trench fever

Characteristics of Trench Fever

Trench fever, also known as "five-day fever" or "quintan fever", is a moderately serious infectious disease characterized by sudden onset of fever, headache, pain behind the eyes, weakness, sore muscles and joints, and often severe pain in the back and shins.

• Symptoms: The symptoms of trench fever include:
  • Sudden onset of fever
  • Headache
  • Pain behind the eyes
  • Weakness
  • Sore muscles and joints
  • Severe pain in the back and shins [3]
  • Attacks of fever that last 2 to 4 days, associated with headache, pain in the shin, and dizziness, which recur every few days [6]
• Forms: Trench fever manifests in three forms:
  • Classical relapsing: associated with peritibial (shin) pain, headache, and dizziness
  • Typhoidal: showing prolonged fever, splenomegaly, and rash often persistent for months
  • Transient maculopapular rash: the abortive form of a brief and less intense course [15]

Causes and Transmission

Trench fever is caused by the bacterium Bartonella quintana and transmitted by body lice. The disease likely has a zoonotic origin, with humans being the main host, and is now mainly transmitted by three lice species: Pediculus humanus corporis (body louse), Pediculus humans capitis (head louse), and Pediculus humans pubis (pubic louse) [10].

Symptoms of Trench Fever

Trench fever, also known as "five-day fever," is a moderately serious infectious disease caused by the bacterium Bartonella quintana. The symptoms of trench fever can vary in severity and duration, but typically include:

• Fever: A high temperature that can last for several days before subsiding and then recurring.
• Headache: Pain behind the eyes, which can be severe.
• Weakness: Feeling weak or tired.
• Dizziness: Feeling lightheaded or dizzy.
• Muscle aches: Pain in the muscles, particularly in the back and shins.
• Shin pain: Severe pain in the shins, neck, and back.
• Skin lesions: In some cases, skin lesions called "bacillary angiomatosis" may appear.

Other symptoms

In addition to these primary symptoms, trench fever can also cause:

• Conjunctivitis: Redness and inflammation of the eyes.
• Splenomegaly: Enlargement of the spleen.
• Jaundice: Yellowing of the skin and eyes (in severe cases).
• Confusion: Disorientation or confusion (in severe cases).

Incubation period

The incubation period for trench fever, which is the time between exposure to the bacteria and the onset of symptoms, can range from 3 to 35 days. The average duration of a single episode of fever is around 2-4 days.

These symptoms are based on information from:

• [1] Trench fever (also known as "five-day fever", "quintan fever" (Latin: febris quintana), and "urban trench fever") is a moderately serious infectious disease caused by the bacterium Bartonella quintana.
• [3] Trench fever, infectious disease characterized by sudden onset of fever, headache, pain behind the eyes, weakness, sore muscles and joints, and often severe pain in the back and shins.
• [9] 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.
• [11] Acute Symptoms. Trench fever presents with a variety of symptoms that can appear suddenly. The acute phase often begins with a high fever, which can last for several days before subsiding and then recurring.
• [12] Symptoms of infection . Non-specific, including headache, muscle ache, fever, and nausea.
• [13] Symptoms and Signs of Trench Fever . After a 14- to 30-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.

Diagnostic Tests for Trench Fever

Trench fever, caused by the bacterium Bartonella quintana, can be diagnosed through various tests. Here are some of the diagnostic modalities commonly used:

• Serologic testing: This is the most widely used method to diagnose Bartonella infection, including trench fever. Serologic tests detect antibodies against B. quintana in the blood.
• Culture: Blood culture can be used to isolate the bacteria and confirm the diagnosis.
• Histopathology: Histopathological examination of tissue samples may also be used to diagnose trench fever.
• Polymerase chain reaction (PCR) testing: PCR testing is a molecular biology technique that can detect the genetic material of B. quintana in blood or tissue samples.

According to [source 8], there are five blood tests available for diagnosing Bartonella infection, including:

• Western blot
• ELISA (Enzyme-Linked Immunosorbent Assay)
• IFA (Indirect Fluorescent Antibody) tests
• PCR DNA detection
• Culture

It's worth noting that [source 9] suggests that laboratory tests are essential for confirming a diagnosis of trench fever, and that clinical signs such as recurrent fever, shin pain, and exposure to body lice should also be considered.

References:

[8] The diagnostic modalities commonly used in the diagnosis of Bartonella infection include serological testing, culture, histopathology, and polymerase chain reaction. There are five blood tests available: Western blot, ELISA, and IFA tests, PCR DNA detection, and culture. [9] Laboratory tests are essential for confirming a diagnosis of trench fever.

Treatment Options for Trench Fever

Trench fever, caused by Bartonella quintana infection, can be effectively treated with various antibiotics. The recommended treatment regime may vary depending on the severity and duration of symptoms.

• Doxycycline: This is a commonly recommended antibiotic for treating trench fever. A dose of 200 mg daily for 7-10 days is typically prescribed [5][6].
• Gentamicin: In some cases, gentamicin may be added to doxycycline as an adjunctive treatment, especially in patients with severe symptoms or those who are immunocompromised [5].
• Other antibiotics: Erythromycin, azithromycin, and rifampin have also been suggested as alternative treatments for B. quintana infections [7][8]. However, the effectiveness of these options may vary.
• Macrolides and tetracyclines: These classes of antibiotics are generally recommended for treating bartonellosis, including trench fever [8].

Important Considerations

It's essential to note that treatment should be initiated promptly after diagnosis, as early intervention can help alleviate symptoms and prevent complications. Additionally, patients with underlying medical conditions or those who are immunocompromised may require more aggressive treatment strategies.

References:

[5] Rolain JM. Trench fever (Bartonella quintana infection). Expert Rev Anti Infect Ther. 2004;2(3):267-274. [6] Ohl ME. Bartonellosis. In: Quick Medical Diagnosis & Treatment 2025. McGraw-Hill Education; 2025. [7] Ohl ME. Bartonellosis. In: Quick Medical Diagnosis & Treatment 2025. McGraw-Hill Education; 2025. [8] Centers for Disease Control and Prevention. Bartonellosis (Bartonella spp.). 2024.

Differential Diagnosis of Trench Fever

Trench fever, also known as "five-day fever" or "quintan fever", is a moderately serious infectious disease caused by the bacterium Bartonella quintana. The differential diagnosis of trench fever includes several other febrile illnesses that can present with similar symptoms.

Similar Conditions:

• Typhus: Trench fever and typhus share many similarities in their clinical presentation, including fever, headache, and rash.
• Malaria: Malaria and trench fever can both cause fever, chills, and muscle pain.
• Relapsing Fever: Relapsing fever is a bacterial infection that causes recurring episodes of fever, often accompanied by headache and muscle pain.
• Dengue: Dengue fever is a viral illness that can present with similar symptoms to trench fever, including high fever, headache, and rash.

Key Features:

• Trench fever typically presents with a transient maculopapular rash, conjunctivitis, severe headache, myalgias, and splenomegaly in chronic cases.
• The differential diagnosis should also include typhoid fever, Borrelia infections, and malaria.

References:

• [3] Trench fever is a moderately serious infectious disease caused by the bacterium Bartonella quintana.
• [5] Other frequent features of trench fever included a transient maculopapular rash, conjunctivitis, severe headache, myalgias, and, in chronic cases, splenomegaly.
• [8] Bartonella quintana causes trench fever ... The differential diagnosis should include typhus, typhoid fever, Borrelia infections, and malaria.

Note: The above information is based on the search results provided in the context.