Trench Fever

A self-limited, louse-borne relapsing febrile disease caused by Bartonella quintana

Epidemic infection in louse-infested troops and civilians during wars

Endemic in scattered geographic areas (eg, Central America)

An urban equivalent of trench fever has been described among the homeless

Humans acquire infection when infected lice feces enter sites of skin breakdown

Recently recognized as an important cause of culture-negative endocarditis

Onset of symptoms is abrupt

Fever lasts 3–5 days with relapses

Patient complains of weakness and severe pain behind the eyes and typically in the back and legs

Lymphadenopathy, splenomegaly, and a transient maculopapular rash may appear

Subclinical infection is frequent, and a carrier state is recognized

Differential diagnosis

• Other febrile, self-limited states, such as

  • Dengue

  • Leptospirosis

  • Malaria

  • Relapsing fever

  • Typhus

Blood cultures

• B quintana will grow in standard BACTEC media

• Growth may require incubation for 4–6 weeks

Positive serology with a compatible clinical syndrome: either documented seroconversion or high titer of antibody (≥ 1:1600) in single ELISA or immunofluorescence test

Treatment is generally not required since spontaneous recovery occurs regularly