Symptoms of trench fever or quintan fever typically appear between 3 to 45 days after contact with the human louse which is the vector transmitting the causative bacteria, Bartonella quintana. The disease has been reported amongst individuals living in unhygienic conditions, such as homeless, in both developing and developed countries [1].

Classically, the onset of symptoms is sudden with high-grade fever appearing in one of three patterns along with rigors and sweating:

• Abortive fever: in which the fever lasts for several days, then abates and does not recur.
• Relapsing/quintan fever is the commonest pattern observed and occurs, most frequently, at intervals of 5 days (hence the name quintan fever). The fever has been reported to recur for months and even years after the initial episode.
• Continuous fever: Lasts for the entire duration of the disease.

The fever is accompanied by frontal or retro-orbital headaches with meningismus, photophobia, weakness, depression, restlessness, insomnia, shin and loin pain radiating to the upper back or lower extremities, dyspnea, conjunctivitis, and an erythematous, macular rash on the chest and back. Other symptoms like anorexia, nausea vomiting, diarrhea, or constipation may also be present. Although urban trench fever includes one or more of the above manifestations, its presentation tends to be more variable with abdominal and neurologic symptoms being uncommon [2] [3] [4] [5] [6] [7].
Certain syndromes are now known to be associated with Bartonella quintana infection. They may be asymptomatic and may have negative blood cultures. Their clinical features are:

• Chronic asymptomatic lymphadenopathy [2].
• Bacillary angiomatosis in immunocompetent individuals - cutaneous lesions with or without regional lymphadenopathy and without other systemic symptoms [4].
• Bacillary angiomatosis in immunocompromised individuals – more widespread cutaneous lesions with a possibility of an involvement of visceral organs.
• Bartonella quintana endocarditis with fever, cardiac murmur, heart failure, and embolic sequelae [8].
• Chronic Bartonella quintana bacteremia may last for years and may be accompanied by all of the above-mentioned manifestations [9].

• Fever

  First Known Use of trench fever 1915, in the meaning defined above Learn More about trench fever Resources for trench fever Statistics for trench fever More Definitions for trench fever \ ˈtrench- \ Medical Definition of trench fever : a disease that [merriam-webster.com]

  Trench fever is also called Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever, His disease and His-Werner disease. The disease is caused by the bacterium Bartonella quintana, found in the stomach walls of the body louse. [definitions.net]

  From Wikidata Jump to navigation Jump to search Human disease His-Werner disease Quintan fever Wolhynian fever shin bone fever tibialgic fever Trench fever Fever, Trench Bartonellosis due to Bartonella quintana infection Fevers, Trench Trench Fevers edit [wikidata.org]

  Classically, the onset of symptoms is sudden with high-grade fever appearing in one of three patterns along with rigors and sweating: Abortive fever: in which the fever lasts for several days, then abates and does not recur. [symptoma.com]

  Early on, highest on the list of possibilities was a kind of enteric fever, thus, a new relative of typhoid fever. The soldiers, with rare insight, began calling it “trench fever” and their superiors eventually followed suit in the summer of 1916. [kumc.edu]

• Cat Scratch

  Bartonella quintana is closely related to Bartonella henselae, the agent of cat scratch fever. U.S. [definitions.net]

  Bartonellosis and trench fever. ( 9002093 ) Bass J.W....Person D.A. 1997 21 Bartonella species infections, including cat-scratch disease, trench fever, and bacillary angiomatosis--what molecular techniques have revealed. ( 8779201 ) Tompkins L.S. 1996 [malacards.org]

  Enlarged lymph node resulting from cat scratch disease. Used with permission of NEJM. [cdc.gov]

  Bartonella quintana is closely related to Bartonella henselae, the agent of cat scratch fever and bacillary angiomatosis. The disease is classically a five-day fever of the relapsing type, rarely exhibiting a continuous course. [en.wikipedia.org]

  Cat scratch disease See separate Cat Scratch Disease article. Trench fever [ 4, 5 ] Synonyms: shinbone fever, five-day fever, Wolhynia fever, quintana fever, His-Werner disease Epidemiology It is caused by B. quintana. [patient.info]

• High Fever

  Also known as the five day fever, urban trench fever and quintan fever, it can last for up to three months. Symptoms include exceedingly high fever of up to 104° Fahrenheit (40° Celsius) and extreme leg pain. [wisegeek.com]

