Trench fever is a bacterial infection that causes repeated cycles of high fever.
The term trench fever refers to the crowded conditions in which troops fought in during World War I and World War II. Because the causative bacteria are passed among humans through contact with body lice, over-crowding, and conditions which interfere with good hygiene (including regular washing of clothing) soldiers were predispose to this disease. Currently, homeless people in the United States are sometimes diagnosed with this illness. The bacteria are sometimes passed through the bite of an infected tick. This can cause the illness in
Causes and symptoms
Two different bacteria can cause trench fever: Bartonella quintana and Bartonella henselae. B. quintana is carried by body lice; B. henselae is carried by ticks.
Infection with B. quintana occurs when an infected louse defecates while feeding on a human. When the person scratches, the feces (which are full of bacteria) are rubbed into the tiny wound. Infection with B. henselae occurs when an infected tick bites a human, passing the bacteria along through the tiny bite wound.
Symptoms of trench fever begin about 2 weeks to a month after exposure to the bacteria. Sudden fever, loss of energy, dizziness, headache, weight loss, skin rash, severe muscle and bone pain can occur. Pain is particularly severe in the shins, leading to the nickname "shin bone fever." The fever can reach 105°F (40.5°C) and stays high for five to six days at a time. The temperature then drops, and stays down for several days, usually recurring in five- to six-day cycles. An individual may experience as many as eight cycles of fever with the illness.
Diagnosis is usually made on the basis of the patient's symptoms, and on knowledge of the conditions in which the patient lives. A blood sample can be drawn and bacteria in the sample are allowed to grow. Identification is made by looking at the number of bacteria that may be present on a glass slide seen under the lens of a microscope. However, this technique can take up to four weeks, because this type of bacterium grows very slowly. By this time, the practitioner has often decided to treat the patient anyway.
Erythromycin and azithromycin are both used to treat trench fever. Four weeks of treatment are usually necessary. Inadequate treatment often results in a relapse. In fact, relapses have been reported to occur as long as 10 years after the first episode.
Prognosis for patients with trench fever is excellent. Recovery may take a couple of months. Without treatment, there is always a risk of recurrence, even years after the original illness.
Prevention involves good hygiene and decent living conditions. When this is impossible, insecticide dusting powders are available to apply to clothing. Avoidance of areas known to harbor ticks or the use of insect repellents is necessary to avoid the type of infection passed by ticks.
Corey, Lawrence. "Rickettsia and Coxiella." In Sherris Medical Microbiology: An Introduction to Infectious Diseases. 3rd ed. Ed. Kenneth J. Ryan. Norwalk, CT: Appleton & Lange, 1994.
Tompkins, Lucy S. "Bartonella Infections, Including Cat-Scratch Disease." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
Bovsun, Mara. "World War I's Trench Fever Germ Making Comeback Among Poor, Homeless." Biotechnology Newswatch (5 Jan. 1998): 6.
Relman, David A. "Has Trench Fever Returned?" The New England Journal of Medicine 332, no. 7 (16 Feb. 1995): 463+.
Tompkins, Lucy S. "Bartonella Species Infections, Including Cat-Scratch Disease, Trench Fever, and Bacillary Angiomatosis: What Molecular Techniques Have Revealed." The Western Journal of Medicine 164, no. 1 (Jan. 1996): 39+.
Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. <http://www.cdc.gov>.
Rosalyn Carson-DeWitt, MD