What Is Bartonella Quintana?

Medically Reviewed by Jabeen Begum, MD on October 11, 2022
Written by Sarah Vallie
5 min read

Our bodies react to different bacteria in different ways. Some types of bacteria don’t cause any problems, and some are even needed for our bodies to healthily function. Other types, though, can cause illness. These harmful bacteria can get into our bodies in a lot of ways, including infections spread by pests and parasites. The Bartonella quintana bacteria is a good example of this, so we will explore its biology and its potential affect on your health.

Bartonella quintana is a disease-causing bacteria. It’s part of the Bartonella genus of bacteria, which contains many species that cause diseases and are commonly spread by pests like lice, fleas, and sand flies. 

Aside from B.quintana, this group also includes:

  • Bartonella henselae, a bacteria that causes cat scratch fever. It is often passed by a scratch from an infected cat. 
  • Bartonella bacilliformis, which causes Carrion’s disease. It’s passed by infected sand flies and so far has only been observed in the Andes Mountains in South America.

Bartonella quintana causes a disease called trench fever, a name that comes from the original discovery of the disease. In 1915, allied soldiers in the trenches of the Western Front began to succumb to an outbreak. While the illness they encountered rarely caused death, it was still severe enough that it took many soldiers out of commission. It was the soldiers who coined the term “trench fever.”

Because this disease thrived in the summer but became less common in the winter, doctors first suggested that it might be carried by mosquitoes. Captain T. Strethill Wright, though, suggested that lice or fleas could be responsible. These pests were common in the poor sanitary conditions of the war trenches. By 1917, scientists had concluded that body lice were the culprit.

Once the source was found, the military sprung into action to control the lice populations in their trenches. They started with strip searches each week and baths every other week, eventually moving on to using hot air and a pest control paste to rid the soldiers of body lice. 

The American military recorded only 743 cases of trench fever in their troops, but between the Belgian, British, and French soldiers, it’s estimated that about 500,000 cases of trench fever occurred between 1915 and 1918.

Body lice (Pediculus humanus humanus) are the carriers of Bartonella quintana. Infections occur when infected body lice feces enter the human bloodstream through a cut, scrape, or bite. Because the bite of the body louse causes itching and scratching, which allows the bacteria to enter the skin, bites from these body lice are the most common way B. quintana infects humans.

There’s never been another outbreak of Bartonella quintana or trench fever at the level that the soldiers in World War I experienced, though there was a resurgence during World War II. Currently, body lice is endemic (commonly found) in Eritrea, Mexico, Poland, Tunisia, and the former Soviet Union, as well as in communities within the U.S. with poor sanitation, such as homeless camps.

To avoid becoming infected with Bartonella quintana, body lice management is critical. Keep in mind that body lice are not the same as hair/head lice, which are often passed between children. While head lice are annoying, they do not typically carry diseases.

Head lice live in the hair and bite the scalp to suck out blood. Body lice, in contrast, do not actually live on the body. They live in fabric like clothing and bedding and crawl onto your skin to bite you. One common area that body lice like to lay their eggs is in the seams of clothing.

The main disease caused by Bartonella quintana is trench fever, which may manifest days or weeks after initial infection. Trench fever is not usually fatal but may cause severe infections in patients with compromised immune systems. 

Symptoms of trench fever may include:

  • Achiness in the bones, especially the shins, back, and neck
  • Chills
  • Dizziness
  • An enlarged liver or spleen
  • Fever
  • Headache
  • Skin rash
  • Weakness

The fever associated with trench fever may have a sudden onset. The initial fever may last four or five days, and the fever may come back multiple times over the course of the illness.

A few other illnesses can also be caused by Bartonella quintana, although they do not occur as frequently as trench fever.

Bacillary angiomatosis. Bacillary angiomatosis refers to skin lesions caused by Bartonella quintana. These are vascular lesions, meaning lesions on the blood vessels, and may occur in the skin or in other organs and bones. Bacillary angiomatosis due to B. quintana is typically only seen in patients with severely compromised immune systems. 

Bacteremia. Bacteremia is a condition in which bacteria have entered the bloodstream. Severe bacteremia may lead to:

  • Endocarditis. Endocarditis is an infection of the lining of the heart that causes inflammation.
  • Infectious arthritis. Infectious arthritis occurs when an infection spreads to the joints.
  • Pericarditis. Pericarditis is swelling of the pericardium, the tissues surrounding the heart, and is caused by infection.
  • Meningitis. Meningitis is the swelling of the membranes that protect the brain and spinal cord, resulting from an infection.
  • Osteomyelitis. Osteomyelitis is inflammation or swelling of the bones due to infection.
  • Sepsis. Sepsis occurs when your body strongly reacts to an infection or toxin. This reaction causes damage to your body’s tissues and organs and can lead to death.

Many bacterial illnesses have symptoms that are similar to trench fever, including leptospirosis and typhus, so your doctor may opt to run some blood tests to narrow down their diagnosis.

Unfortunately, diagnosing Bartonella quintana isn’t easy. It is a slow-growing bacteria, and it may take up to a month for samples in a culture to visibly grow in the lab. Your doctor can also have your blood checked for antibodies, but these tests will not necessarily distinguish between the different types of Bartonella.

Bartonella quintana treatment may be twofold: treating the illness and treating the lice infestation, if necessary. An antibiotic like doxycycline is usually needed to treat B. quintana. If you’re prescribed such an antibiotic, always follow your doctor’s instructions and take the full dose unless you have a severe reaction. 

Meanwhile, if you’ve discovered a body lice infestation, it must be treated right away to prevent the spread of disease. You should:

  • Machine-wash infested clothes on the hot water cycle and dry on the high heat cycle. Launder infested clothes at least once a week.
  • Bathe and change into clean clothes regularly, at least once a week.
  • Don’t share clothing, bedding, or towels with someone who has an infestation.
  • Consider fumigation or dusting in the case of severe infestations.