Trench Fever

What is Trench Fever?

Trench fever (synonym: Volyn fever, five-day fever) is an infectious disease characterized by short repeated bouts of fever, rash and muscle pain of various localization.

Trench fever was first described among the soldiers who fought in Europe during World War I as a severe infection, accompanied by the prolonged presence of Bartonella quintana in the blood. In recent years, trench fever has reappeared in the United States, and it can be caused by both Bartonella quintana and Bartonella henselae, the causative agent of bacterial angiomatosis and felinosis.

Causes of Trench Fever

The causative agent of trench fever – rickettsia Rochalimaea quintana. Sources of the causative agent of infection are sick people, sometimes having had a disease, in the blood of which the causative agent can remain up to 1-2 years, the carrier is the clothes louse. Human infection occurs when feces are infected with lice infected with rickettsia in superficial wounds formed when combing the skin at the bite sites. Individual cases of the disease are found in various regions of the globe, with adverse sanitary and hygienic conditions (for example, war, famine), epidemic outbreaks are possible.

Pathogenesis during Trench Fever

The pathogenesis of trench fever has much in common with the pathogenesis of typhus epidemic and other rickettsiosis. When ingested, the pathogen enters the bloodstream, affecting mainly the endothelium of capillaries, small arteries and veins. Intoxication is of great importance in the pathogenesis of trench fever.

Immunity after the illness is short-term and unstable, reinfection is possible in 4-6 months.

Symptoms of Trench Fever

The incubation period is 5-17 days. The disease begins acutely with chills and a rapid rise in temperature to 39-40 ° and above. The elevated temperature lasts 1-3 days, then comes a period of normal temperature, which usually lasts 4-5 days. The total number of fever attacks is usually 2-4, sometimes up to 12. In milder forms of the disease, a slight and short-term rise in body temperature can be observed. During the first attacks on the skin of the back, chest, abdomen, a scanty roseolous rash often appears, disappearing with a drop in temperature. Constant headaches, pains in the eyeballs, in the calf and other muscles, as well as in the joints (their shape does not change), tibial bones and ribs are constantly noted. Characterized by the injection of sclera and facial flushing. Often enlarged spleen. In the blood, there is a leukocytosis of up to 10,000–20,000 leukocytes in 1 μl of blood with a moderate neutrophilic left shift. The average duration of the disease is 3-5 weeks. Complications are rare. Recovery is slow.

Diagnosis of Trench Fever

The diagnosis of trench fever is based on data from the epidemiological history (intended contact with patients with trench fever), the clinical picture of the disease, as well as laboratory results (determination of specific antibodies in the blood by an immunoassay method).

The diagnosis is confirmed by repeated isolation of Bartonella quintana or Bartonella henselae from the blood for a long time. The pathogen colonies grow slowly; on agar with rabbit blood in an atmosphere enriched with CO2, they appear after 1-4 weeks.

There are no generally accepted methods for serodiagnosis.

Treatment of Trench Fever

Patients are always treated in the hospital. Tetracycline antibiotics are prescribed for 6-7 days, symptomatic therapy is conducted (analgin, amidopirin, cordiamine, caffeine, etc.). Convalescents are discharged from the hospital at normal body temperature no earlier than on the 12th day after the last attack.

The prognosis is favorable.

Trench Fever Prevention

Early detection and hospitalization of patients; disinsection in the outbreak (chamber disinsection of clothes and bed linen, treatment of the room with insecticides).