What is Trench Fever: Causes, Symptoms, Treatment, Risk Factors, Prevention

Trench Fever is a louse-borne disease that affects humans. It was first observed among the military population during World War I and World War II (hence the name ‘Trench Fever’) ⁽¹⁾. It is a bacterial disease caused by a gram-negative bacterium called Bartonella quintana (also called as Rochalimaea quintana) found within the stomach walls of body louse. Trench Fever transmits from one human to other when faeces from infected lice rubs onto abraded skin on the conjunctiva. This condition is considered endemic in Poland, Tunisia, Eritrea, Mexico and Soviet Union. It has been noted that Trench Fever is now reappearing among the homeless population in the United States of America. Trench fever is also known as five-day fever, shin bone fever, Meuse fever, quintan fever, Wolhynia fever, His-Werner disease, and Werner-His disease.

Trench Fever generally begins with sudden onset of high fever associated with back pain, severe headache, dizziness, weakness, leg pain and rash⁽²⁾. The affected person may also experience pain behind the eyes which worsens with eye movement, generalised muscle soreness and increased sensitivity over the shins. The most common symptom of Trench Fever is pain in legs. Another classic sign is the appearance of pinkish-red rash in small patches and bumps commonly over the chest area that comes and goes. Trench Fever generally lasts for about 5 to 6 days and can reach up to 40.5 degree Celsius. Complete recovery takes about a month. It is not uncommon to have relapse of trench fever with or without fever. Relapse can occur at intervals of 5 – 6 days recurring about 1 to 8 times. There are cases where relapse of Trench Fever has occurred for up to 10 years post initial attack⁽³⁾. The incubation period is about 15 – 25 days; however, it has been found to be 6 days under experimental conditions⁽⁴⁾. In rare cases, the persistent fever can lead to cardiac failure (endocarditis) which can eventually lead to death⁽⁵⁾.

As mentioned earlier, Trench Fever is caused by infection caused by the bacterium called as Bartonella quintana. The bacteria transmit upon contamination of abraded skin with faeces of infected body louse. The body louse is a wingless insect that lives in the clothes of the infected patients. In some cases, body lice bite can also cause transmission of the infection.

Trench Fever poses a threat to people who live in close groups in unhygienic conditions. It is more likely to occur in overcrowded and other low socio-economic conditions. Some of these include:

• Inmates living in unhygienic and poor sanitary conditions
• Refugees in camps
• Homeless population who do not have access to clean clothes and other hygienic facilities
• Healthcare workers who work closely with patients with Trench Fever.

Trench Fever is suspected among people who live in louse infested areas. When one is suspected, confirmatory tests such as blood cultures, serological tests, and PCR are advised. Tests are done to rule out other diseases such as typhus, relapsing fever, malaria and leptospirosis.

Trench Fever is confirmed upon lab findings that shows bacteraemia in the blood samples of the patient⁽⁶⁾. Other supporting tests such as serological tests showing high titre of IgG antibodies will further confirm the diagnosis. High level of IgG should also trigger immediate evaluation for endocarditis. Additional supporting tests include PCR testing of blood and/or tissue samples ⁽⁷⁾.

Trench Fever is treated with antibiotics such as Doxycycline (a macrolide) or Ceftriaxone. Strict measures should be taken to control the spread of body lice. Although the Trench Fever patient usually recovers clinically in 1 to 2 months, the bacteria may still be present within the patient for months after the initial attack leading to relapse. Thus, an extended coverage of doxycycline or other macrolide may be required. In most of the cases, 100 mg of doxycycline is prescribed for 4 to 6 weeks or longer. Gentamycin is prescribed if endocarditis is suspected. As with every other illnesses, adequate hydration and rest is recommended.

Preventive measures include controlling the spread of the body lice by maintaining hygiene and proper sanitation ⁽¹⁾. It is advised to bathe regularly and change clothes regularly. Bed sheets and other clothes should be laundered regularly in temperature above 60 degree Celsius. Oral ivermectin is often recommended by health care providers for body delousing. In case of rash, itching should be avoided as abrasion of skin can cause further infection with bacteria.

Trench Fever is a contagious, relapsing, bacterial disease that transmits though body louse. It is commonly seen among groups of people living in unhygienic conditions. Trench Fever disease starts with high fever that lasts for about 5 days followed by frequent episodes of relapse. Other symptoms includes rash over chest, pain over shin, muscle soreness, weakness, pain behind eyes etc. Treatment for Trench fever is done with antibiotics such as Doxycycline. In extreme cases, trench fever can lead with serious complication such as endocarditis and even death if left uncontrolled. Preventive measures include eradication of body louse and maintaining hygiene.

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