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For further information, see CMDT Part 33-29: Bartonella Species

Key Features

  • 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 persons who are 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

  • Onset of symptoms is abrupt

  • Fever lasts 3–5 days with relapses, although isolated febrile episodes and prolonged fevers can also occur

  • 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


  • Blood cultures: Growth may require incubation for 4–6 weeks

  • Positive serology: High antibody titer by indirect immunofluorescence or nucleic acid amplification test


  • Optimal therapy is uncertain

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