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
DurationFive 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 infectious disease caused by the bacterium Bartonella quintana and transmitted by body lice. 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. [3] Outbreaks have been documented, for example, in Seattle [4] and Baltimore in the United States among injecting drug users [5] and in Marseille, France, [4] and Burundi. [6]

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). [7]

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. [8] The most constant symptom is pain in the legs. [9] 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. [10] Recovery takes a month or more. Lethal cases are rare, but in a few cases "the persistent fever might lead to heart failure". [8] [11] Aftereffects may include neurasthenia, cardiac disturbances, and myalgia. [8]

Cause, transmission, pathophysiology

The disease is caused by the bacterium Bartonella quintana (older names: Rochalimea quintana, Rickettsia quintana), found in the stomach walls of the body louse. [9] Bartonella quintana is closely related to Bartonella henselae , the agent of cat scratch fever and bacillary angiomatosis.

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. [8] [9] B. quintana infection has also been noted in transplant recipients from infected donors. [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 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. [13] 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 ]

Treatment usually consists of a 4- to 6-week course of doxycycline as first-line, or erythromycin, or azithromycin. [14] [15]

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. 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. [16] 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. [17]

Since the vector of the disease is a human body louse, 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. [18]

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. In a 2021 outbreak investigation in Denver, Colorado, 15% of the 241 tested homeless persons were positive. [19] A 2012 study in Marseille, France had found the bacterium in 5.4% of the 930 homeless individuals they tested. [20]

History

Trench fever affected armies in Flanders, France, Poland, Galicia, Italy, Macedonia, Mesopotamia, Russia and Egypt in World War I. [2] [9] Three noted cases during WWI were the authors J. R. R. Tolkien, [11] A. A. Milne, [21] and C. S. Lewis. [22]

Discovery and taxonomy

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. [23] The MRC and TFIC findings were very similar essentially confirming the louse as the vector of transmission, the TFIC correctly implicating louse fecal contamination as the mode of transmission rather than directly through louse bite. [23]

The TFIC speculated that the disease was "likely" related to a rickettsial infection based on studies of infected lice, [23] and the bacterium had been named by Schmincke one year prior in 1917. [24] [25]

It was not until the 1960s that J. Vinson demonstrated that Rickettsia quintana could be cultured extracellularly on blood agar and fulfilled Koch's postulates. [26] This led to the reclassification of Rickettsia quintana as Rochalimaea quintana and subsequently Bartonella quintana. [23] [24] [27]

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. [28] [ dead link ‍]

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">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.

<i>Rickettsia rickettsii</i> Species of bacterium

Rickettsia rickettsii is a Gram-negative, intracellular, cocco-bacillus bacterium that was first discovered in 1902. Having a reduced genome, the bacterium harvests nutrients from its host cell to carry out respiration, making it an organo-heterotroph. Maintenance of its genome is carried out through vertical gene transfer where specialization of the bacterium allows it to shuttle host sugars directly into its TCA cycle.

<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 fleas, sand flies, and mosquitoes. At least eight Bartonella species or subspecies are known to infect humans.

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, soft-bodied ticks, or hard-bodied ticks.

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

The body louse or the cootie 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 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.

<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">Typhus</span> Group of infectious diseases

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Rickettsia typhi is a small, aerobic, obligate intracellular, rod shaped gram negative bacterium. It belongs to the typhus group of the Rickettsia genus, along with R. prowazekii. R. typhi has an uncertain history, as it may have long gone shadowed by epidemic typhus. This bacterium is recognized as a biocontainment level 2/3 organism. R. typhi is a flea-borne disease that is best known to be the causative agent for the disease murine typhus, which is an endemic typhus in humans that is distributed worldwide. As with all rickettsial organisms, R. typhi is a zoonotic agent that causes the disease murine typhus, displaying non-specific mild symptoms of fevers, headaches, pains and rashes. There are two cycles of R. typhi transmission from animal reservoirs containing R. typhi to humans: a classic rat-flea-rat cycle that is most well studied and common, and a secondary periodomestic cycle that could involve cats, dogs, opossums, sheep, and their fleas.

<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 on clothing and to a lesser extent on human hairs.

<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.

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Rickettsia helvetica, previously known as the Swiss agent, is a bacterium found in Dermacentor reticulatus and other ticks, which has been implicated as a suspected but unconfirmed human pathogen. First recognized in 1979 in Ixodes ricinus ticks in Switzerland as a new member of the spotted fever group of Rickettsia, the R. helvetica bacterium was eventually isolated in 1993. Although R. helvetica was initially thought to be harmless in humans and many animal species, some individual case reports suggest that it may be capable of causing a nonspecific fever in humans. In 1997, a man living in eastern France seroconverted to Rickettsia 4 weeks after onset of an unexplained febrile illness. In 2010, a case report indicated that tick-borne R. helvetica can also cause meningitis in humans.

Rickettsia felis is a species of bacterium, the pathogen that causes cat-flea typhus in humans, also known as flea-borne spotted fever. Rickettsia felis also is regarded as the causative organism of many cases of illnesses generally classed as fevers of unknown origin in humans in Africa.

<span class="mw-page-title-main">Cat-scratch disease</span> Bacterial infection from a cat

Cat-scratch disease (CSD) 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.

