Trench fever
Encyclopedia
Trench fever is a moderately serious disease
transmitted by body lice
. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, and Egypt in World War I
(three noted sufferers being the authors J.R.R. Tolkien A. A. Milne
, and C.S. Lewis) and the German army in Russia during World War I
. 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
and Baltimore in the United States
among injection drug users and in Marseille
, France
, and Burundi
.
Trench fever is also called Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever, His disease and His-Werner disease (after Wilhelm His, Jr.
and Heinrich Werner).
The disease is caused by the bacterium Bartonella quintana
(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
.
(Pediculus humanus corporis). There have also been reports of an infected louse bite passing on the infection.
of the relapsing type, rarely with a continuous course instead. 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 frequently 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". After effects may include neurasthenia
, cardiac disturbances and myalgia
.
) 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 exanthem
a (measles
or rubella
).
, tetracycline) are commonly used. Chloramphenicol
is an alternative medication recommended under circumstances that render tetracycline derivates usage undesirable (such as severe liver
malfunction, kidney
deficiency, in children under nine years and pregnant women). The drug is administered for seven to ten days.
The treatment for bacillary angiomatosis
is erythromycin
given for three to four months.
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
transmitted by body lice
Body louse
The body louse is a louse which infests humans. The condition of being infested with head lice, body lice, or pubic lice is known as pediculosis.-Origins:...
. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, and Egypt in World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
(three noted sufferers being the authors J.R.R. Tolkien A. A. Milne
A. A. Milne
Alan Alexander Milne was an English author, best known for his books about the teddy bear Winnie-the-Pooh and for various children's poems. Milne was a noted writer, primarily as a playwright, before the huge success of Pooh overshadowed all his previous work.-Biography:A. A...
, and C.S. Lewis) and the German army in Russia during World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
. 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, Washington
Seattle is the county seat of King County, Washington. With 608,660 residents as of the 2010 Census, Seattle is the largest city in the Northwestern United States. The Seattle metropolitan area of about 3.4 million inhabitants is the 15th largest metropolitan area in the country...
and Baltimore in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
among injection drug users and in Marseille
Marseille
Marseille , known in antiquity as Massalia , is the second largest city in France, after Paris, with a population of 852,395 within its administrative limits on a land area of . The urban area of Marseille extends beyond the city limits with a population of over 1,420,000 on an area of...
, France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, and Burundi
Burundi
Burundi , officially the Republic of Burundi , is a landlocked country in the Great Lakes region of Eastern Africa bordered by Rwanda to the north, Tanzania to the east and south, and the Democratic Republic of the Congo to the west. Its capital is Bujumbura...
.
Trench fever is also called Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever, His disease and His-Werner disease (after Wilhelm His, Jr.
Wilhelm His, Jr.
Wilhelm His, Jr. was a Swiss-born cardiologist and anatomist.He was born on December 29, 1863 to Wilhelm His, Sr.. In 1893, he discovered the bundle of His, which is a specialized tissue in the heart that transmits the electrical impulses and helps synchronize contraction of the cardiac muscles...
and Heinrich Werner).
The disease is caused by the bacterium Bartonella quintana
Bartonella quintana
Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a microorganism that is transmitted by the human body louse. This microorganism is the caustative agent of trench fever...
(older names: Rochalimea quintana, Rickettsia quintana), found in the stomach walls of the body louse
Body louse
The body louse is a louse which infests humans. The condition of being infested with head lice, body lice, or pubic lice is known as pediculosis.-Origins:...
. Bartonella quintana is closely related to Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
, the agent of cat scratch fever
Cat Scratch Fever
Cat Scratch Fever is an album by Ted Nugent released in 1977, as well as the name of the album's title song. "Death By Misadventure" recounts the death of Brian Jones of the Rolling Stones. Guitarist Derek St. Holmes came back during this album after he left...
.
Pathology and transmission
Bartonella quintana is transmitted by contamination of a skin abrasion or louse-bite wound with the faeces of an infected body louseBody louse
The body louse is a louse which infests humans. The condition of being infested with head lice, body lice, or pubic lice is known as pediculosis.-Origins:...
(Pediculus humanus corporis). There have also been reports of an infected louse bite passing on the infection.
Symptoms
The disease is classically a five-day feverFever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
of the relapsing type, rarely with a continuous course instead. The incubation period
Incubation period
Incubation period is the time elapsed between exposure to a pathogenic organism, a chemical or radiation, and when symptoms and signs are first apparent...
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 frequently hyperaesthesia
Hyperesthesia
Hyperesthesia is a condition that involves an abnormal increase in sensitivity to stimuli of the sense. "When a non-noxious stimulus causes the sensation of pain the area will be termed hyperaesthetic". Stimuli of the senses can include sound that one hears, foods that one tastes, textures that...
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". After effects may include neurasthenia
Neurasthenia
Neurasthenia is a psycho-pathological term first used by George Miller Beard in 1869 to denote a condition with symptoms of fatigue, anxiety, headache, neuralgia and depressed mood...
, cardiac disturbances and myalgia
Myalgia
Myalgia means "muscle pain" and is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections...
.
Diagnostics
Serological testing (e.g., the Weil-Felix testWeil-Felix test
The Weil-Felix test is an agglutination test for the diagnosis of rickettsial infections. It was first described in 1916. By virtue of its long history and of its simplicity, it has been one of the most widely employed tests for rickettsia on a global scale, despite being superseded in many...
) is typically used to obtain a definitive diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
. Most serological tests would succeed only after a certain period of time past the symptom onset (usually a week). The differential diagnosis
Differential diagnosis
A differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...
list includes typhus
Typhus
Epidemic typhus is a form of typhus so named because the disease often causes epidemics following wars and natural disasters...
, ehrlichiosis
Ehrlichiosis
Ehrlichiosis is a tick-borne disease of dogs usually caused by the organism Ehrlichia canis. Ehrlichia canis is the pathogen of animals. Humans can become infected by E. canis and other species after tick exposure. German Shepherd dogs are thought to be particularly affected by the disease, other...
, leptospirosis
Leptospirosis
Leptospirosis is caused by infection with bacteria of the genus Leptospira, and affects humans as well as other mammals, birds, amphibians, and reptiles.The...
, Lyme disease
Lyme disease
Lyme disease, or Lyme borreliosis, is an emerging infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi sensu stricto is the main cause of Lyme disease in the United States, whereas Borrelia afzelii and Borrelia garinii cause most...
and virus
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
-caused exanthem
Exanthem
An exanthem is a widespread rash usually occurring in children. Exanthems can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease.It can be contrasted with an enanthem.-Types:...
a (measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
or rubella
Rubella
Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
).
Treatment
Tetracycline-group antibiotics (doxycyclineDoxycycline
Doxycycline INN is a member of the tetracycline antibiotics group, and is commonly used to treat a variety of infections. Doxycycline is a semisynthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin...
, tetracycline) are commonly used. Chloramphenicol
Chloramphenicol
Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...
is an alternative medication recommended under circumstances that render tetracycline derivates usage undesirable (such as severe liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
malfunction, kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
deficiency, in children under nine years and pregnant women). The drug is administered for seven to ten days.
The treatment for bacillary angiomatosis
Bacillary angiomatosis
Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana....
is erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
given for three to four months.