Medication Summary

The goal of antibiotic therapy is to eradicate all forms of B quintana infection, minimizing morbidity and mortality.

Class Summary

Antibiotic therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Doxycycline (Vibramycin, Adoxa, Monodox)

View full drug information

Doxycycline is a synthetically derived broad-spectrum antibiotic in the tetracycline class. It is almost completely absorbed, is concentrated in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations. Doxycycline is bacteriostatic, and its mechanism of action is inhibition of protein synthesis through binding to the 50S subunit of the ribosome. Tetracyclines, as a class, evoke a dramatic response, with rapid disappearance of the associated symptoms and defervescence (usually in 1-2 days).

Ceftriaxone (Rocephin)

View full drug information

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity; it has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Ceftriaxone is bactericidal; it arrests bacterial growth by binding to 1 or more of the penicillin-binding proteins.

Gentamicin

View full drug information

Gentamicin is an aminoglycoside antibiotic used for coverage of gram-negative bacteria, including Pseudomonas species. It is synergistic with beta-lactamase against enterococci. It interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.

Dosing regimens for gentamicin are numerous and are adjusted on the basis of creatinine clearance and changes in the volume of distribution, as well as the body space into which the agent must distribute. Doses may be given either intravenously or intramuscularly. Each regimen must be followed by at least a trough level drawn on the third or fourth dose, 30 minutes before dosing; a peak level may be drawn 30 minutes after a 30-minute infusion.

Gentamicin is used in combination with both an agent that covers gram-positive organisms and one that covers anaerobes. It may be considered if penicillins or other less toxic drugs are contraindicated, if there are particular clinical indications for its use, or if a patient has a mixed infection caused by susceptible staphylococci and gram-negative organisms.

Erythromycin (E.E.S., Ery-Tab, Erythrocin)

View full drug information

Erythromycin is a highly bacteriostatic macrolide antibiotic isolated from a Streptomyces strain. Its spectrum is between those of penicillin and tetracyclines. The mechanism of action involves binding to the 50S ribosomal subunit and inhibiting microbial protein synthesis.