  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. [medicinenet.com]

  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. [en.wikipedia.org]

  The symptoms were high fever up to 104 Degrees F., leg pain, inflamed eyes, headaches, skin rashes and lymph involvement. These symptoms easily could be confused with the symptoms of Typhoid Fever or the flu. [kansasww1.org]

• Intermittent Fever

  National Library of Medicine (0.00 / 0 votes) Rate this definition: Trench Fever An intermittent fever characterized by intervals of chills, fever, and splenomegaly each of which may last as long as 40 hours. [definitions.net]

  It is characterized by the sudden onset of headache, hyperesthesia of the skin, pain in the back of the legs, and intermittent fever recurring every 4 to 5 days. [whonamedit.com]

  […] specific to the perinatal period ( P35-P39 ) influenza and other acute respiratory infections ( J00 - J22 ) Use Additional code to identify resistance to antimicrobial drugs ( Z16.- ) Certain infectious and parasitic diseases Clinical Information An intermittent [icd10data.com]

  So-called trench fever. Lancet 1915; ii : 1214 4. Hunt GH, Rankin AC. Intermittent fever of obscure origin occurring among British soldiers in France. The so-called “trench fever”. Lancet 1915; ii : 1133-6 5. Herringham WP. [ncbi.nlm.nih.gov]

• Anorexia

  Other symptoms like anorexia, nausea vomiting, diarrhea, or constipation may also be present. [symptoma.com]

  Acute-onset frontal or retro-orbital headache, often associated with a stiff neck and photophobia Neuropsychiatric symptoms, such as weakness, depression, restlessness, and insomnia Conjunctivitis Dyspnea Diffuse abdominal pain, often associated with anorexia [emedicine.com]

• Abdominal Pain

  This disease has two distinct phases: Oroya fever: During this phase, fever, headache, muscle aches, abdominal pain, and severe anemia may occur. [cdc.gov]

  Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself [nejm.org]

  pain, often associated with anorexia, nausea, vomiting, weight loss, diarrhea, and constipation Bone pain, particularly involving the shins; loin pain Erythematous, macular rash Urban trench fever typically includes 1 or more of these symptoms, but the [emedicine.com]

• Heart Failure

  Bartonella quintana endocarditis with fever, cardiac murmur, heart failure, and embolic sequelae. Chronic Bartonella quintana bacteremia may last for years and may be accompanied by all of the above-mentioned manifestations. [symptoma.com]

  Lethal cases are rare, but in a few cases "the persistent fever might lead to heart failure". Aftereffects may include neurasthenia, cardiac disturbances and myalgia. [en.wikipedia.org]

  The high fever caused by this disease can, in rare cases, lead to heart failure — which alcoholics and those who already have heart issues are already prone to. [wisegeek.com]

  […] valves; embolic events; possible heart failure Many patients with microbiologic or serologic evidence of B quintana infection are asymptomatic. [emedicine.com]

• Hepatomegaly

  […] episode to recurrent episodes to persistently elevated body temperature for weeks; conjunctivitis; skin eruption most commonly occurring during first fever episode; groups of erythematous macules or papules on abdomen, chest, and back; splenomegaly; hepatomegaly [link.springer.com]

  A transient macular or papular rash and, occasionally, hepatomegaly and splenomegaly occur. Endocarditis may complicate some cases. Relapses are common and have occurred up to 10 years after the initial attack. [msdmanuals.com]

• Skin Lesion

  Trench fever, infectious disease characterized by sudden onset with fever; headache; sore muscles, bones, and joints; and outbreaks of skin lesions on the chest and back. [britannica.com]

  Presentation Symptoms depend on the anatomical site involved and may include fever, tender lymphadenopathy and skin lesions. Lesions are often dark purple and resemble Kaposi's sarcoma. There may be enlargement of the liver, lymph nodes or spleen. [patient.info]

  Three additional syndromes are associated with B quintana infection, as follows: Chronic lymphadenopathy – Enlarged cervical lymph nodes, without fever or other associated symptoms Bacillary angiomatosis – characteristic skin lesions, with or without [emedicine.com]

