Table 1.

WHO Criteria for Classifying a Condition as a Neglected Tropical Disease and Applicability to Bartonella quintana

WHO Criteria for Neglected Tropical Disease Classification	Applicability to B quintana
1. Disproportionately affect populations living in poverty and cause important morbidity and mortality—including stigma and discrimination.	B quintana infection is associated with conditions of severe deprivation (eg, houselessness, living in a refugee camp, lacking running water to maintain hygiene). B quintana endocarditis causes morbidity (heart failure, renal dysfunction, cerebral embolization causing neurologic impairment) and mortality (>10% despite treatment). Pediculosis associated with stigma.
2. Primarily affects populations living in tropical and subtropical areas.	Europe-Africa gradient with greater burden in Africa. Reliance on molecular testing and cardiovascular surgery creates bias against reporting in low- and middle-income countries.
3. Is immediately amenable to broad control, elimination, or eradication by applying ≥1 of the 5 public health strategies adopted by the Department for Control of Neglected Tropical Diseases.	B quintana infection may be treated with preventable chemotherapy (eg, doxycycline). Intensified case management may prevent ongoing household transmission (eg, via shared bedding). Vector control: treatment of pediculosis (eg, washing clothing and bedding, pediculicidal therapy with permethrin or ivermectin). Veterinary public health: not applicable. Primarily human pathogen. Infrequent evidence of cat and monkey infection. Safe water, sanitation, and hygiene: access to water to maintain hygiene is essential to interrupt transmission.
4. Is relatively neglected by research—specifically, resource allocation is not commensurate with the magnitude of the problem.	Epidemiology: not notifiable disease. Hidden burden. No prevalence data. No screening guidelines. Diagnostics: no new development of diagnostics. No rapid diagnostic tests. Current diagnostics (eg, immunofluorescent antibody testing, quantitative polymerase chain reaction) not available in many low-resource settings. Treatment: Antimicrobial therapy based on limited evidence (single open trial of gentamicin and doxycycline vs placebo). Toxicity associated with gentamicin. Elevated mortality despite treatment. Anecdotal reports of success with other regimens.

Abbreviation: WHO, World Health Organization.