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Previous Volume 332:424-428 February 16, 1995 Number 7 Next

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ABSTRACT

Background Bartonella (Rochalimaea) quintana is a fastidious gram-negative bacterium known to cause trench fever, cutaneous bacillary angiomatosis, and endocarditis. Between January and June 1993 in Seattle, we isolated B. quintana from 34 blood cultures obtained from 10 patients not known to be infected with the human immunodeficiency virus (HIV).

Methods After identifying the isolates as B. quintana by direct immunofluorescence and DNA-hybridization studies, we determined strain hybridization with studies of restriction-fragment–length polymorphisms (RFLPs) of the intergenic spacer (noncoding) region of ribosomal DNA amplified by the polymerase chain reaction (PCR). To characterize the epidemiologic and clinical features of bartonella infections in these patients, we performed a retrospective case–control study using as controls 20 patients from whom blood was obtained for culture at approximately the same time as from the index patients.

Results B. quintana isolates from the 10 patients were indistinguishable by PCR–RFLP typing. All 10 patients had chronic alcoholism, and 8 were homeless (P = 0.001 for both comparisons with controls). The six patients who underwent HIV testing were seronegative. At the time of their initial presentation, seven patients had temperatures of at least 38.5°C. Six patients had three or more blood cultures that were positive for B. quintana, and in four of these patients B. quintana was isolated from blood cultures obtained 10 or more days apart. Subacute endocarditis developed in two patients and required surgical removal of the infected aortic valve in one of them. Nine patients recovered; one died of sepsis from Streptococcus pneumoniae infection.

Conclusions B. quintana is a cause of fever, bacteremia, and endocarditis in HIV-seronegative, homeless, inner-city patients with chronic alcoholism.

Source Information

From the Division of Infectious Diseases and the Department of Medicine (D.H.S., R.K.R., W.E.S.) and the Department of Laboratory Medicine (M.J.D., A.M.L., M.B.C.), Harborview Medical Center and the University of Washington Medical Center, Seattle; the Department of Medicine, University of Washington Medical Center, Seattle (A.S.K.); the Emerging Bacterial and Mycotic Diseases Branch (D.J.B.) and the Foodborne and Diarrheal Diseases Branch (B.S., G.M.M.), Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta; and the Department of Pediatrics and the Clinical Microbiology Laboratories, University of Oklahoma Health Sciences Center, Oklahoma City (D.F.W.). Presented at the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, October 17–20, 1993.

Address reprint requests to Dr. Spach at Madison Clinic, ZA-09, 1001 Broadway, Suite 206, Seattle, WA 98122.

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