Bartonella quintana is a fastidious, gram-negative, rod-shaped bacterium that causes prolonged bacteremia in immunocompetent humans and severe infections in immunocompromised individuals. We sought to define the outer membrane subproteome of B. quintana in order to obtain insight into the biology and pathogenesis of this emerging pathogen and to identify the predominant B. quintana antigens targeted by the human immune system during infection. We isolated the total membrane proteins of B. quintana and identified 60 proteins by two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis and peptide mass fingerprinting. Using the newly constructed proteome map, we then utilized two-dimensional immunoblotting with sera from 21 B. quintana-infected patients to identify 24 consistently recognized, immunoreactive B. quintana antigens that have potential relevance for pathogenesis and diagnosis. Among the outer membrane proteins, the variably expressed outer membrane protein adhesins (VompA and VompB), peptidyl-prolyl cis-trans-isomerase (PpI), and hemin-binding protein E (HbpE) were recognized most frequently by sera from patients, which is consistent with surface expression of these virulence factors during human infection.Bartonella quintana, the agent of trench fever, is a fastidious, gram-negative, rod-shaped organism that can cause prolonged bacteremia in immunocompetent humans and severe infections in immunocompromised individuals. Humans are the only known reservoir for B. quintana (12), and the vector for transmission is the human body louse, Pediculus humanus corporis (38). B. quintana infections have occurred worldwide, and severe, potentially lethal complications, such as endocarditis and bacillary angiomatosis, can develop in immunocompromised patients with AIDS, cancer, and organ transplants. However, little is known about the pathogenesis of B. quintana, and diagnosis of human infection remains extremely challenging. To address this paucity of knowledge, we sought to identify potential membrane-associated virulence factors, as well as protective and diagnostically relevant B. quintana antigens, by characterizing the total membrane fraction and immunome of B. quintana.Bacterial outer membrane proteins (OMP) can be important virulence factors, playing a critical role in adherence, invasion, and immune evasion during infection of the host, as well as during transmission via arthropod vectors. Many outer membrane-associated proteins that are important for pathogenesis also are consistent targets for the host immune system after infection. Workers in our lab previously identified a family of variably expressed outer membrane proteins (Vomp) that play a role in adhesion and autoaggregation (45). To initially identify the Vomp family, we used two-dimensional (2D) sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis (PAGE) to visualize changes in expression of membrane proteins in sequential isolates from animals experimentally infected with B. quintana.To identify additional membrane pr...