Trench fever is a bacterial infection caused by the bacterium Bartonella quintana, which is carried and transmitted to humans by the common body louse a small, wingless insect that lives in the clothes of infested people. Trench fever received its name during World War I, when millions of troops living in close, unhygienic quarters were infested with body lice and infected with trench fever.
Trench fever is not usually a serious disease and can be easily treated; if left untreated, serious complications include heart damage. In the United States, this usually includes:.
Fever that comes and goes in a 5-day cycle Headache Pain behind the eyes Pain in the shin bones General body aches Classic rash — pink-red patches and small bumps that appear and disappear, usually on the chest, as the fever comes and goes.
It is important to get rid of the body lice entirely to prevent reinfection. Symptoms and signs include fever which may be periodic , chills, rigors, sweating, diarrhea, abdominal pain, respiratory distress, confusion, seizures The organism is identified by blood culture, although growth may take 1 to 4 weeks. The disease is marked by persistent bacteremia Bacteremia Bacteremia is the presence of bacteria in the bloodstream. It can occur spontaneously, during certain tissue infections, with use of indwelling genitourinary or IV catheters, or after dental Serologic testing is available and can provide support for the diagnosis.
High titers of IgG antibodies should trigger evaluation for endocarditis Diagnosis Infective endocarditis is infection of the endocardium, usually with bacteria commonly, streptococci or staphylococci or fungi.
PCR testing of blood or tissue samples can be done. Doxycycline , a macrolide, or ceftriaxone. Combination therapy is given for serious or complicated infections. Body lice Body lice Lice can infect the scalp, body, pubis, and eyelashes. Head lice are transmitted by close contact; body lice are transmitted in cramped, crowded conditions; and pubic lice are transmitted by From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.
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This site complies with the HONcode standard for trustworthy health information: verify here. Although it causes prolonged disability, the mortality of trench fever is low.
Chronic bacteraemia is possible due the ability of B. This has been demonstrated in both immunocompromised and immunocompetent patients. Fever is frequently reported. Valvular vegetations are often visible on echocardiography.
Laboratory confirmation assays can be performed on cardiac valve if surgery is required. Differential diagnoses vary according to the clinical presentation, and include: Trench fever: louse-borne and tick-borne relapsing fever, infection due to B. Bacillary angiomatosis: Kaposi sarcoma, pyogenic granuloma, or Peruvian wart verruga peruana due to Bartonella bacilliformis.
Lymphadenopathy: infectious fungal infection, tularaemia, tuberculosis, plague, lymphogranuloma venereum LGV , AIDS, and syphilis and non-infectious causes lymphoma, leukaemia and other neoplasms.
Epidemiology Historically, trench fever was described in relation to outbreaks among soldiers during the first and second world wars. Since then, few cases have been documented, mainly in Europe and Russia. The disease is considered to have a worldwide distribution based on serological evidence and molecular identification Africa and South-east Asia notably [4,5].
During the s, B. The main risk factors for infection are impoverished, overcrowded and unhygienic conditions, chronic alcoholism, cat-contact, and body louse infestation. The disease is therefore primarily observed among homeless people. Small case series of B. Humans are considered the main host for this organism but several publications have reported isolation or molecular identification of the bacteria in mammals macaques, cats and dogs [8].
Transmission B. However head lice, Pediculus humanus capitis , have been found to be infected, but their role as a vector has not been established. When feeding on an infected human, the body louse ingests B.
Body louse infection is lifelong. Infected dried body louse faeces can remain infectious for 12 months and new cases can arise for some time even after elimination of the louse population [8,14]. Human infection probably results from inoculation of B. The transmission does not invoke the death of the louse, therefore an individual louse can spread the disease to several persons.
On average a mature body louse lives for 20—30 days. Diagnostics The laboratory diagnostic of choice is isolation in culture from blood or tissues on specific media under specific conditions. Due the low-growing characteristic of B. Regarding serological test, indirect immunofluorescence assay is the reference method.
However cross reactions are possible, notably with other Bartonella species. High levels of antibodies are usually detected among immunocompetent patients with endocarditis related to B. Serologic testing cannot stand alone as a means to confirm Bartonella infection and should be interpreted in the context of the clinical presentation, immunological status of the patient and results of others supporting laboratory test.
Immunohistochemical tests are supportive of the diagnosis of bacillary angiomatosis or identification with biopsies cardiac valve, lymph node, skin or other tissue. PCR—based genomic assays on blood and tissues can distinguish Bartonella species in targeting specific genes. Case management and treatment [2,15,16] Information on efficacy of treatment is limited due to the small number of studies available and so choice of treatment relies on expert recommendations.
Note that doxycycline should not be used in children as tooth discoloration is a concern.
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