Trench fever (also known as "five-day fever", "quintan fever" ( la, febris quintana), and "urban trench fever"
) is a moderately serious
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
transmitted by
body lice. It infected armies in
Flanders
Flanders (, ; Dutch: ''Vlaanderen'' ) is the Flemish-speaking northern portion of Belgium and one of the communities, regions and language areas of Belgium. However, there are several overlapping definitions, including ones related to cultu ...
, France, Poland,
Galicia
Galicia may refer to:
Geographic regions
* Galicia (Spain), a region and autonomous community of northwestern Spain
** Gallaecia, a Roman province
** The post-Roman Kingdom of the Suebi, also called the Kingdom of Gallaecia
** The medieval King ...
, Italy,
Salonika
Thessaloniki (; el, Θεσσαλονίκη, , also known as Thessalonica (), Saloniki, or Salonica (), is the second-largest city in Greece, with over one million inhabitants in its metropolitan area, and the capital of the geographic region of ...
, Macedonia,
Mesopotamia
Mesopotamia ''Mesopotamíā''; ar, بِلَاد ٱلرَّافِدَيْن or ; syc, ܐܪܡ ܢܗܪ̈ܝܢ, or , ) is a historical region of Western Asia situated within the Tigris–Euphrates river system, in the northern part of the ...
, Russia and Egypt in
World War I
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was List of wars and anthropogenic disasters by death toll, one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, ...
.
Three noted cases during WWI were the authors
J. R. R. Tolkien,
A. A. Milne, and
C. S. Lewis
Clive Staples Lewis (29 November 1898 – 22 November 1963) was a British writer and Anglican lay theologian. He held academic positions in English literature at both Oxford University (Magdalen College, 1925–1954) and Cambridge Univer ...
.
From 1915 to 1918 between one-fifth and one-third of all British troops reported ill had trench fever while about one-fifth of ill German and Austrian troops had the disease.
The disease persists among the homeless. Outbreaks have been documented, for example, in
Seattle
Seattle ( ) is a seaport city on the West Coast of the United States. It is the seat of King County, Washington. With a 2020 population of 737,015, it is the largest city in both the state of Washington and the Pacific Northwest region o ...
and
Baltimore
Baltimore ( , locally: or ) is the most populous city in the U.S. state of Maryland, fourth most populous city in the Mid-Atlantic, and the 30th most populous city in the United States with a population of 585,708 in 2020. Baltimore was ...
in the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
among injection drug users and in
Marseille
Marseille ( , , ; also spelled in English as Marseilles; oc, Marselha ) is the prefecture of the French department of Bouches-du-Rhône and capital of the Provence-Alpes-Côte d'Azur region. Situated in the camargue region of southern Fra ...
,
France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
,
and
Burundi
Burundi (, ), officially the Republic of Burundi ( rn, Repuburika y’Uburundi ; Swahili: ''Jamuhuri ya Burundi''; French: ''République du Burundi'' ), is a landlocked country in the Great Rift Valley at the junction between the African Gr ...
.
Trench fever is also called Wolhynia fever, shin bone fever, Meuse fever, His disease, and His–Werner disease or Werner-His disease (after
Wilhelm His Jr.
Wilhelm His Jr. (29 December 1863 – 10 November 1934) was a Swiss cardiologist and anatomist, son of Wilhelm His Sr.
In 1893, His discovered the bundle of His, the collection of specialized cardiac muscle cells in the heart that transmits el ...
and
Heinrich Werner).
The disease is caused by the bacterium ''
Bartonella quintana
''Bartonella quintana'', originally known as ''Rochalimaea quintana'', and "''Rickettsia quintana''", is a bacterium transmitted by the human body louse that causes trench fever. This bacterial species caused outbreaks of trench fever affecting 1 ...
'' (older names: ''Rochalimea quintana'', ''Rickettsia quintana''), found in the stomach walls of the
body louse.
''Bartonella quintana'' is closely related to ''
Bartonella henselae'', the agent of
cat scratch fever and
bacillary angiomatosis.
Signs and symptoms
The disease is classically a five-day
fever
Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
of the relapsing type, rarely exhibiting a continuous course. The
incubation period
Incubation period (also known as the latent period or latency period) is the time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent. In a typical infectious disease, the in ...
is relatively long, at about two weeks. The onset of symptoms is usually sudden, with high fever, severe headache, pain on moving the eyeballs, soreness of the muscles of the legs and back, and frequent
hyperaesthesia of the shins. The initial fever is usually followed in a few days by a single, short rise but there may be many relapses between periods without fever.
The most constant symptom is pain in the legs.
Recovery takes a month or more. Lethal cases are rare, but in a few cases "the persistent fever might lead to heart failure".
Aftereffects may include
neurasthenia
Neurasthenia (from the Ancient Greek νεῦρον ''neuron'' "nerve" and ἀσθενής ''asthenés'' "weak") is a term that was first used at least as early as 1829 for a mechanical weakness of the nerves and became a major diagnosis in North A ...
, cardiac disturbances, and
myalgia
Myalgia (also called muscle pain and muscle ache in layman's terms) is the medical term for muscle pain. Myalgia is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another li ...
.
Pathophysiology
''Bartonella quintana'' is transmitted by contamination of a skin abrasion or louse-bite wound with the faeces of an infected
body louse (''Pediculus humanus corporis''). There have also been reports of an infected louse bite passing on the infection.
