Summary about Disease
Quintan fever, also known as trench fever or shin bone fever, is a bacterial disease transmitted to humans by the human body louse ( Pediculus humanus corporis). The causative agent is the bacterium *Bartonella quintana*. Historically, it was a significant health problem during World War I, affecting soldiers living in unsanitary trench conditions. While less common today, it still occurs in populations with poor hygiene, homelessness, and those exposed to body lice.
Symptoms
Symptoms can vary but often include:
Recurrent fever (lasting 5-6 days or longer, possibly with afebrile periods)
Severe headache
Leg pain, especially in the shins (tibias)
Back pain
Dizziness
Weakness
Enlarged spleen (less common)
Macular rash (less common)
Causes
The sole cause of Quintan fever is infection with the bacterium Bartonella quintana. Transmission occurs when infected body lice defecate while feeding on a human. The bacteria are then introduced into the bite wound or through broken skin when the person scratches the area. *B. quintana* can also be transmitted through blood transfusions in rare cases.
Medicine Used
Antibiotics are the primary treatment for Quintan fever. Common antibiotics used include:
Doxycycline
Azithromycin
Erythromycin
Gentamicin (often in combination with doxycycline) The specific antibiotic and duration of treatment depend on the severity of the infection and the individual's health status.
Is Communicable
Quintan fever is not directly communicable from person to person. Transmission requires the human body louse as a vector. An infected person cannot directly spread the disease to another person through casual contact.
Precautions
Prevention focuses on controlling body lice and maintaining good hygiene:
Regular bathing and laundering of clothes (especially bedding and clothing worn close to the skin) in hot water.
Insecticide treatment of clothing and bedding.
Avoiding close contact with individuals who have poor hygiene and are likely to harbor body lice.
For individuals with suspected or confirmed cases, isolation and delousing procedures are crucial.
How long does an outbreak last?
The duration of an outbreak depends on factors such as the extent of louse infestation, the effectiveness of control measures, and the availability of treatment. Outbreaks can last for weeks to months if left unchecked. Control efforts targeting the louse vector and treating infected individuals are essential to curtail the duration.
How is it diagnosed?
Diagnosis typically involves:
Clinical Evaluation: Assessment of symptoms and risk factors (e.g., louse infestation, homelessness).
Blood Tests:
Bartonella quintana PCR (polymerase chain reaction) to detect bacterial DNA.
Serological tests to detect antibodies against B. quintana (e.g., indirect immunofluorescence assay).
Blood culture (though B. quintana can be difficult to culture).
Other Tests: Rule out other potential causes of the symptoms.
Timeline of Symptoms
Incubation Period: Varies but is typically 5-20 days.
Initial Symptoms: Abrupt onset of fever, headache, and muscle pain.
Fever Pattern: Intermittent or relapsing fever, with episodes lasting several days.
Persistent Symptoms: Leg pain, weakness, and dizziness can persist for weeks to months, even after treatment.
Chronic Infections: In untreated or immunocompromised individuals, chronic infections with milder, prolonged symptoms may occur.
Important Considerations
Differential Diagnosis: It's crucial to differentiate Quintan fever from other febrile illnesses with similar symptoms, such as malaria, typhoid fever, and other vector-borne diseases.
Co-infections: Individuals with Quintan fever may also have other infections, particularly if living in unsanitary conditions.
Endocarditis: B. quintana can cause endocarditis (infection of the heart valves), a serious complication. Patients with suspected endocarditis should be evaluated with echocardiography.
Homeless Populations: Quintan fever is a significant concern in homeless populations due to crowding, poor hygiene, and limited access to healthcare.
Public Health Importance: Outbreaks require prompt public health intervention to control louse infestations and prevent further transmission.