Trench fever
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Trench fever is a moderately serious disease, transmitted by lice, that infected more than a million soldiers during World War I and World War II. The disease persists among the homeless. Outbreaks have been documented, for example, in Seattle and Baltimore among injected drug users and in Marseille and Burundi.
Trench fever is also called Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever, His disease and His-Werner disease (after Wilhelm His, Jr. and Heinrich Werner).
The disease is caused by the organism Bartonella quintana, found in the stomach walls of the body louse.
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Symptoms
The disease is classically a 5-day fever, rarely with a contiunous course instead. Latent period is relatively long (circa 2 weeks). The onset of symptoms is usually sudden with high fever, severe headache, back and leg pain and a fleeting rash. Spleen enlargement is very common (50-90% of cases). Recovery takes a month or more. Relapses are common.
Transmission
Transmission of the disease to people can occur by rubbing feces of infected louse into abraded skin or into the eyes.
Diagnostics
Serological testing (e.g., the Weil-Felix test) is typically used to obtain a definitive diagnosis. Most serological tests would succeed only after a certain period of time past the symptom onset (usually a week). Differential diagnosis list includes typhus, Ehrlichiosis, leptospirosis, Lyme disease and virus-caused exanthema (measles, rubella).
Treatment
Tetracycline-group antibiotics (doxycycline, tetracycline) are commonly drugs of choice. Laevomycetine is an alternative medication recommended under circumstances that render tetracycline derivates usage undesirable (such as severe liver malfunction, kidney deficiency, in children under 9 years and pregnant). The drug is administered for 7-10 days.
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