BARTONELLA (ROCHALIMAEA) QUINTANA INFECTIONS

Bartonella (formerly Rochalimaea) quintana is the etiological agent of trench fever; a disease extensively reported during the World Wars. R ecent molecular biology approaches have allowed dramatic Extension of the spectrum of Bartonella infections. B. quintana is I now also recog nized as an etiological agent of fever and bacteremia, endocarditis, b acillary angiomatosis, and chronic lymphadenopathy. Human immunodefici ency, virus-infected patients and/or homeless people are the most vuln erable to infection. Poverty and louse infestation were the main epide miological factors associated with B. quintana infections during warti me. Although poverty and chronic alcoholism have been associated with modern cases of trench fever and bacteremia due to B. quintana in Euro pe and the United States, vectors for B. quintana have not been clearl y identified and B. quintana has not been isolated from modern-day lic e. Microscopic bacillary angiomatosis lesions are characterized by tum or-like capillary lobules, with proliferating endothelial cells. In vi tro experiments have shown that B. quintana survives within endothelia l cells and stimulates cell proliferation. These observations, togethe r with the finding that lesions may regress when antibiotic therapy is administered, strongly suggest that B. quintana itself stimulates ang iogenesis. Bartonella infections are characterized by a high frequency of relapses after brief courses of antibiotic therapy. It is to be no ted that in vitro, although Bartonella species air highly susceptible to antibiotics, only the aminoglycosides have proved to be bactericida l. However; the most effective antibiotic regimen for Bartonella infec tions remains to be established.