• Insect Bite

  The vector for Trench Fever was, of course the body louse, pediculus corporis which became infected by feeding on the blood of infected soldiers; spread was by migration of the louse and infection of the new host by the insect bite or by scratching the [vlib.us]

• Myalgia

  […] came to prominence in the first world war. manifestations of trench fever ranged from a mild influenza-like illness to a debilitating protracted or recurrent disease onset may be insidious or abrupt recognised manifestations include fevers, headache, myalgia [gpnotebook.co.uk]

  The disease is spread by the human louse and is characterized by sudden onset of fever, headaches, myalgias, shin pain, arthralgia, and cutaneous lesions on the chest and back. [symptoma.com]

  Aftereffects may include neurasthenia, cardiac disturbances and myalgia. 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). [en.wikipedia.org]

  Common symptoms include headaches, anterior tibial pain, retro-orbital pain, myalgias, arthralgias, hepatosplenomegaly, truncal rash (80%-90% of patients), and fever, which cycles approximately every 5 days. [visualdx.com]

  The third type is an afebrile infection which can present with a variety of nonspecific symptoms including headaches, myalgias, rash, hepatosplenomegaly, vertigo, lymphadenopathy, and arthralgias. [journals.lww.com]

• Arthralgia

  The disease is spread by the human louse and is characterized by sudden onset of fever, headaches, myalgias, shin pain, arthralgia, and cutaneous lesions on the chest and back. [symptoma.com]

  Common symptoms include headaches, anterior tibial pain, retro-orbital pain, myalgias, arthralgias, hepatosplenomegaly, truncal rash (80%-90% of patients), and fever, which cycles approximately every 5 days. [visualdx.com]

  The third type is an afebrile infection which can present with a variety of nonspecific symptoms including headaches, myalgias, rash, hepatosplenomegaly, vertigo, lymphadenopathy, and arthralgias. [journals.lww.com]

• Eye Pain

  Signs and Symptoms 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 [skinsight.com]

• Headache

  The disease is spread by the human louse and is characterized by sudden onset of fever, headaches, myalgias, shin pain, arthralgia, and cutaneous lesions on the chest and back. [symptoma.com]

  Patient is restless with extreme pain in limbs and discomfort with headache confined mainly to the frontal or retro orbital region. Stiffness of neck may be present. [healthdrip.com]

  In 1915, a British medical officer on the Western Front reported on a soldier with relapsing fever, headache, dizziness, lumbago, and shin pain. [ncbi.nlm.nih.gov]

  Chief symptoms of the illness were headaches, skin rashes, inflamed eyes and leg pain. [dailyadvertiser.com.au]

  […] disease that came to prominence in the first world war. manifestations of trench fever ranged from a mild influenza-like illness to a debilitating protracted or recurrent disease onset may be insidious or abrupt recognised manifestations include fevers, headache [gpnotebook.co.uk]

• Hyperesthesia

  It is characterized by the sudden onset of headache, hyperesthesia of the skin, pain in the back of the legs, and intermittent fever recurring every 4 to 5 days. [whonamedit.com]

The diagnosis of trench fever should be suspected in individuals with poor personal hygiene and poor immunity. Classical symptoms may raise the suspicion of the disease but in atypical cases diagnosis can be challenging. Laboratory diagnosis of trench fever can be unequivocal. Bartonella quintana can be isolated by subculturing the blood culture broth although results may be available from anywhere between 14 to 45 days [9]. Cross-reactivity with other organisms is the cause of poor specificity of serological tests. In addition, the poor immune response in immunocompromised patients can interfere with tests. Immunofluorescent assays (IFAs) can be confirmatory in acute cases as well as convalescing patients.
Enzyme immunoassay (EIA) and enzyme-linked immunosorbent assay (ELISA) techniques are helpful in detection of antibodies [9] [10]. Endocarditis is associated with the highest levels of antibodies [9]. Polymerase chain reaction (PCR) assays and histochemical stains can detect Bartonella quintana DNA and are very specific if the results are positive [2]. Bartonella quintana DNA can be detected in vegetations obtained from cases of endocarditis as well as in skin samples if cutaneous lesions of bacillary angiomatosis are suspected [4] [9].

