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Previous Volume 340:184-189 January 21, 1999 Number 3 Next

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ABSTRACT

Background Infection with Bartonella quintana can cause trench fever, endocarditis, bacillary angiomatosis, and peliosis. An outbreak of bacteremia due to B. quintana has been reported among homeless people in Seattle, and the seroprevalence is high among homeless people in both the United States and Europe. Body lice are known to be the vectors of B. quintana.

Methods We studied all the homeless people who presented in 1997 to the emergency departments of the University Hospital, Marseilles, France. Blood was collected for microimmunofluorescence testing for antibodies against B. quintana and for culture of the bacterium. Body lice were collected and analyzed by the polymerase chain reaction and sequencing of a portion of the citrate synthase gene of B. quintana.

Results In 10 of 71 homeless patients (14 percent), blood cultures were positive for B. quintana, and 21 of the patients (30 percent) had high titers of antibody against the organism. A total of 17 patients (24 percent) had evidence of recent infection (bacteremia or seroconversion). Tests of lice from 3 of the 15 patients from whom they were collected were positive for B. quintana. The homeless people with B. quintana bacteremia were more likely to have been exposed to lice (P=0.002), were more likely to have headaches (P=0.03) and severe leg pain (P<0.001), and had lower platelet counts (P=0.006) than the homeless people who were seronegative for B. quintana and did not have bacteremia; 8 of the 10 patients with bacteremia were afebrile. Five patients had chronic bacteremia, as indicated by positive blood cultures over a period of several weeks.

Conclusions In an outbreak of urban trench fever among homeless people in Marseilles, B. quintana infections were associated with body lice in patients with nonspecific symptoms or no symptoms.

Source Information

From the Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Félix Houphouët-Boigny, Assistance Publique–Hôpitaux de Marseille (P.B.), and the Unité des Rickettsies, Centre National de la Recherche Sciéntifique, Unité Propre de Recherche de l'Enseignement Superieur Associé 6020, Faculté de Médecine (P.B., B.L., V.R., D.R.) — both in Marseilles, France.

Address reprint requests to Dr. Raoult at the Unité des Rickettsies, CNRS UPRES A 6020, Faculté de Médecine, 27 Blvd. J Moulin, 13885 Marseilles, France, or at didier.raoult{at}medecine.univ-mrs.fr.

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