Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 33-29: Bartonella Species + Key Features Download Section PDF Listen +++ ++ A self-limited, louse-borne relapsing febrile disease caused by Bartonella quintana Epidemic infection in louse-infested troops and civilians during wars Endemic in scattered geographic areas (eg, Central America) An urban equivalent of trench fever has been described among the homeless Humans acquire infection when infected lice feces enter sites of skin breakdown Recently recognized as an important cause of culture-negative endocarditis + Clinical Findings Download Section PDF Listen +++ ++ Onset of symptoms is abrupt Fever lasts 3–5 days with relapses Patient complains of weakness and severe pain behind the eyes and typically in the back and legs Lymphadenopathy, splenomegaly, and a transient maculopapular rash may appear Subclinical infection is frequent, and a carrier state is recognized Differential diagnosis Other febrile, self-limited states, such as Dengue Leptospirosis Malaria Relapsing fever Typhus + Diagnosis Download Section PDF Listen +++ ++ Blood cultures B quintana will grow in standard BACTEC media Growth may require incubation for 4–6 weeks Positive serology with a compatible clinical syndrome: either documented seroconversion or high titer of antibody (≥ 1:1600) in single ELISA or immunofluorescence test + Treatment Download Section PDF Listen +++ ++ Treatment is generally not required since spontaneous recovery occurs regularly