Trench fever

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Trench fever
Other namesWolhynia fever, shin bone fever, Meuse fever, His disease, and His–Werner disease
Specialty Infectious diseases, military medicine   OOjs UI icon edit-ltr-progressive.svg
Symptoms fever
Duration5 days
Causesinfected insect bite
Preventionbody hygiene
Medication Tetracycline-group antibiotics
DeathsRare

Trench fever (also known as "five-day fever", "quintan fever" (Latin : febris quintana), and "urban trench fever" [1] ) is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Macedonia, Mesopotamia, Russia and Egypt in World War I. [2] [3] Three noted cases during WWI were the authors J. R. R. Tolkien, [4] A. A. Milne, [5] and C. S. Lewis. [6] 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. [2] The disease persists among the homeless. [7] Outbreaks have been documented, for example, in Seattle [8] and Baltimore in the United States among injection drug users [9] and in Marseille, France, [8] and Burundi. [10]

Contents

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. and Heinrich Werner). [11]

The disease is caused by the bacterium Bartonella quintana (older names: Rochalimea quintana, Rickettsia quintana), found in the stomach walls of the body louse. [3] 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 of the relapsing type, rarely exhibiting a continuous course. The incubation period 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. [12] The most constant symptom is pain in the legs. [3] Trench fever episodes may involve loss of appetite, shin pain or tenderness, and spleen enlargement. Generally, one to five periodic episodes of fever occur, separated by four-to-six-day-long asymptomatic periods. [13] Recovery takes a month or more. Lethal cases are rare, but in a few cases "the persistent fever might lead to heart failure". [4] [12] Aftereffects may include neurasthenia, cardiac disturbances, and myalgia. [12]

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. [3] [12]

Diagnosis

Serological testing is typically used to obtain a definitive diagnosis. Most serological tests would succeed only after a certain period of time past the symptom onset (usually a week). The differential diagnosis list includes typhus, ehrlichiosis, leptospirosis, Lyme disease, and virus-caused exanthema (measles or rubella).[ citation needed ]

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. [14] 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 is an alternative medication recommended under circumstances that render the use of tetracycline derivates undesirable, such as severe liver disease, kidney dysfunction, in children under nine years and in pregnant women. The medication is administered for seven to ten days.[ citation needed ]

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. [15] 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. [16]

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. [17]

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. [18] Another study done in Marseille, France found the bacterium in 5.4% of the 930 homeless individuals they tested. [19]

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, sandfly, or paratyphoid fever. Because insects were the suspected vector of transmission, Alexander Peacock 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 started the Medical Research Committee (MRC). The MRC performed human experiments on trench fever, and their research was published in March 1918. [20] 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.

During World War II, the British Government commissioned sheep dip manufacturer, Cooper, McDougall & Robertson of Berkhamsted, Herts to develop a product which troops could use to ward off lice. After much trial and error, 'AL63', was developed and successfully used in a powder form. The initials stood for 'Anti-Louse' and it was the 63rd preparation which was the most efficacious. [21]

Related Research Articles

<span class="mw-page-title-main">Epidemic typhus</span> Medical condition

Epidemic typhus, also known as louse-borne typhus, is a form of typhus so named because the disease often causes epidemics following wars and natural disasters where civil life is disrupted. Epidemic typhus is spread to people through contact with infected body lice, in contrast to endemic typhus which is usually transmitted by fleas.

<span class="mw-page-title-main">Sucking louse</span> Suborder of insects

Sucking lice have around 500 species and represent the smaller of the two traditional superfamilies of lice. As opposed to the paraphyletic chewing lice, which are now divided among three suborders, the sucking lice are monophyletic.

<span class="mw-page-title-main">Pediculosis</span> Medical condition

Pediculosis is an infestation of lice from the sub-order Anoplura, family Pediculidae. Accordingly, the infestation with head lice is named pediculosis capitis, while this with body lice, pediculosis corporis. Although pediculosis in humans may properly refer to lice infestation of any part of the body, the term is sometimes used loosely to refer to pediculosis capitis, the infestation of the human head with the specific head louse.

<span class="mw-page-title-main">Head louse</span> Insect parasite of humans

The head louse is an obligate ectoparasite of humans. Head lice are wingless insects that spend their entire lives on the human scalp and feed exclusively on human blood. Humans are the only known hosts of this specific parasite, while chimpanzees and bonobos host a closely related species, Pediculus schaeffi. Other species of lice infest most orders of mammals and all orders of birds.

<i>Bartonella henselae</i> Species of bacterium

Bartonella henselae, formerly Rochalimæa henselae, is a bacterium that is the causative agent of cat-scratch disease (bartonellosis).

