People experiencing homelessness face ‘substantial risk’ for trench fever
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Bartonella quintana, the bacterial pathogen that caused trench fever among soldiers during World War I, was identified in 15% of people experiencing homelessness during a recent outbreak in Denver, researchers reported.
The finding, published in Open Forum Infectious Diseases, suggests that people experiencing homelessness “may have a substantial risk of infection” from B. quintana, which is transmitted by human body lice, David McCormick, MD, MPH, an Epidemic Intelligence Service officer in the CDC’s Division of Vector-Borne Diseases, told Healio.
“Clinicians should maintain a high index of suspicion for B. quintana as a possible cause of fever or endocarditis in persons experiencing homelessness,” McCormick said. “When ordering blood cultures for patients with suspected B. quintana, clinicians should notify the microbiology lab that Bartonella is a potential diagnosis so that culture techniques can be optimized and the incubation period extended for at least 21 days.”
PCR testing of blood and tissue samples can also be useful for diagnosing Bartonella-associated infections, McCormick said, and clinicians should identify and treat body lice, as well as promote increased access to hygienic services among patients experiencing homelessness.
McCormick and colleagues tested samples from 241 patients experiencing homelessness in Denver who presented for SARS-CoV-2 testing for B. quintana. They collected samples between June and July 2020 and examined information on each patient’s age, gender, collection setting, race, ethnicity and SARS-CoV-2 test result.
Of the patients, 15% were seroreactive for Bartonella. Patients who were seroreactive for Bartonella were significantly older (median age = 50.5; interquartile range [IQR] = 40-57 years) than nonseroreactive people (median age = 43 years; IQR = 35-54 years; P = .04).
McCormick said the study’s limitations included cross-reactivity in antibody assays and an inability to link the prevalence of Bartonella seropositivity in the study with an outbreak of B. quintana endocarditis in Denver.
“Without a comparison group from the general population not experiencing homelessness, it is not possible to say whether this population is disproportionately affected, or what other risk factors there may be for infection,” McCormick said. “Further studies that compare diagnostic methods for B. quintana and clarify the natural history of antibody persistence following infection would be helpful.”
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