Trench Fever - Causes, Symptoms, Diagnosis, and Treatment

 

Trench fever is also called as "five-day fever". Usually this disease is caused by the gram-negative bacterium Bartonella quintana which is typically a louse borne disease and it was observed originally in military people during World War I and II. Bartonella quintana infection’s only reservoir is humans. This Trench fever caused a huge epidemic during the period of World War I, because it is the source of morbidity and mortality and it affected 1 million military soldiers. Because of this infection, soldiers were reported with relapsing fever, headache, dizziness, and shin pain. Typically, the symptoms of trench fever are acute with an occasional rash.

Diagnosis is made through blood culture tests. People with Trench fever are usually treated with macrolide or Doxycycline. Typically, this infection rarely causes death but in some severe cases can be debilitating. Trench fever infection in previous years became endemic in some of the countries like Mexico, Eritrea, Tunisia, Poland, and the former Soviet Union. Nowadays, in the US, this infection is reappearing in homeless people. A mature body louse lives in the body for 20 days to 30 days. Generally, humans are the foremost main host for this gram-negative bacterium Bartonella quintana bacteria but some researchers have reported the identification of bartonella bacteria in mammal species like macaques, cats, and dogs.

Causes

Bartonella quintana bacteria is primarily carried by a vector called the body louse. Usually, the louse reproduces in the part of intestinal lumen and louse can transmit the infection or diseases via louse contaminated feces of louse in the exposed skin or conjunctivae. This route of transmission is documented by the medical research committee which was set up by the American Red Cross in the year of 1918. Bacteria remains infective in dried feces from the louse body which can be inhaled as well. Transmission can be detected in crowded areas and among people who have poor hygiene especially homeless people and alcohol abusers. Body lice are mainly transmitted through direct contact with an infected person and it can also occur through fomites, clothes, or bedding.

Who Is At Risk?

Nowadays, Trench fever can be identified around the world but it can occur usually among people who live close together with poor sanitary conditions.

Usually occurs in:

• Particularly Homeless people, or those in poor hygiene shelters or people with no resources to clean clothes.

• Homeless people who are alcohol abusers are at higher risk.

• Roommate in prisons.

• Refugee people in camps.

Symptoms 

An incubation period of 14 to 30 days is noticeable period after which the following symptoms are appear:

• Fever which comes and goes 1 to 8 times in a 5-day cycle and it may reach 40.5 °C and this fever can last about 5 to 6 days.

• Sudden headache

• Often feel Pain behind the eyes.

• Usually pain in the shin.

• Full body aches.

• General rashes which look like pink to red patches and small bumps which can appear and disappear along with the fever which can be usually seen on the chest as the fever comes and goes.

• More often hepatomegaly and splenomegaly are associated.

• In some complex cases, Endocarditis will appear.

Relapses are most common which can occur up to 10 years after the first attack.

Diagnosis

Trench fever infection is generally diagnosed through :

• Blood cultures - which identify the organism but it may take up to 1 to 4 weeks for results.

• Serologic tests - which provide the support for the diagnosis of infection.

• Polymerase chain reaction (PCR) testing  - which tests the  blood or tissue samples can be done.

Treatment

Typically, physicians prescribed medications like Doxycycline, a macrolide, or Ceftriaxone. Recovery from a trench fever is completely flushed away in a month to 2 months. But mortality is negligible but bacteremia may live for months after the recovery. Hence, More than a month of  Doxycycline or macrolide treatment might be needed. People with chronic bacteremia must be monitored for any signs of endocarditis.

Complications of Trench Fever

Chronically infected patients particularly those who had compromised immune systems must have developed endocarditis. Typically, people with endocarditis disease have associated symptoms like chest pain, weight loss, shortness of breath, night sweats, malaise, cough, and fatigue. Usually, the clinical examinations resemble classic endocarditis. This can also include Janeway lesions, new cardiac murmurs, Osler nodes, and vascular and immunologic phenomena.

Self-Care Methods 

Mainly you have to focus on getting rid of body lice completely to prevent reinfection. If you infected with trench fever:

• You should Bathe regularly.

• You must change clothes frequently and you must wash them regularly. Body lice highly avoided the cold and dryness. Body lice are found on clothes which come in contact with human skin. This trench fever infection can be controlled to a certain level by disposing of the infected clothes. Clothes also be washed and dried at above the temperature of  60ºC,

• For the sake of fever, you can take Acetaminophen, Aspirin, Ibuprofen  which can be avoided for children who are under 18 years twice daily after food.

• If an itching rash is present, then you should avoid scratching. Because this may lead to further bacterial infections.

• You should take more rest and stay well hydrated.

Visit Urgency

You should see your healthcare professional for any illness which causes recurrent fever especially if the fever lasts more than 5 days. Usually, the signs and symptoms of trench fever are more common to many other illnesses, so it is more important to talk to your doctor if you suspect that you have body lice or trench fever.

Frequently Asked Questions

Q1. What causes trench fever?

Ans: Trench fever is a vector-borne disease primarily transmitted by the human body louse Pediculus humanus humanus.

Q2. Can trench fever be cured?

Ans: Trench fever is cured with antibiotic treatment protocol depending upon the disease presentation. 

Q3. What is trench fever called by?

Ans: Trench fever is an infection caused by the fastidious aerobic gram-negative rod bacteria, Bartonella quintana, formerly known as Rickettsia quintana.

Q4. How serious was trench fever?

Ans: In the past, trench fever was a serious condition that could lead to death. Today, most cases of trench fever are curable with early diagnosis and treatment.