Summary about Disease
Trench fever is a bacterial infection transmitted by the human body louse (Pediculus humanus corporis). It's characterized by recurring fever, headache, leg pain, and weakness. Historically associated with trench warfare, it can still occur in situations of poor hygiene and crowding. While rarely fatal, it can cause significant morbidity.
Symptoms
Recurring fever (lasting 5-6 days, recurring at 5-6 day intervals, hence "trench" fever)
Headache
Severe leg pain, especially in the shins
Weakness and dizziness
Splenomegaly (enlarged spleen)
Rash (macular or papular)
Endocarditis (inflammation of the heart lining, a rare but serious complication)
Bone pain
Causes
Trench fever is caused by the bacterium Bartonella quintana. The bacteria are transmitted to humans through the feces of infected body lice. When a person scratches a louse bite, the bacteria can enter the bloodstream through the broken skin. Contaminated louse feces can also enter through conjunctiva or inhaled.
Medicine Used
Antibiotics: Doxycycline is often the first-line treatment. Other options include azithromycin, erythromycin, and gentamicin. The choice of antibiotic and duration of treatment depend on the severity of the infection and the patient's overall health.
Pain relievers: Medications like ibuprofen or acetaminophen can help manage pain and fever.
Endocarditis Treatment: If endocarditis is present, a prolonged course of intravenous antibiotics (such as gentamicin in combination with doxycycline) is required, and surgery may be necessary to repair or replace damaged heart valves.
Is Communicable
Trench fever is not directly communicable from person to person. Transmission occurs through the bite of an infected body louse, or contamination of broken skin or mucous membranes with infected louse feces. Therefore, it's an arthropod-borne disease, not a directly contagious one.
Precautions
Personal Hygiene: Maintaining good personal hygiene is crucial. Regular bathing and washing of clothes, particularly undergarments and bedding, help prevent louse infestations.
Delousing: If lice are present, effective delousing methods should be implemented. This includes washing clothes and bedding in hot water (at least 130°F/54°C) and using appropriate insecticides to kill lice and their eggs.
Avoidance of Crowded, Unsanitary Conditions: Reducing exposure to crowded and unsanitary living conditions minimizes the risk of louse infestations.
Insect Repellents: Insect repellents containing DEET can help prevent louse bites.
How long does an outbreak last?
The duration of a trench fever outbreak depends on factors such as the extent of louse infestation, the effectiveness of control measures, and the availability of medical treatment. Without intervention, outbreaks can persist for months or even years, particularly in environments with poor sanitation and overcrowding. With effective delousing and treatment, outbreaks can be controlled more quickly.
How is it diagnosed?
Clinical Presentation: The characteristic symptoms, especially recurring fever and leg pain, raise suspicion.
Blood Tests:
Bacterial Culture: Bartonella quintana can be cultured from blood samples, but this is not always successful.
Serology: Antibody tests (e.g., indirect immunofluorescence assay or ELISA) can detect antibodies against B. quintana, indicating past or present infection.
PCR: Polymerase chain reaction (PCR) can detect B. quintana DNA in blood samples, offering a more sensitive and rapid diagnostic method.
Echocardiogram: If endocarditis is suspected, an echocardiogram is performed to assess heart valve function.
Timeline of Symptoms
Incubation Period: Approximately 5-20 days between exposure to infected louse feces and the onset of symptoms.
Initial Symptoms: Sudden onset of fever, headache, and muscle pain.
Recurring Fever: The hallmark of trench fever is the relapsing fever, with episodes lasting 5-6 days and recurring at similar intervals.
Chronic Symptoms: In some cases, symptoms can persist for weeks or months, even after treatment, leading to chronic fatigue, bone pain, and other complications.
Endocarditis: If endocarditis develops, symptoms such as shortness of breath, chest pain, and heart murmur may appear weeks or months after the initial infection.
Important Considerations
Differential Diagnosis: Trench fever symptoms can mimic other infections, such as influenza, malaria, and typhoid fever. Accurate diagnosis is crucial for appropriate treatment.
Endocarditis Risk: While rare, endocarditis is a serious complication of trench fever. Early detection and treatment are essential to prevent permanent heart damage.
Treatment Adherence: Completing the full course of antibiotics is important to eradicate the bacteria and prevent relapse.
Public Health Measures: Effective control of trench fever requires public health interventions to improve sanitation, prevent louse infestations, and provide access to medical care.
Co-infections: Individuals with trench fever may also be at risk for other louse-borne diseases, such as epidemic typhus and relapsing fever.