BARTONELLA QUINTANA

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Bartonella quintana

SYNONYM OR CROSS REFERENCE: Rochalimaea quintana, trench fever ^(1-4,5), urban trench fever, volhynia fever, Meuse fever, His-Werner disease, shinbone fever, shank fever, quintan, 5-day fever, bacillary angiomatosis, chronic lymphadenopathy, bacteremia.

CHARACTERISTICS: Facultative, intracellular, fastidious, Gram-negative short rod (0.3-0.5 µm wide by 1-1.7 µm long) ^{(1, 2)}, often slightly curved, belonging to the α2 subgroup of proteobacteria.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Trench fever is characterized by sudden onset of chills, headache, relapsing fever, and maculopapular rash on the trunk and abdomen ^{(1, 2, 4)}. No deaths have been reported due to trench fever. In immunocompetent persons, the disease is self-limiting and is marked by febrile episodes that occur after 15-25 days of incubation, each lasting 4-5 days, and recurring 3-5 times ⁽²⁾. Cases of milder or asymptomatic disease have been reported.

Bacillary angiomatosis (epithelioid angiomatosis): Neovascular proliferation of the skin, marked by blood-filled cystic structures that are partially endothelial cell-lined ⁽²⁾. Can also involve liver, spleen, bone, brain, lung, and bowel ^{(1, 2, 6)}. When visceral parenchymal organs become involved, the disease is referred to as bacillary peliosis hapatis, splenic peliosis, or systemic bacillary angiomatosis ⁽²⁾. In immunocompromised patients, such as those with AIDS, symptoms can be far more severe and can be life threatening if untreated.

Endocarditis: 11.9% mortality rate seen in studies of B. quintana endocarditis despite antimicrobial drug therapy and valvular surgery ⁽¹⁾.

EPIDEMIOLOGY: B. quintana is of worldwide prevalence ⁽²⁾. Trench fever is associated with poor sanitation and personal hygiene. Originally described and named based on high levels in trench soldiers of World War I, estimated >1 million people infected during World War I ⁽¹⁾. Most recently, an epidemic of trench fever erupted in a refugee camp in Burundi ⁽³⁾. Bacteremia and endocarditis described in homeless, alcoholic men in France and US ^{(3, 5, 7)}.

HOST RANGE: Human ^{(1, 4, 6)}, cynomolgus monkey (Macaca fascicularis) ⁽⁸⁾, cats ^(9-11).

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: Transmitted by the arthropod vector, the body louse, Pediculus humanus ^{(1, 2, 4)}.

INCUBATION PERIOD: The incubation period for trench fever varies from 15 – 25 days ⁽⁴⁾.

COMMUNICABILITY: Human-to-human transfer occurs through the arthropod vector, Pediculus humanus ⁽⁴⁾.

SECTION III - DISSEMINATION

RESERVOIR: Human ^{(1, 2, 6)}; possible reservoirs in non-human primates ⁽⁸⁾ and cats ^(9-11).

ZOONOSIS: None reported.

VECTORS: Body lice (Pediculus humanus) ^{(1, 4, 6, 12)}; possibly cat lice ⁽⁹⁾.

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Bartonella are susceptible to penicillins, cephalosporins, aminoglycosides, chloramphenicol, tetracyclines, macrolides, rifampin, fluoroquinolones, and cotrimoxazole ^{(1, 13)}. Aminoglycosides has also demonstrated to be bactericidal ^{(1, 13)}. Doxycycline in combination with gentamicin is effective in treating chronic bacteremia, with improved outcome in endocarditis ⁽¹⁾. Prolonged treatment with erythromycin is effective against bacillary angiomatosis: ^{(1, 4)}.

DRUG RESISTANCE: Resistance has been shown against fluoroquinolones ⁽¹⁴⁾. This area remains a growing concern when repeated doses are administered, especially in endemic areas.

SUSCEPTIBILITY TO DISINFECTANTS: Information specific to B. quintana is not available, but many bacteria have been shown to be susceptible to low concentration of chlorine, 70% ethanol, phenolics such as orthophenylphenol and ortho-benzyl-paua-chlorophenol, 2% aqueous glutaraldehyde, peracetic acid (0.001% to 0.2%) ^{(15, 16)}.

PHYSICAL INACTIVATION: Information specific to B. quintana is not available, but many bacteria can be inactivated by moist heat (121°C for 15 min - 30 min) and dry heat (160-170°C for 1-2 hours) ⁽¹⁷⁾.

SURVIVAL OUTSIDE HOST: Unknown.

SECTION V – FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Serologic testing is the most widely used method to diagnose Bartonella infection. Indirect immunofluorescence is the reference method ^{(1, 2, 4)}. B. quintana can be grown by direct plating onto blood agar media, blood culture in broth, and cocultivation in cell culture ⁽¹⁾. Identification and diagnosis can be carried out using PCR, immunohistochemistry, and/or immunofluorescence ^{(1, 2)}.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Doxycycline in combination with gentamicin is effective in treating chronic bacteremia, and improves the outcome in cases of endocarditis ⁽¹⁾. Prolonged treatment with erythromycin is effective against bacillary angiomatosis ^{(1, 4)}.

IMMUNIZATION: None.

PROPHYLAXIS: None.

SECTION VI - LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: No documented cases.

SOURCES/SPECIMENS: Blood and tissue of infected patients, infected vector, and blood of potential reservoir hosts ^{(2, 4, 8-10)}.

PRIMARY HAZARDS: Accidental inoculation with infective material ⁽¹¹⁾.

SPECIAL HAZARDS: None.

SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 ⁽¹⁸⁾.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infected materials, animals, or cultures.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes ⁽¹⁹⁾.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities ⁽¹⁹⁾.

SECTION VIII – HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up ⁽¹⁹⁾.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled.

SECTION IX – REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: November 2010

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©
Public Health Agency of Canada, 2010
Canada

REFERENCES:

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