BARTONELLA (ROCHALIMAEA) QUINTANA BACTEREMIA IN INNER-CITY PATIENTS WITH CHRONIC-ALCOHOLISM

Background. Bartonella (Rochalimaea) quintana is a fastidious gram-neg ative bacterium known to cause trench fever, cutaneous bacillary angio matosis, and endocarditis. Between January and June 1993 in Seattle, w e isolated B. quintana from 34 blood cultures obtained from 10 patient s not known to be infected with the human immunodeficiency virus (HIV) . Methods. After identifying the isolates as B. quintana by direct imm unofluorescence and DNA-hybridization studies, we determined strain hy bridization with studies of restriction-fragment-length polymorphisms (RFLPs) of the intergenic spacer (noncoding) region of ribosomal DNA a mplified by the polymerase chain reaction (PCR). To characterize the e pidemiologic and clinical features of bartonella infections in these p atients, we performed a retrospective case-control study using as cont rols 20 patients from whom blood was obtained for culture at approxima tely the same time as from the index patients. Results. B. quintana is olates from the 10 patients were indistinguishable by PCR-RFLP typing. All 10 patients had chronic alcoholism, and 8 were homeless (P=0.001 for both comparisons with controls). The six patients who underwent HI V testing were seronegative. At the time of their initial presentation , seven patients had temperatures of at least 38.5 degrees C. Six pati ents had three or more blood cultures that were positive for B. quinta na, and in four of these patients B. quintana was isolated from blood cultures obtained 10 or more days apart. Subacute endocarditis develop ed in two patients and required surgical removal of the infected aorti c valve in one of them. Nine patients recovered; one died of sepsis fr om Streptococcus pneumoniae infection. Conclusions. B. quintana is a c ause of fever, bacteremia, and endocarditis in HIV-seronegative, homel ess, inner-city patients with chronic alcoholism.