From the Guidelines
Bartonella quintana infection presents with symptoms including relapsing fever, headache, bone pain, and a maculopapular rash, and treatment typically involves doxycycline 100mg twice daily for 4-6 weeks, with alternative antibiotics and extended treatment durations considered in certain cases. The clinical presentation of Bartonella quintana infection, also known as trench fever, includes a range of symptoms such as:
- Relapsing fever
- Headache
- Bone pain, particularly in the shins
- Maculopapular rash Patients may also experience prolonged bacteremia, endocarditis, and bacillary angiomatosis (vascular proliferative lesions of the skin) 1.
Treatment Options
Treatment options for Bartonella quintana infection include:
- Doxycycline 100mg twice daily for 4-6 weeks, which is effective against the intracellular bacteria
- Combination therapy with gentamicin (3mg/kg/day divided into 2-3 doses) for the first 2 weeks along with doxycycline for a total of 6 weeks for severe infections or endocarditis
- Alternative antibiotics such as azithromycin, erythromycin, or fluoroquinolones for patients who cannot tolerate doxycycline
- Extended treatment duration of at least 3 months for immunocompromised patients with bacillary angiomatosis
Diagnosis and Prevention
Diagnosis of Bartonella quintana infection requires blood cultures using special techniques (lysis-centrifugation or prolonged incubation) as the bacteria is fastidious and slow-growing. The infection is transmitted by body lice and is more common in homeless populations and those with poor hygiene conditions, so addressing these underlying factors is essential for prevention of reinfection. Long-term suppression of infection with erythromycin or doxycycline should be considered in cases of relapse or reinfection 1.
From the Research
Clinical Presentation of Bartonella Quintana Infection
- The clinical manifestations of Bartonella quintana infection can range from asymptomatic to severe and life-threatening disease 2, 3.
- Common clinical presentations include:
- The severity of the infection correlates with the patient's immune status, with more severe disease occurring in immunocompromised individuals 4.
Treatment Options for Bartonella Quintana Infection
- The treatment of Bartonella quintana infection typically involves the use of antibiotics, with the specific regimen depending on the severity and nature of the infection 2, 3, 5.
- Recommended treatment options include:
- The duration of treatment can vary, but typically ranges from 4-6 weeks for uncomplicated bacteremia to 4-6 months for endocarditis 2.
- Aminoglycosides, such as gentamicin, have been shown to be bactericidal against Bartonella species and are recommended for treatment of severe infections 3, 5.