References

  1. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1095. ISBN   978-1-4160-2999-1.
  2. 1 2 Hill, Justina Hamilton (1942). Silent Enemies: The Story of the Diseases of War and Their Control. G. P. Putnam's Sons.
  3. ↑ Perloff, Sarah (17 January 2020). "Trench Fever". EMedicine.
  4. 1 2 Ohl, M. E.; Spach, D. H. (1 July 2000). "Bartonella quintana and Urban Trench Fever". Clinical Infectious Diseases. 31 (1): 131–135. doi:10.1086/313890. PMID   10913410.
  5. ↑ Comer, James A. (25 November 1996). "Antibodies to Bartonella Species in Inner-city Intravenous Drug Users in Baltimore, Md". Archives of Internal Medicine. 156 (21): 2491–5. doi:10.1001/archinte.1996.00440200111014. PMID   8944742.
  6. ↑ Raoult, D; Ndihokubwayo, JB; Tissot-Dupont, H; Roux, V; Faugere, B; Abegbinni, R; Birtles, RJ (1998). "Outbreak of epidemic typhus associated with trench fever in Burundi". The Lancet. 352 (9125): 353–358. doi:10.1016/S0140-6736(97)12433-3. PMID   9717922. S2CID   25814472.
  7. ↑ "Trench Fever". MSD Manual. Retrieved 30 May 2023.
  8. 1 2 3 4 Edward Rhodes Stitt (1922). The Diagnostics and treatment of tropical diseases. P. Blakiston's Son & Co.
  9. 1 2 3 4 Timoney, Francis; William Arthur Hagan (1973). Hagan and Bruner's Microbiology and Infectious Diseases of Domestic Animals. Cornell University Press.
  10. ↑ "Facts about Bartonella quintana infection ('trench fever')". European Centre for Disease Prevention and Control. 17 June 2017.
  11. 1 2 Garth, John (2003). Tolkien and the Great War: The Threshold of Middle-earth. HarperCollins Publishers.
  12. ↑ Beeson, Amy M.; Rich, Shannan N.; Russo, Michael E.; Bhatnagar, Julu; Kumar, Rebecca N.; Ritter, Jana M.; Annambhotla, Pallavi; Takeda, Moe R.; Kuhn, Kira F. "Bartonella quintana Infection in Kidney Transplant Recipients from Donor Experiencing Homelessness, United States, 2022 - Volume 30, Number 12—December 2024 - Emerging Infectious Diseases journal - CDC". doi:10.3201/eid3012.240310 . Retrieved 27 November 2024.
  13. ↑ Rolain, J. M.; Brouqui, P.; Koehler, J. E.; Maguina, C.; Dolan, M. J.; Raoult, D. (June 2004). "Recommendations for Treatment of Human Infections Caused by Bartonella Species". Antimicrobial Agents and Chemotherapy. 48 (6): 1921–1933. doi:10.1128/AAC.48.6.1921-1933.2004. ISSN   0066-4804. PMC   415619 . PMID   15155180.
  14. ↑ Slater, Leonard N.; Welch, David F.; Hensel, Diane; Coody, Danese W. (1990). "A Newly Recognized Fastidious Gram-negative Pathogen as a Cause of Fever and Bacteremia". New England Journal of Medicine. 323 (23): 1587–93. doi: 10.1056/NEJM199012063232303 . PMID   2233947.
  15. ↑ Myers, WF; Grossman, DM; Wisseman Jr, CL (1984). "Antibiotic susceptibility patterns in Rochalimaea quintana, the agent of trench fever". Antimicrobial Agents and Chemotherapy. 25 (6): 690–3. doi:10.1128/aac.25.6.690. PMC   185624 . PMID   6742814.
  16. ↑ "Trench Fever in the First World War". www.kumc.edu. Retrieved 11 November 2021.
  17. ↑ "Facts about Bartonella quintana infection ('trench fever')". European Centre for Disease Prevention and Control. 17 June 2017. Retrieved 11 November 2021.
  18. ↑ "Trench Fever: Practice Essentials, Background, Pathophysiology". 21 October 2021.
  19. ↑ "People experiencing homelessness face 'substantial risk' for trench fever". www.healio.com. 22 May 2021. Retrieved 2 December 2021.
  20. ↑ Badiaga, S.; Brouqui, P. (1 April 2012). "Human louse-transmitted infectious diseases". Clinical Microbiology and Infection. 18 (4): 332–337. doi: 10.1111/j.1469-0691.2012.03778.x . ISSN   1198-743X. PMID   22360386.
  21. ↑ Carpenter, Humphrey; Mari Prichard (1984). The Oxford companion to children's literature . Oxford University Press. p.  351. ISBN   9780192115829.
  22. ↑ Lewis, C. S. (1955). Surprised By Joy. Harcourt.
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  24. 1 2 Brouqui, P.; Raoult, D. (1996). "Bartonella quintana invades and multiplies within endothelial cells in vitro and in vivo and forms intracellular blebs". Research in Microbiology. 147 (9): 719–731. doi: 10.1016/S0923-2508(97)85119-4 . PMID   9296106.
  25. ↑ Flamm, Heinz (2015). "Das Fleckfieber und die Erfindung seiner Serodiagnose und Impugn bee Der k. u. k. Armee I'm Ersten Weltkrieg" [Spotted fever and the invention of its serodiagnosis and vaccination in the Austro-Hungarian army in World War I]. Wiener Medizinische Wochenschrift (in German). 165: 152–163. doi:10.1007/s10354-014-0332-7.
  26. ↑ Ohl, Michael E.; Spach, David H. (2000). "Bartonella quintana and Urban Trench Fever". Clinical Infectious Diseases. 31 (1): 131–135. doi:10.1086/313890. PMID   10913410.
  27. ↑ Okorji, Onyinyechukwu; Olarewaju, Olubunmi; Smith, Travis; Pace, William C. (13 March 2024). "Trench Fever". StatPearls. Treasure Island, Florida: StatPearls Publishing. PMID   32965930. NLM Bookshelf Identification NBK562259. Retrieved 22 November 2024– via National Library of Medicine, National Center for Biotechnology Information.
  28. ↑ "War Work in Dacorum". 12 March 2023. Retrieved 12 March 2023.

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