Grant: CIHR Fellowship

Bartonella quintana, the etiologic agent of trench fever, is a louse-borne bacterium that remains a poorly characterized cause of fever and heart valve infection. Due to the link with body lice, transmission is tied to overcrowding and inadequate water access, with documented outbreaks in homeless shelters, remote Canadian indigenous communities and refugee camps. Our collective neglect of this bacterium likely has a multifactorial explanation: B. quintana is difficult to diagnose, it causes a broad clinical spectrum of illness with prolonged periods of mild disease that may evolve to catastrophic complications, and it disproportionately affects populations facing barriers to care. We hypothesize that Bartonella quintana is a common and under-diagnosed cause of blood-stream infection among populations experiencing houselessness in Belgium. We hypothesis that body lice infestation remains undiagnosed among houseless populations in Belgium, and that these insects are vectors for this neglected disease. We also theorize that this bacterium is a neglected cause of fever in low-income countries. We will test this hypothesis by analyzing stored blood samples of febrile patients from around the world. We will perform antibody tests to look for exposure to B. quintana among 2 populations: houseless individuals in Belgium (active case finding) and febrile individuals from certain low-income countries (stored samples). We will also identify active infection in both populations using molecular tests for bacterial DNA. We will then elucidate local and global transmission of B. quintana through genetic sequencing.