Trench fever

Trench fever is moderately serious disease transmitted by body lice.

It infected armies in World War I.

The disease persists among the homeless.

Symptoms include: fever of 5 day duration.

Caused by infected insect bite.

Prevented by body hygiene.

The disease is caused by the bacterium Bartonella quintana (Rickettsia quintana), found in the stomach walls of the body louse.

Bartonella quintana is transmitted by contamination of a skin abrasion or louse-bite wound with the feces of an infected body louse (Pediculus humanus corporis).

Bartonella quintana is closely related to Bartonella henselae, the agent of cat scratch fever and bacillary angiomatosis.

The five-day fever of the relapsing type, rarely exhibits a continuous course.

The incubation period of trench fever is 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 frequently hyperesthesia of the shins.

Pain is the legs is the most consistent symptom.

Recovery usually takes a month or more.

Persistence of fever might lead to heart failure.

It is rarely fatal.

Late effects include: neurasthenia, cardiac disturbances and myalgia.

Serological testing is used to obtain a definitive diagnosis.

The serological tests are positive only after one week of symptom onset.

Differential diagnosis: typhus, ehrlichiosis, leptospirosis, Lyme disease and virus-caused exanthema such as measles or rubella.

Tetracycline antibiotics are commonly used.

Chloramphenicol is an alternative.

The treatment for bacillary angiomatosis is erythromycin given for three to four months.

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