McNee JW, Renshaw A, Brunt EH. Trench Fever. Brit Med J. 1916. i:225-34.
Byam W, Carroll JH, Churchill L, Dimond VE, Sorapure VE, Wilson RM, et al. Trench fever: a louse-born disease. London: Oxford University Press; 1919.
Cheng J, Hu H, Kang Y, Chen W, Fang W, Wang K, et al. Identification of pathogens in culture-negative infective endocarditis cases by metagenomic analysis. Ann Clin Microbiol Antimicrob. 2018 Dec 20. 17 (1):43. [QxMD MEDLINE Link].
Graham JHP. A note on a relapsing febrile illness of unknown origin. Lancet. 1915. ii:703-4.
Hunt GH, Rankin AC. Intermittent fever of obscure origin occurring among British soldiers in France. The so-called "trench fever.". Lancet. 1915. ii:1133-6.
Raoult D, Dutour O, Houhamdi L, Jankauskas R, Fournier PE, Ardagna Y, et al. Evidence for louse-transmitted diseases in soldiers of Napoleon's Grand Army in Vilnius. J Infect Dis. 2006 Jan 1. 193(1):112-20. [QxMD MEDLINE Link].
Drancourt M, Tran-Hung L, Courtin J. Bartonella quintana in a 4000-year-old human tooth. J Infect Dis. 2005 Feb 15. 191(4):607-11. [QxMD MEDLINE Link].
Vinson JW, Varela G, Molina-Pasquel C. Trench fever. 3. Induction of clinical disease in volunteers inoculated with Rickettsia quintana propagated on blood agar. Am J Trop Med Hyg. 1969 Sep. 18(5):713-22. [QxMD MEDLINE Link].
Ruhrah J. Infectious Disease. Hare HA, ed. Progressive Medicine. Philadelphia and New York: Lea & Febiger; 1919. Vol 1: 151-244.
Maurin M, Raoult D. Bartonella (Rochalimaea) quintana infections. Clin Microbiol Rev. 1996 Jul. 9(3):273-92. [QxMD MEDLINE Link].
Biswas S, Rolain JM. Bartonella infection: treatment and drug resistance. Future Microbiol. 2010 Nov. 5(11):1719-31. [QxMD MEDLINE Link].
Peacock A, Pearson W. The Peacock versus the louse (pediculus humanus corporis): one soldier's contribution to combating trench fever in the First World War. J R Coll Physicians Edinb. 2010 Sep. 40(3):256-62. [QxMD MEDLINE Link].
Matera G, Liberto MC, Joosten LA, Vinci M, Quirino A, Pulicari MC, et al. The Janus face of Bartonella quintana recognition by Toll-like receptors (TLRs): a review. Eur Cytokine Netw. 2008 Sep. 19(3):113-8. [QxMD MEDLINE Link].
Brouqui P, Lascola B, Roux V, Raoult D. Chronic Bartonella quintana bacteremia in homeless patients. NEJM. Jan/1999. 340(3):184-9. [QxMD MEDLINE Link].
Foucault C, Brouqui P, Raoult D. Bartonella quintana characteristics and clinical management. Emerg Infect Dis. Feb/2006. 12(2):217-23. [QxMD MEDLINE Link].
Piérard-Franchimont C, Quatresooz P, Piérard GE. Skin diseases associated with Bartonella infection: facts and controversies. Clin Dermatol. 2010 Sep-Oct. 28(5):483-8. [QxMD MEDLINE Link].
Rolain JM, Foucault C, Guieu R, Lascola B, Brouqui P, Raoult D. Bartonella quintana in human erythrocytes. Lancet. July/2002. 360(9328):226-8. [QxMD MEDLINE Link].
Dehio C. Molecular and cellular basis of bartonella pathogenesis. Annu Rev Microbiol. 2004. 58:365-90. [QxMD MEDLINE Link].
Capo C, Amirayan-Chevillard N, Broqui P, Raoult D, Mege JL. Bartonella quintana bacteremia and overproduction of interleukin-10: Model of bacterial persistence in homeless people. JID. Oct, 2003. 187:837-44. [QxMD MEDLINE Link].
LaScola B, Raoult D. Culture of Bartonella quintana and Bartonella henselae from human samples: a 5-year experience (1993 to 1998). J Clin Microbiol. 1999 Jun;37(6):1899-905. [QxMD MEDLINE Link]. [Full Text].
Liberto MC, Matera G, Lamberti AG, Barreca GS, Quirino A, Foca A. In vitro Bartonella quintana infection modulates the programmed cell death and inflammatory reaction of endothelial cells. Diagn Microbiol Infect Dis. Feb/2003. 45(2):107-15. [QxMD MEDLINE Link].
Schulte B, Linke D, Klumpp S, Schaller M, Riess T, Autenrieth IB, et al. Bartonella quintana variably expressed outer membrane proteins mediate vascular endothelial growth factor secretion but not host cell adherence. Infect Immun. 2006 Sep. 74(9):5003-13. [QxMD MEDLINE Link]. [Full Text].
