Trench Fever

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

• Treatment is generally not required since spontaneous recovery occurs regularly