with endocarditis.

Methods Blood samples were cultured on a human endothelial cell line and on blood agar. Bacteria were identified by sequencing the amplified 16S ribosomal RNA gene. The presence of bartonella in tissue was assessed by Gram's staining, immunostaining, and polymerase-chain-reaction amplification. Serologic studies for antibodies to bartonella species were performed by indirect immunofluorescence and Western immunoblotting.

Results B. quintana was isolated from one patient in the blood-agar culture and from the other two patients in the endothelial-cell culture. The organism was also identified by both immunostaining and molecular techniques in the valvular vegetations from the three patients and in a cervical lymph node from one patient. The 16S ribosomal RNA gene sequences of the three isolates were almost identical to that of the prototype strain of B. quintana. High titers of antibodies to B. quintana were detected in all three patients, but so were cross-reacting antibodies to chlamydia species. In all three patients studies were repeatedly negative for antibodies to the human immunodeficiency virus.

Conclusions B. quintana is a cause of endocarditis in homeless patients and may be serologically misdiagnosed as a chlamydial infection.

Source Information

From the Unité des Rickettsies, Faculté de Médecine, Marseilles (M.D., A.C., D.R.); Laboratoire de Microbiologie Médicale (J.L.M., F.G., J.A.) and Service de Cardiologie (F.L.), Hôpital Saint-Joseph, Paris; Service des Maladies Tropicales et Infectieuses, Hôpital Félix Houphouet-Boigny, Marseilles (P.B.); and Laboratoire de Bactériologie, Hôpital Louis Pradel, Lyons (F.V., J.E.) — all in France. Supported by a grant from the French Ministry of Health.

Address reprint requests to Dr. Raoult at Unité des Rickettsies, Faculté de Médecine, Blvd. Jean Moulin, 13385 Marseilles CEDEX 5, France.

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