Tick-borne diseases, which afflict humans and other animals, are caused by infectious agents transmitted by tick bites. They are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. The economic impact of tick-borne diseases is considered to be substantial in humans, and tick-borne diseases are estimated to affect ~80 % of cattle worldwide. Most of these pathogens require passage through vertebrate hosts as part of their life cycle. Tick-borne infections in humans, farm animals, and companion animals are primarily associated with wildlife animal reservoirs. many tick-borne infections in humans involve a complex cycle between wildlife animal reservoirs and tick vectors. The survival and transmission of these tick-borne viruses are closely linked to their interactions with tick vectors and host cells. These viruses are classified into different families, including Asfarviridae, Reoviridae, Rhabdoviridae, Orthomyxoviridae, Bunyaviridae, and Flaviviridae.

<i>Bartonella</i> Genus of bacteria

Bartonella is a genus of Gram-negative bacteria. It is the only genus in the family Bartonellaceae. Facultative intracellular parasites, Bartonella species can infect healthy people, but are considered especially important as opportunistic pathogens. Bartonella species are transmitted by vectors such as ticks, fleas, sand flies, and mosquitoes. At least eight Bartonella species or subspecies are known to infect humans.

<span class="mw-page-title-main">Carrion's disease</span> Infectious disease caused by Bartonella bacilliformis

Carrion's disease is an infectious disease produced by Bartonella bacilliformis infection.

<span class="mw-page-title-main">Treatment of human lice</span>

The treatment of human lice is the removal of head lice parasites from human hair. It has been debated and studied for centuries. However, the number of cases of human louse infestations has increased worldwide since the mid-1960s, reaching hundreds of millions annually. There is no product or method that assures 100% destruction of the eggs and hatched lice after a single treatment. However, there are a number of treatment modalities that can be employed with varying degrees of success. These methods include chemical treatments, natural products, combs, shaving, hot air, and silicone-based lotions.

Bartonellosis is an infectious disease produced by bacteria of the genus Bartonella. Bartonella species cause diseases such as Carrión's disease, trench fever, cat-scratch disease, bacillary angiomatosis, peliosis hepatis, chronic bacteremia, endocarditis, chronic lymphadenopathy, and neurological disorders.

Relapsing fever is a vector-borne disease caused by infection with certain bacteria in the genus Borrelia, which is transmitted through the bites of lice or soft-bodied ticks.

<span class="mw-page-title-main">Body louse</span> Subspecies of insect

The body louse is a hematophagic ectoparasite louse that infests humans. It is one of three lice which infest humans, the other two being the head louse, and the crab louse or pubic louse.

<span class="mw-page-title-main">Bacillary angiomatosis</span> Medical condition

Bacillary angiomatosis (BA) is a form of angiomatosis associated with bacteria of the genus Bartonella.

Bartonella rochalimae is a recently discovered strain of Gram-negative bacteria in the genus Bartonella, isolated by researchers at the University of California, San Francisco (UCSF), Massachusetts General Hospital, and the United States Centers for Disease Control and Prevention. The bacterium is a close relative of Bartonella quintana, the microbe which caused trench fever in thousands of soldiers during World War I. Named after Brazilian scientist Henrique da Rocha Lima, B. rochalimae is also closely related to Bartonella henselae, a bacterium identified in the mid-1990s during the AIDS epidemic in San Francisco as the cause of cat scratch fever, which still infects more than 24,000 people in the United States each year.

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 million soldiers in Europe during World War I.

Ehrlichia chaffeensis is an obligate intracellular, Gram-negative species of Rickettsiales bacteria. It is a zoonotic pathogen transmitted to humans by the lone star tick. It is the causative agent of human monocytic ehrlichiosis.

<span class="mw-page-title-main">Head lice infestation</span> Medical condition

Head lice infestation, also known as pediculosis capitis, is the infection of the head hair and scalp by the head louse. Itching from lice bites is common. During a person's first infection, the itch may not develop for up to six weeks. If a person is infected again, symptoms may begin much more quickly. The itch may cause problems with sleeping. Generally, however, it is not a serious condition. While head lice appear to spread some other diseases in Africa, they do not appear to do so in Europe or North America.

<span class="mw-page-title-main">Pediculosis corporis</span> Medical condition

Pediculosis corporis or Vagabond's disease is a cutaneous condition caused by body lice that lay their eggs in the seams of clothing.

<span class="mw-page-title-main">African tick bite fever</span> Medical condition

African tick bite fever (ATBF) is a bacterial infection spread by the bite of a tick. Symptoms may include fever, headache, muscle pain, and a rash. At the site of the bite there is typically a red skin sore with a dark center. The onset of symptoms usually occurs 4–10 days after the bite. Complications are rare but may include joint inflammation. Some people do not develop symptoms.

<span class="mw-page-title-main">Cat-scratch disease</span> Human disease

Cat-scratch disease (CSD) or felinosis is an infectious disease that most often results from a scratch or bite of a cat. Symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes. People may feel tired, have a headache, or a fever. Symptoms typically begin within 3–14 days following infection.

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