• Bartonella Quintana

  Definition of trench fever : a disease that is usually marked by fever and pain in muscles, bones, and joints and that is caused by a bacterium ( Bartonella quintana synonym Rochalimaea quintana ) transmitted by the human body louse ( Pediculus humanus [merriam-webster.com]

  The disease is caused by the bacterium Bartonella quintana, found in the stomach walls of the body louse. Bartonella quintana is closely related to Bartonella henselae, the agent of cat scratch fever. U.S. [definitions.net]

  Trench fever is caused by the Gram-negative bacterium, Bartonella quintana. [symptoma.com]

  From Wikidata Jump to navigation Jump to search Human disease His-Werner disease Quintan fever Wolhynian fever shin bone fever tibialgic fever Trench fever Fever, Trench Bartonellosis due to Bartonella quintana infection Fevers, Trench Trench Fevers edit [wikidata.org]

  […] being reclassified as Bartonella quintana in 1993. [emedicine.com]

Treatment Erythromycin and azithromycin are both used to treat trench fever. Four weeks of treatment are usually necessary. Inadequate treatment often results in a relapse. [encyclopedia.com]

Treatment Weil Felix reaction is negative both for 0X19 and OXK. Complement fixation reaction and indirect fluorescent antibody (IFA) tests may help in making diagnosis. [healthdrip.com]

Treatment is with a macrolide or doxycycline. Humans are the only reservoir of this Bartonella infection. B. quintana is transmitted to humans when feces from infected lice are rubbed into abraded skin or the conjunctiva. [msdmanuals.com]

Prognosis 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. [encyclopedia.com]

Prognosis Usually self-limiting. Trench fever re-infection may occur within 3-6 months because antibodies do not give full protection. [patient.info]

Prognosis In most immunocompetent hosts, B quintana infection is self-limited unless endocarditis occurs. In immunocompromised hosts, however, B quintana infection tends to be more severe and may result in death. [emedicine.com]

Abstract Rochalimaea quintana, the etiological agent of trench fever, was tested by an agar dilution method for its susceptibility to the following 14 antibiotics: penicillin G, methicillin, ampicillin, cephalothin, vancomycin, doxycycline, tetracycline [ncbi.nlm.nih.gov]

The etiology of the Typhus Fever (Tabardillo) of Mexico City. Journ. Amer. Med. Assoc. LIV. p. 1373. [journals.cambridge.org]

DOI: 10.1128/AAC.25.6.690 ABSTRACT Rochalimaea quintana, the etiological agent of trench fever, was tested by an agar dilution method for its susceptibility to the following 14 antibiotics: penicillin G, methicillin, ampicillin, cephalothin, vancomycin [aac.asm.org]

Author information 1 Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda. [email protected] 2 CTS Global assigned to U.S. [ncbi.nlm.nih.gov]

More recently, Koehler et al. [ 12 ] analyzed the molecular epidemiology of bartonella infections in HIV-infected patients with bacillary angiomatosis in San Francisco. [doi.org]

[…] of Macacus rhesus with Rickettsia quintana (trench fever). ( 13120859 ) MOOSER H....WEYER F. 1953 38 Hurst A. 1942 39 Trench Fever: Final Report of the War Office Trench Fever Investigation Committee. ( 20474739 ) Bruce D. 1921 40 Trench Fever: Its Epidemiology [malacards.org]

PATHOPHYSIOLOGY The bacterium infects endothelial cells and can infect erythrocytes by binding and entering with a large vacuole Once inside, they begin to proliferate and cause nuclear atypia This leads to the suppression of cells apoptosis and result [slideshare.net]

The spectrum of disease associated with B quintana infection includes asymptomatic infection, urban trench fever, angioproliferative disease, chronic lymphadenopathy, bacteremia, and endocarditis. [9, 14, 15] Pathophysiology The human body louse P humanus [emedicine.com]

In the future, our laboratory-derived B. quintana mutant may play a useful role in angiogenesis models and help to clarify the pathophysiology and treatment of B. quintana infection. [doi.org]

Centers for Disease Control and Prevention, Kigali, Rwanda. 10 National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia. 11 University of British Columbia, Vancouver, Canada. [ncbi.nlm.nih.gov]

Prevention Prevention involves good hygiene and decent living conditions. When this is impossible, insecticide dusting powders are available to apply to clothing. [encyclopedia.com]

The control of body lice is the chief means of prevention. [britannica.com]

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