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The oldest indication of human Bartonella infection (bartonellosis) was found in a tooth of a person who died about 4,000 years ago.
The history of the scientific description of Bartonella is much shorter. Three acute diseases caused by these bacteria—trench fever, Carrión’s disease, and cat scratch disease—were only scientifically described starting toward the end of the 19th century, and chronic infection was only recognized at the end of the 20th century. At the start of the 21st century, accurate tests and effective treatments are the main challenges that Bartonella researchers are focused on.
Trench fever, also called five-day fever, is most commonly seen today in underhoused and homeless populations. It was first identified in soldiers involved in the trench warfare of World War I, where the unhygienic and crowded conditions allowed vectors like body lice to thrive. These soldiers called it “shin bone fever” because of the associated leg pain. Up to a third of British soldiers and up to a fifth of German soldiers are believed to have been infected. Famous veterans, including the writers J.R.R. Tolkien and C.S. Lewis, are among those who developed the disease.
During World War I, Major W. Byam and members of the British military proved that body lice transmitted the disease. Their results were published in 1919. They found that they could diagnose Bartonella quintana by allowing uninfected lice to feed on the patient and then inspecting the lice for signs of bacteria.
Bartonella quintana (“quin” is the five in five-day fever) was proven to be the causative agent of trench fever in in the 1960s by J.W. Vinson. Vinson, working for the United States Army, was able to culture the bacteria in blood. Vinson proved the bacteria caused trench fever by infecting body lice and allowing the lice to bite volunteers.
As Europe was hurtling toward World War I, immigrant laborers on the other side of the world were facing another species of Bartonella. The disease caused by Bartonella bacilliformis sometimes showed up as fever and severe anemia and sometimes involved characteristic wart-like skin nodules. The nodules, referred to now as Peruvian warts, appear on a carved human figure that is more than 2,000 years old.
By the time the immigrant laborers were falling ill, the illness had come to be called Carrión’s disease. Daniel Alcides Carrión Garcia had proven in 1885 that the skin nodules were related to the fever illness by infecting himself from a skin nodule. He subsequently died from the infection. The Peruvian government declared him a national hero in 1991.
The workers on the La Oroyo-Lima railway in Peru were sickening and dying at a rate previously unseen. By the time the outbreak was over, as many as 10,000 had died. In 1905, Dr. Alberto Leonardo Barton Thompson found a bacteria in their blood that we now call Bartonella bacilliformis. For this discovery he received the Orden del Sol de la Nación from Peru and when the genus Bartonella was separated from Rickettsia it was named for him.
Apart from war and hard labor, cat scratch disease was a condition that struck in the home. Children often experienced the symptoms of fever and inflamed lymph nodes. Though humans had likely experienced cat scratch disease for thousands of years, the symptoms were first described scientifically in 1889 by Henri Parinaud, a French physician.
In 1950, Robert Debre further specified the syndrome and identified cats as the reservoir for the bacteria. After a misstep in which Afipia felis was thought to be the causative bacteria, further study of the antibody reactions of patients with cat scratch disease clarified that Bartonella henselae and another species, Bartonella clarridgeiae, were responsible for cat scratch disease.
In 1985, a clinical microbiology technologist at the University of Oklahoma collected samples during an outbreak. Her name is Diane Marie Hensel and the bacteria she collected, Bartonella henselae, was named for her.
By the 1990s, the emergence of Bartonella henselae infections in patients with HIV was making clear that more people were infected with the bacteria than just those exhibiting the symptoms of cat scratch disease. In the past, it was thought that cat scratch disease was self-limiting and that only immunocompromised people (people with reduced immune systems) would develop symptoms. However, Bartonella species have increasingly been implicated in chronic diseases with non-specific or atypical symptoms.
Galaxy Diagnostics co-founders Ed B. Breitschwerdt and Ricardo G. Maggi, along with Galaxy Diagnostics medical director Dr. Robert Mozayeni, have published key research expanding the understanding of acute and chronic bartonellosis. In 2014, Dr. Paul M. Lantos of Duke University, Drs. Breitschwerdt and Maggi, and others published the results of a study documenting Bartonella infection as an occupational risk of veterinarians. Ongoing research is being conducted to learn more about the prevalence of Bartonella infections in people without obvious signs of the named conditions caused by Bartonella, but it is at an early stage.
This history covers only three common species of Bartonella. At this time, two dozen species have been identified and more are suspected to exist. The symptoms that these new species may cause and how they are transmitted are not clear, but scientific methods have thankfully improved immensely since the end of the 19th century. Galaxy’s patented ePCR process is being used in research right now to further the understanding of Bartonella species and their associated diseases around the world.
References
Byam, W. et al. (1918). Trench fever: A louse-borne disease. Transactions of the Royal Society of Tropical Medicine and Hygiene, 11(7), 237-284.
Lantos, P. M. et al. (2014). Detection of Bartonella species in the blood of veterinarians and veterinary technicians: A newly recognized occupational hazard? Vector Borne and Zoonotic Diseases, 14(8), 563-570. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117269/
Mascarelli, P. E. et al. (2013). Bartonella henselae infection in a family experiencing neurological and neurocognitive abnormalities after woodlouse hunter spider bites. Parasites & Vectors, 6, 98.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639822/
Ohl, M. E. & Spach, D. H. (2000). Bartonella quintana and urban trench fever. Clinical Infectious Diseases, 31(1), pp. 131-135. https://academic.oup.com/cid/article/31/1/131/317741
Perkocha, L. A. et al. (1990). Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection. The New England Journal of Medicine, 323, 1581-1586.
https://www.nejm.org/doi/full/10.1056/NEJM199012063232302
Vinson, J. W. (1966). In vitro cultivation of the rickettsial agent of trench fever. Bulletin of the World Health Organization, 35(2), 155-164. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2476134/?page=1
Vizcarra, H. E. (1997). La Bartonella de Alberto Barton T. y las neuvas Bartonellas. Folia Dermatológica Peruana, 8. http://sisbib.unmsm.edu.pe/BVrevistas/folia/Vol8_N4_dic97/bartonella.htm
