Also called trench fever, this is a
dise
ase borne by body lice that
was first recognized in the trenches of World War I, when it is
estimated to have affected more than a million people in Russia and
on the fronts in Europe. Trench fever was again a major problem in
the military in World War II and is seen endemically in Mexico,
Africa, E. Europe, and elsewhere.
Urban trench fever occurs among the homeless people and people
with alcoholism today. Outbreaks have been documented, for example,
in Seattle, Baltimore (among injection-drug users), Marseilles
(France) and Burundi.
The cause of trench fever is Bartonella quintana (also called
Rochalimaea quintana), an unusual rickettsial organism that
multiplies in the gut of the body louse. Transmission of the
rickettsia to people can occur by rubbing infected louse feces into
abraded (scuffed) skin or into the conjunctivae (whites of the eyes).
The disease is classically a 5-day fever. The onset of symptoms is
sudden with high fever, severe headache, back pain and leg pain and a
fleeting rash.
Recovery takes a month or more. Relapses are common.
It is now clear, that at least in its urban form among the
homeless, trench fever can be associated with nonspecific symptoms or
no symptoms (New England Journal of Medicine 340: 184-189, 1999).
The organism (B. quintana) that causes trench fever also has been
found responsible for a disease called bacillary angiomatosis in
people infected with HIV and for infection of the heart and great
vessels (endocarditis) with bloodstream infection.
Trench fever is also called Wolhynia fever, shin bone fever,
quintan
fever, Meuse fever, His' disease, His-Werner
disease, Werner-His disease.
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