Diagnosis
Serological
Serology is the scientific study of serum and other body fluids. In practice, the term usually refers to the diagnostic identification of antibodies in the serum. Such antibodies are typically formed in response to an infection (against a given mic ...
testing is typically used to obtain a definitive
diagnosis
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
. Most serological tests would succeed only after a certain period of time past the symptom onset (usually a week). The
differential diagnosis
In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...
list includes
typhus
Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus, and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposure. ...
,
ehrlichiosis,
leptospirosis
Leptospirosis is a blood infection caused by the bacteria '' Leptospira''. Signs and symptoms can range from none to mild (headaches, muscle pains, and fevers) to severe ( bleeding in the lungs or meningitis). Weil's disease, the acute, sever ...
,
Lyme disease
Lyme disease, also known as Lyme borreliosis, is a vector-borne disease caused by the '' Borrelia'' bacterium, which is spread by ticks in the genus '' Ixodes''. The most common sign of infection is an expanding red rash, known as erythema ...
, and
virus
A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea.
Since Dmitri Ivanovsk ...
-caused
exanthem
An exanthem is a widespread rash occurring on the outside of the body and usually occurring in children. An exanthem can be caused by toxins, drugs, or microorganisms, or can result from autoimmune disease.
The term exanthem is from the Greek el ...
a (
measles
Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
or
rubella
Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...
).
Treatment
The treatment of trench fever can vary from case to case, as the human body has the ability to rid itself of the disease without medical intervention. Some patients will require treatment, and others will not. For those who do require treatment, the best treatment comes by way of doxycycline in combination with gentamicin.
Chloramphenicol
Chloramphenicol is an antibiotic useful for the treatment of a number of bacterial infections. This includes use as an eye ointment to treat conjunctivitis. By mouth or by injection into a vein, it is used to treat meningitis, plague, chole ...
is an alternative medication recommended under circumstances that render the use of tetracycline derivates undesirable, such as severe
liver
The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it i ...
disease,
kidney dysfunction, in children under nine years and in pregnant women. The medication is administered for seven to ten days.
Epidemiology
Trench fever is a vector-borne disease in which humans are primarily the main hosts. The vector through which the disease is typically transmitted is referred to as the human body louse "Pediculus humanus humanus", which is better known as lice. The British Expeditionary Force Pyrexia of Unknown Origin Enquiry Sub-Committee concluded that the specific means by which the vector infected the host was louse waste entering the body through abraded skin. Although the disease is typically found in humans, the gram-negative bacterium which induces the disease has been seen in mammals such as dogs, cats, and macaques in small numbers.
Being that the vector of the disease is a human body louse, it can be determined that the main risk factors for infection are mostly in relation to contracting body louse. Specifically, some risk factors include body louse infestation, overcrowded and unhygienic conditions, body hygiene, war, famine, malnutrition, alcoholism, homelessness, and intravenous drug abuse.
The identified risk factors directly correlate with the subpopulations of identified infected persons throughout the duration of the known disease. Historically, trench fever was found in young male soldiers of World War I, whereas in the 21st century the disease mostly has a prevalence in middle-aged homeless men. This can be seen when looking at a 21st-century outbreak of the disease in Denver, Colorado, where researcher David McCormick and his colleagues came across the gram-negative bacterium in 15% of the 241 homeless persons who were tested. Another study done in Marseille, France found the bacterium in 5.4% of the 930 homeless individuals they tested.
History
Trench fever was first described and reported by British major John Graham in June 1915. He reported symptoms such as dizziness, headaches, and pain in the shins and back. The disease was most common in the military and consequently took much longer to identify than usual. These cases were originally confused for
dengue
Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin three to fourteen days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic ...
,
sandfly
Sandfly (or sand fly) is a colloquial name for any species or genus of flying, biting, blood-sucking dipteran (fly) encountered in sandy areas. In the United States, ''sandfly'' may refer to certain horse flies that are also known as "greenhea ...
, or
paratyphoid fever. Because insects were the suspected vector of transmission,
Alexander Peacock
Sir Alexander James Peacock (11 June 1861 – 7 October 1933) was an Australian politician who served as the 20th Premier of Victoria.
Early Years
Peacock was born of Scottish descent at Creswick, the first Victorian Premier born after ...
published a study of the
body louse in 1916. Due in part to his findings, the louse was determined to be the primary cause of transmission by many, but this was still contested by multiple voices in the field such as John Muir who believed the disease was of a viral nature. In 1917, the Trench Fever Investigation Commission (TFIC) had its first meeting. The TFIC performed experiments with infected blood and louse and learned much about the disease and louse behavior. Also in 1917, the
American Red Cross
The American Red Cross (ARC), also known as the American National Red Cross, is a non-profit humanitarian organization that provides emergency assistance, disaster relief, and disaster preparedness education in the United States. It is the des ...
started the Medical Research Committee (MRC). The MRC performed human experiments on trench fever, and their research was published in March 1918.
The MRC and TFIC findings were very similar essentially confirming the louse as the vector of transmission. It was not until the 1920s that the bacteria B Quintana was identified as the cause of trench fever.
References
External links
{{DEFAULTSORT:Trench Fever
Bacterial diseases
Bacterium-related cutaneous conditions
Trench warfare