Recently the organ transplant program at the University of Alberta Hospital encountered a rare and potentially serious infection in a group of immunocompromised patients after they received organ transplants. A previously uncommonly found bacteria called Bartonella reportedly caused infections in five transplant patients.
But it turns out that there is more to this story than the usual challenges posed by infections in these immune-suppressed patients.
Disease due to Bartonella was first recognized as trench fever in the First World War, in soldiers enduring the muddy trenches, unable to bathe or wash their clothes and living in extremely close quarters. These famously terrible conditions enabled the spread of body lice, which can transmit Bartonella bacteria.
Body lice are related to but are quite different from the head lice that periodically cause alarm in schools and among middle-class parents in Canada. Most importantly, body lice can transmit a number of potentially fatal infections, but head lice have not been clearly associated with disease transmission. Body lice attach to a person’s clothes and bite their hosts to obtain a blood meal. If the louse is carrying Bartonella bacteria, it may transmit the infection.
Body lice are relative newcomers to many Canadian cities, reflecting a growing population living in conditions that are distressingly similar to First World War trenches or developing-world refugee camps. With body lice have come Bartonella infections. The typical patient with Bartonella infection has been homeless, and is usually experiencing one or more associated financial, social or mental health problems.
So where do the transplant patients come in? In recent years, increasing numbers of people who have died from opiate poisoning have become organ donors. Not surprisingly, this population overlaps considerably with the group at risk for body lice infestation, so they may be carrying Bartonella bacteria, even without symptoms. Many cases likely go undiagnosed or are treated by antibiotics geared to other conditions.
Fortunately, transplant teams have a long history of reducing infection transmission risks in transplantation and have moved very rapidly to recognize and address this new threat in caring for transplant recipients.
This recent development reminds us of the health and health-care impact of the closely linked problems of poverty, homelessness and the toxic drug epidemic. These problems have complex causes that require serious long-term societal responses.
But even if homelessness can’t be eradicated in the short to medium term, simply giving unhoused people stable access to safe places to shower and wash their clothes is achievable. It is sad to realize that people in our communities don’t have access to these basic services, which could potentially have prevented or limited our similarly shocking Shigella dysentery outbreaks.
As infectious diseases specialists, we recognize that increases in historical diseases that were previously controlled by basic public health measures and sanitation are a very bad sign of the times. Body lice and Bartonella provide yet more evidence that our failure to address extreme poverty and disadvantage will literally come back to bite us.
Read more: Health, Rights + Justice, Alberta
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