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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]
  • 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]
  • 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]
  • Within months, additional cases were described, mostly in frontline troops, and the new disease was called trench fever.[ncbi.nlm.nih.gov]
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]
  • .- ) Certain infectious and parasitic diseases Clinical Information An intermittent fever characterized by intervals of chills, fever, and splenomegaly each of which may last as long as 40 hours.[icd10data.com]
  • 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]
  • Intermittent fever of obscure origin occurring among British soldiers in France. The so-called “trench fever”. Lancet 1915; ii : 1133-6 5. Herringham WP. On trench fever and its allies. Q J Med 1915- 16 ; 9 : 429-32 6. The National Archive.[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]
Vomiting
  • Other symptoms like anorexia, nausea vomiting, diarrhea, or constipation may also be present.[symptoma.com]
  • ‘Diarrhoea and vomiting affected everyone, as did the fiery aches and pains of trench fever, or ‘pyrrhexia of unknown origin’ as Captain Ivoro insisted on calling it.’[oxforddictionaries.com]
  • […] 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, nausea, vomiting[emedicine.com]
Constipation
  • Other symptoms like anorexia, nausea vomiting, diarrhea, or constipation may also be present.[symptoma.com]
  • Lieutenant W J Rutherford, for example, suggested that the common field vole or mouse might transmit the disease. 11 Another dissenter, Captain B Hughes, claimed that trench fever might be the result of a rat-derived infection, combined with constipation[ncbi.nlm.nih.gov]
  • […] 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]
Nausea
  • Other symptoms like anorexia, nausea vomiting, diarrhea, or constipation may also be present.[symptoma.com]
  • Non-specific, including headache, muscle ache, fever, and nausea. Humans are the only known reservoir. The human body louse Pediculus humanus. Via feces of infected body lice being scratched into the skin.[extension.entm.purdue.edu]
  • […] 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, nausea[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]
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 yr after the initial attack.[msdmanuals.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]
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]
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]
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]
  • 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]
  • 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]
  • 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]
  • […] 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]
Insomnia
  • 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]
  • […] 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 Neuropsychiatric symptoms, such as weakness, depression, restlessness, and insomnia[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 Prowazekii
  • KEYWORDS: Bartonella quintana; DNA sequencing; Pediculus humanus capitis; Rickettsia prowazekii[ncbi.nlm.nih.gov]
  • It must be admitted that, had this rickettsia had the lethality of its cousin, the agent of typhus, Rickettsia prowazekii, the war on the Western Front might have gone quite differently.[kumc.edu]
Rickettsia Rickettsii
  • 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. [Medline].[emedicine.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. [Medline].[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 (pg[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]
  • 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]
  • Diagnosis, treatment The most widely used method to diagnose B. quintana infection is serological testing, using indirect immunofluorescence or western blot.[healio.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 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]

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]
  • The etiology of the Typhus Fever (Tabardillo) of Mexico City. Journ. Amer. Med. Assoc. LIV. p. 1373.[journals.cambridge.org]
  • The etiology of their infection was confirmed by xenodiagnostic louse-feeding. R. quintana was propagated from the blood of both volunteer patients directly on blood agar.[ajtmh.org]

Epidemiology

  • Author information 1 Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda. umulisa5@gmail.com. 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]
  • 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: 2019-07-11 22:17