(See also Overview of Bartonella Infections Overview of Bartonella Infections Bartonella species are gram-negative bacteria previously classified as Rickettsiae. They are facultative intracellular organisms that typically live within red blood cells (RBCs) and... read more .)
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.
Trench fever is endemic in Mexico, Tunisia, Eritrea, Poland, and the former Soviet Union and is reappearing in the homeless population in the US.
Symptoms and Signs of Trench Fever
After a 14- to 30-day incubation period, onset of trench fever is sudden, with fever, weakness, dizziness, headache (with pain behind the eyes), conjunctival injection, and severe back and leg (shin) pains.
Fever may reach 40.5° C and persist for 5 to 6 days. In about half the cases, fever recurs 1 to 8 times at 5- to 6-day intervals.
A transient macular or papular rash and, occasionally, hepatomegaly and splenomegaly occur. Endocarditis Infective Endocarditis Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic... read more may complicate some cases.
Relapses are common and have occurred up to 10 years after the initial attack.
Diagnosis of Trench Fever
Serologic tests and polymerase chain reaction (PCR) testing
Trench fever should be suspected in people living where louse infestation is heavy.
Leptospirosis Leptospirosis Leptospirosis is an infection caused by one of several pathogenic serotypes of the spirochete Leptospira. Symptoms are biphasic. Both phases involve acute febrile episodes; the 2nd phase... read more , typhus Diseases Caused by Rickettsia, Orientia, Ehrlichia, Anaplasma, and Coxiella Species , relapsing fever Relapsing Fever Relapsing fever is a recurring febrile disease caused by several species of the spirochete Borrelia and transmitted by lice or ticks. Symptoms are recurrent febrile episodes with headache... read more , and malaria Malaria Malaria is infection with Plasmodium species. Symptoms and signs include fever (which may be periodic), chills, rigors, sweating, diarrhea, abdominal pain, respiratory distress, confusion... read more must be considered.
The organism is identified by blood culture, although growth may take 1 to 4 weeks. The disease is marked by persistent bacteremia Bacteremia Bacteremia is the presence of bacteria in the bloodstream. It can occur spontaneously, during certain tissue infections, with use of indwelling genitourinary or IV catheters, or after dental... read more during the initial attack, during relapses, throughout the asymptomatic periods between relapses, and in patients with endocarditis.
Serologic testing is available and can provide support for the diagnosis. High titers of IgG antibodies should trigger evaluation for endocarditis Diagnosis Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic... read more with cardiac echocardiography. PCR testing of blood or tissue samples can be done.
Treatment of Trench Fever
Doxycycline or a macrolide
Although recovery is usually complete in 1 to 2 months and mortality is negligible, bacteremia may persist for months after clinical recovery, and prolonged (> 1 month) doxycycline or macrolide treatment may be needed. Patients are given doxycycline 100 mg orally 2 times a day for 4 to 6 weeks, plus, if endocarditis is suspected, gentamicin 3 mg/kg/day IV for the initial 2 weeks. Combination therapy is given for serious or complicated infections.
Body lice Body lice Lice can infect the scalp, body, pubis, and eyelashes. Head lice are transmitted by close contact; body lice are transmitted in cramped, crowded conditions; and pubic lice are transmitted by... read more must be controlled.
Patients with chronic bacteremia should be monitored for signs of endocarditis.