Homelessness and Organ Donor-Derived Bartonella quintana Infection

Abstract

Louseborne Bartonella quintana infections in the United States occur almost exclusively among persons experiencing homelessness because of inadequate access to hygiene resources. Homelessness is increasing, and persons experiencing homelessness can be organ donors, despite barriers to receiving donated organs themselves. Recent reports have documented B. quintana transmission via organs transplanted from donors who had recently experienced homelessness. Those reports demonstrate the threat of severe bartonellosis in immunosuppressed organ transplant recipients after donor-derived B. quintana infection. Addressing the root causes of B. quintana transmission could improve the quality of life for persons experiencing homelessness and simultaneously mitigate risk for donor-derived B. quintana transmission. Interventions include improved access to housing, consistent access to hot water for showers and laundry, early treatment of body lice infestation and B. quintana infection, and B. quintana testing and prophylactic treatment of recipients of organs from donors who have experienced risk factors for B. quintana, including homelessness.

Keywords: Bartonella quintana; Pediculus humanus humanus; United States; bacteria; bartonellosis; homeless; homelessness; lice; louse; parasites; pediculosis.

Figure 1

Dimorphous Pediculus humanus humanus (human body louse). A) The female adult (top) is larger than the male adult (bottom). B) Eggs, also known as nits, observed behind a coat button. Photographs courtesy of Denise Bonilla and the California Department of Public Health.

Figure 2

Life cycle of the human body louse (Pediculus humanus humanus).

Figure 3

Conceptual framework for reducing transmission of Bartonella quintana in the United States among PEH and among organ transplant recipients through universal access to hygiene services, prevention and treatment of body lice infestation, and early diagnosis and treatment of B. quintana infection. Diagnostic testing for B. quintana includes bacterial culture with prolonged incubation time (minimum 14 days), serology, and molecular diagnostic methods (e.g., PCR or microbial cell-free DNA testing). PEH, persons experiencing homelessness.