O'Rourke LG, Pitulle C, Hegarty BC, Kraycirik S, Killary KA, Grosenstein P, et al. Bartonella quintana in cynomolgus monkey (Macaca fascicularis). Emerg Infect Dis. 2005 Dec. 11(12):1931-4. [QxMD MEDLINE Link]. [Full Text].
Ohl ME, Spach DH. Bartonella quintana and urban trench fever. Clin Infect Dis. 2000 Jul. 31(1):131-5. [QxMD MEDLINE Link].
Breitschwerdt EB, Maggi RG, Sigmon B, Nicholson WL. Isolation of Bartonella quintana from a woman and a cat following putative bite transmission. J Clin Microbiol. 2007 Jan. 45(1):270-2. [QxMD MEDLINE Link]. [Full Text].
La VD, Tran-Hung L, Aboudharam G, Raoult D, Drancourt M. Bartonella quintana in domestic cat. Emerg Infect Dis. 2005 Aug. 11(8):1287-9. [QxMD MEDLINE Link]. [Full Text].
Brouqui P, Houpikian P, Dupont HT, Toubiana P, Obadia Y, Lafay V, et al. Survey of the seroprevalence of Bartonella quintana in homeless people. Clin Infect Dis. 1996 Oct. 23(4):756-9. [QxMD MEDLINE Link].
Kernif T, Leulmi H, Socolovschi C, Berenger JM, Lepidi H, Bitam I, et al. Acquisition and excretion of Bartonella quintana by the cat flea, Ctenocephalides felis felis. Mol Ecol. 2014 Mar. 23(5):1204-12. [QxMD MEDLINE Link].
Bonilla DL, Kabeya H, Henn J, Kramer VL, Kosoy MY. Bartonella quintana in body lice and head lice from homeless persons, San Francisco, California, USA. Emerg Infect Dis. 2009 Jun. 15(6):912-5. [QxMD MEDLINE Link]. [Full Text].
Jackson LA, Spach DH. Emergence of Bartonella quintana infection among homeless persons. Emerg Infect Dis. 1996 Apr-Jun. 2(2):141-4. [QxMD MEDLINE Link]. [Full Text].
Tea A, Alexiou-Daniel S, Arvanitidou M, Diza E, Antoniadis A. Occurrence of Bartonella henselae and Bartonella quintana in a healthy Greek population. Am J Trop Med Hyg. 2003 May. 68(5):554-6. [QxMD MEDLINE Link].
Ehrenborg C, Byström R, Hjelm E, Friman G, Holmberg M. High Bartonella spp. seroprevalence in a Swedish homeless population but no evidence of trench fever. Scand J Infect Dis. 2008. 40(3):208-15. [QxMD MEDLINE Link].
Seki N, Sasaki T, Sawabe K, Sasaki T, Matsuoka M, Arakawa Y, et al. Epidemiological studies on Bartonella quintana infections among homeless people in Tokyo, Japan. Jpn J Infect Dis. 2006 Feb. 59(1):31-5. [QxMD MEDLINE Link].
da Costa PS, Brigatte ME, Greco DB. Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil. Mem Inst Oswaldo Cruz. 2005 Dec. 100(8):853-9. [QxMD MEDLINE Link].
Raoult D, Birtles RJ, Montoya M, Perez E, Tissot-Dupont H, Roux V, et al. Survey of three bacterial louse-associated diseases among rural Andean communities in Peru: prevalence of epidemic typhus, trench fever, and relapsing fever. Clin Infect Dis. 1999 Aug. 29(2):434-6. [QxMD MEDLINE Link].
Vilibic-Cavlek T, Karlovic-Martinkovic D, Ljubin-Sternak S, Tabain I, Persic Z, Mlinaric-Galinovic G. High prevalence of Bartonella henselae and Bartonella quintana antibodies in Croatian patients presenting with lymphadenopathy. Pol J Microbiol. 2012. 61(4):315-7. [QxMD MEDLINE Link].
Drancourt M, Mainardi JL, Brouqui P, Vandenesch F, Carta A, Lehnert F, et al. Bartonella (Rochalimaea) quintana endocarditis in three homeless men. N Engl J Med. 1995 Feb 16. 332(7):419-23. [QxMD MEDLINE Link].
Woolley MW, Gordon DL, Wetherall BL. Analysis of the first Australian strains of Bartonella quintana reveals unique genotypes. J Clin Microbiol. 2007 Jun. 45(6):2040-3. [QxMD MEDLINE Link]. [Full Text].
Yoda M, Hata M, Sezai A, Unosawa S, Furukawa N, Minami K. First report of Bartonella quintana endocarditis in Japan. Circ J. 2008 Jun. 72(6):1022-4. [QxMD MEDLINE Link].
Znazen A, Rolain JM, Hammami N, Kammoun S, Hammami A, Raoult D. High prevalence of Bartonella quintana endocarditis in Sfax, Tunisia. Am J Trop Med Hyg. 2005 May. 72(5):503-7. [QxMD MEDLINE Link].
Balakrishnan N, Menon T, Fournier PE, Raoult D. Bartonella quintana and Coxiella burnetii as causes of endocarditis, India. Emerg Infect Dis. 2008 Jul. 14(7):1168-9. [QxMD MEDLINE Link]. [Full Text].
Raoult D, Fournier PE, Vandenesch F, Mainardi JL, Eykyn SJ, Nash J, et al. Outcome and treatment of Bartonella endocarditis. Arch Intern Med. 2003 Jan 27. 163(2):226-30. [QxMD MEDLINE Link].
