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Trench Fever

Fevers Trench

Trench fever is caused by the Gram-negative bacterium, Bartonella quintana. 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. A high incidence of the illness was reported during the two world wars and is now reported amongst those living in unhygienic conditions or extreme poverty.


Presentation

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
  • 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]
  • Trench fever (also known as "five-day fever", "quintan fever" (febris quintana in Latin), and "urban trench fever") is a moderately serious disease transmitted by body lice.[en.wikipedia.org]
  • Within months, additional cases were described, mostly in frontline troops, and the new disease was called trench fever.[ncbi.nlm.nih.gov]
  • It may have amounted at times to one half or more of 'fever'. This may account for the comparatively low mortality in some years from 'fever'.[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]
Constipation
  • Other symptoms like anorexia, nausea vomiting, diarrhea, or constipation may also be present.[symptoma.com]
  • […] 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, nausea, vomiting, weight loss, diarrhea, and constipation[emedicine.com]
Heart Failure
  • 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]
  • 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]
  • 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]
  • failure Many patients with microbiologic or serologic evidence of B quintana infection are asymptomatic.[emedicine.com]
Tachycardia
  • […] 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; tachycardia[link.springer.com]
  • Characteristics of classic trench fever were fairly consistent, as follows: Fever up to 104 F Toxic initial appearance associated with prostration Characteristic blanching, erythematous, macular rash Conjunctivitis at the onset of illness Paroxysmal tachycardia[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]
Maculopapular Rash
  • rash spread of disease was associated with crowded, insanitary living conditions disease was rarely fatal.[gpnotebook.co.uk]
  • Other frequent features of trench fever included a transient maculopapular rash, conjunctivitis, severe headache, myalgias, and, in chronic cases, splenomegaly.[doi.org]
Muscle Tenderness
  • tenderness Loss of Achilles reflex Associated lice infestation Physical findings of urban trench fever are more variable, but tend to include the following: Presence of rash, fever, conjunctivitis, bone tenderness, splenomegaly, and neuropsychiatric[emedicine.com]
Photophobia
  • 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[symptoma.com]
  • Acute-onset fever in any of 3 distinct patterns, all of which are often associated with chills and diaphoresis: Abortive, relapsing (the most common pattern), or continuous Acute-onset frontal or retro-orbital headache, often associated with a stiff neck and photophobia[emedicine.com]

Workup

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
  • Trench fever is caused by the Gram-negative bacterium, Bartonella quintana.[symptoma.com]
  • KEYWORDS: Bartonella quintana; DNA sequencing; Pediculus humanus capitis; Rickettsia prowazekii[ncbi.nlm.nih.gov]
  • 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]
  • The disease is caused by the bacterium Bartonella quintana (older names: Rochalimea quintana, Rickettsia quintana), found in the stomach walls of the body louse.[en.wikipedia.org]
  • Background Trench fever is a clinical syndrome caused by infection with Bartonella quintana.[emedicine.com]
Rickettsia Akari
  • Sera from patients with other rickettsial infections were also tested for reactivity with R. quintana antigen: typhus group (Rickettsia prowazekii, Ricketsia mooseri), 15 sera; spotted fever group (Ricketsia ricketsii, Rickettsia akari), eight sera; and[ncbi.nlm.nih.gov]
  • akari A79.8 Other specified rickettsioses A79.81 Rickettsiosis due to Ehrlichia sennetsu A79.89 Other specified rickettsioses A79.9 Rickettsiosis, unspecified A80 Acute poliomyelitis A80.0 Acute paralytic poliomyelitis, vaccine-associated A80.1 Acute[icd10data.com]
Rickettsia Typhi
  • Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil. Mem Inst Oswaldo Cruz . 2005 Dec. 100(8):853-9.[emedicine.com]
Plasmodium Falciparum
  • S84 - 92 ) 19 Effect of vitamin A supplementation on morbidity due to Plasmodium falciparum in young children in Papua New Guinea: a randomised trial , Lancet , 1999 , vol. 354 (pg. 203 - 9 ) 20 Return of trench fever [letter] , Lancet , 1995 , vol. 345[doi.org]

Treatment

  • 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]
  • Treatments Your Physician May Prescribe Your doctor may choose to test your blood for the presence B. quintana .[skinsight.com]

Prognosis

  • 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 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]

Etiology

  • 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]
  • Abstract Although trench fever appears to be endemic in many areas of the world, recognition of the disease has been handicapped by the difficulties of making a clinical diagnosis and the unavailability of a simple laboratory procedure to establish the etiology[ncbi.nlm.nih.gov]
  • BACKGROUND: Bartonella quintana, the etiologic agent of trench fever and other human diseases, is transmitted by the feces of body lice.[ncbi.nlm.nih.gov]
  • 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]
  • The etiology of the Typhus Fever (Tabardillo) of Mexico City . Journ. Amer. Med. Assoc . LIV . p. 1373 .[journals.cambridge.org]

Epidemiology

  • Author information 1 Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda. [email protected].com. 2 CTS Global assigned to U.S.[ncbi.nlm.nih.gov]
  • Between January and September, 1997, nationwide epidemiological data on the prevalence and distribution of sutama was obtained through liaison with local health services.[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]
  • Epidemiology Predisposing factors for B quintana infection include war, famine, malnutrition, homelessness, alcoholism, intravenous (IV) drug abuse, and poor hygiene.[emedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • 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]

Prevention

  • 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]

References

Article

  1. Badiaga S, Brouqui P. Human louse- transmitted infectious diseases. Clin Microbiol Infect. 2012;18(4):332-337
  2. Maurin M, Raoult D. Bartonella (Rochalimaea) quintana infections. Clin Microbiol Rev. 1996;9(3):273-292.
  3. Matera G, Liberto MC, Joosten LA, et al. The Janus face of Bartonella quintana recognition by Toll-like receptors (TLRs): a review. Eur Cytokine Netw. 2008;19(3):113-118.
  4. Foucault C, Brouqui P, Raoult D. Bartonella quintana characteristics and clinical management. Emerg Infect Dis. 2006;12(2):217-223.
  5. Drancourt M, Mainardi JL, Brouqui P et al. Bartonella (Rochalimaea) quintana endocarditis in three homeless men. N Engl J Med. 1995; 332: 419–423.
  6. Raoult D, Fournier PE, Vandenesch F, et al. Outcome and treatment of Bartonella endocarditis. Arch Intern Med. 2003; 163(2):226-230.
  7. Foucault C, Barrau K, Brouqui P, Raoult D. Bartonella quintana Bacteremia among Homeless People. Clin Infect Dis. 2002; 35(6):684-689.
  8. Fournier PE, Lelievre H, Eykyn SJ, et al. Epidemiologic and clinical characteristics of Bartonella quintana and Bartonella henselae endocarditis: a study of 48 patients. Medicine (Baltimore). 2001; 80(4):245-251.
  9. LaScola B, Raoult D. Culture of Bartonella quintana and Bartonella henselae from human samples: a 5-year experience from 1993 to 1998. J Clin Microbiol. 1999;37(6):1899-905.
  10. Brouqui P, Houpikian P, Dupont HT, et al. Survey of the seroprevalence of Bartonella quintana in homeless people. Clin Infect Dis. 1996; 23(4):756-759.

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Last updated: 2017-08-09 17:32