Trench fever is a louse-borne disease caused by the gram-negative bacterium Bartonella quintana
(See also Overview of Bartonella Infections.)
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. It is reappearing in people who are unhoused in the United States.
Symptoms and Signs of Trench Fever
After a 3- to 35-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 may complicate some cases.
Relapses are common and have occurred up to 10 years after the initial attack.
Diagnosis of Trench Fever
Blood cultures
Serologic tests and polymerase chain reaction (PCR) testing
Trench fever should be suspected in people living where louse infestation is heavy. It should also be considered in potentially exposed patients with endocarditis whose routine blood cultures are negative (culture-negative endocarditis) (1).
Leptospirosis, typhus, relapsing fever, and malaria must be considered as alternative diagnoses.
The organism is identified by blood culture, although growth may take 1 to 4 weeks.
The disease is marked by persistent bacteremia 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 with cardiac echocardiography. PCR testing of blood or tissue samples can be done.
Diagnosis reference
1. Spach DH, Kanter AS, Daniels NA, et al. Bartonella (Rochalimaea) species as a cause of apparent "culture-negative" endocarditis. Clin Infect Dis. 1995;20(4):1044-1047. doi:10.1093/clinids/20.4.1044
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, so prolonged (>doxycycline
Body lice must be controlled.
Patients with chronic bacteremia should be monitored for signs of endocarditis.