Fournier PE, Lelievre H, Eykyn SJ, Mainardi JL, Marrie TJ, Bruneel F, et al. Epidemiologic and clinical characteristics of Bartonella quintana and Bartonella henselae endocarditis: a study of 48 patients. Medicine (Baltimore). 2001 Jul. 80(4):245-51. [QxMD MEDLINE Link].
Foucault C, Barrau K, Brouqui P, Raoult D. Bartonella quintana Bacteremia among Homeless People. Clin Infect Dis. 2002 Sep 15. 35(6):684-9. [QxMD MEDLINE Link].
Koo M, Manalili S, Bankowski MJ, Sampath R, Hofstadler SA, Koo J. A "silent culture-negative" abdominal aortic mycotic aneurysm: Rapid detection of Bartonella species using PCR and high-throughput mass spectrometry. Hawaii Med J. 2010 Mar. 69(3):68-9. [QxMD MEDLINE Link]. [Full Text].
Meher-Homji Z, Graves SR, Trubiano J, Holmes NE. Bartonella Quintana prosthetic aortitis successfully treated with doxycycline. BMJ Case Rep. 2019 Jul 10. 12 (7):[QxMD MEDLINE Link].
CLSI. Principles and Procedures for Blood Cultures: Approved Guidelines. 2007. Available at http://www.clsi.org.
Larson AM, Dougherty MJ, Nowowiejski DJ, Welch DF, Matar GM, Swaminathan B, et al. Detection of Bartonella (Rochalimaea) quintana by routine acridine orange staining of broth blood cultures. J Clin Micro. June/1994. 32(6):1492-6. [QxMD MEDLINE Link].
Rahimian J, Raoult D, Tang YW, Hanna BA. Bartonella quintana endocarditis with positive serology for Coxiella burnetii. J Infect. Sept /2006. 53(3):e151-3. [QxMD MEDLINE Link].
Rolain JM, Broqui P, Koehler JE, Maguina C, Dolan MJ, and Raoult D. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemo. June 2004. 48(6):1921-33. [QxMD MEDLINE Link].
Myers WF, Grossman DM, Wisseman CL Jr. Antibiotic susceptibility patterns in Rochalimaea quintana, the agent of trench fever. Antimicrob Agents Chemother. 1984. 25:690-3. [QxMD MEDLINE Link].
Rolain JM, Maurin M, Mallet MN, Parzy D, Raoult D. Culture and antibiotic susceptibility of Bartonella quintana in human erythrocytes. Antimicrob Agents Chemother. 2003 Feb. 47(2):614-9. [QxMD MEDLINE Link].
Foucault C, Raoult D, Brouqui P. Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia. Antimicrob Agents Chemother. 2003 Jul. 47(7):2204-7. [QxMD MEDLINE Link].
Prutsky G, Domecq JP, Mori L, Bebko S, Matzumura M, Sabouni A, et al. Treatment outcomes of human bartonellosis: a systematic review and meta-analysis. Int J Infect Dis. 2013 Oct. 17(10):e811-9. [QxMD MEDLINE Link].
Mazzitelli M, Lamberti AG, Quirino A, Marascio N, Barreca GS, Costa C, et al. Utility of Molecular Identification and Quantitation of Bartonella Species with Species-Specific Real-Time PCR for Monitoring Treatment Response: A Case Series. Open Microbiol J. 2018. 12:148-153. [QxMD MEDLINE Link].
Brouqui P, Stein A, Dupont HT, Gallian P, Badiaga S, Rolain JM, et al. Ectoparasitism and vector-borne diseases in 930 homeless people from Marseilles. Medicine (Baltimore). 2005 Jan. 84 (1):61-8. [QxMD MEDLINE Link].
Badiaga S, Raoult D, Brouqui P. Preventing and controlling emerging and reemerging transmissible diseases in the homeless. Emerg Infect Dis. 2008 Sep. 14 (9):1353-9. [QxMD MEDLINE Link].
Cerimele F, Brown LF, Bravo F, Iher GM, Kouadio P, Arbiser JL, et al. Infectious angiogenesis: Bartonella bacilliformis infection results in endothelial production of angiopoetin-2 and epidermal production of vascular endothelial growth factor. Am J Pathol. Oct 2003. 163:1321-7. [QxMD MEDLINE Link].
Kostrzewski J. The epidemiology of trench fever. Bull Acad Pol Sci (Med). 1949. 7:233-63. [QxMD MEDLINE Link].
Popa C, Abdollahi-Roodsaz S, Joosten LA, Takahashi N, Sprong T, Matera G, et al. Bartonella quintana lipopolysaccharide is a natural antagonist of Toll-like receptor 4. Infect Immun. Oct/2007. 75(10):4831-7. [QxMD MEDLINE Link].
Ulutasdemir N, Eroglu F, Tanrıverdi M, Dagli EI, Koltas IS. The epidemic typhus and trench fever are risk for public health due to increased migration in southeast of Turkey. Acta Trop. 2018 Feb. 178:115-118. [QxMD MEDLINE Link].

Media Gallery

Dorsal view of female body louse, Pediculus humanus var corporis. This louse is a known vector responsible for transmission of epidemic typhus, trench fever, and Asiatic relapsing fever; it also causes dermatitic condition known as pediculosis. Image courtesy of Centers for Disease Control and Prevention.

of 1

Author

Sarah Perloff, DO, FACP Associate Chair for Faculty Affairs, Department of Internal Medicine, Program Director, Infectious Diseases Fellowship, Associate Program Director, Internal Medicine Residency, Einstein Medical Center

Sarah Perloff, DO, FACP is a member of the following medical societies: American College of Physicians, American Osteopathic Association, HIV Medicine Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical School

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Percy Guanzon Balderia, MD, RhMSUS Physician, Department of Rheumatology, The Polyclinic

Disclosure: Nothing to disclose.

Acknowledgements

Michael A Forgione Jr, MD Chief of Infectious Diseases, Instructor, Department of Medicine, Keesler Medical Center

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Alfred Scott Lea, MD Associate Professor of Medicine, Department of Medicine, Division of Infectious Diseases, University of Texas Medical Branch School of Medicine

Alfred Scott Lea, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Certified Wound Specialists, American College of Physicians, Harris County Medical Society, Infectious Diseases Society of America, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeffrey M Zaks, MD Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital

Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association

Disclosure: Nothing to disclose.

Acknowledgments

The author would like to thank A Clinton White, MD, for his encouragement and suggestions during the composition of this article.

The authors and editors of Medscape Reference also gratefully acknowledge the contributions of previous author Eleftherios Mylonakis, MD, and previous coauthor Michael Forgione, MD, to the development and writing of this article.