trench fever

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. There may be one period of fever, or the fever may recur several times at intervals of four to five days. The disease was first recognized in 1915, when it was a major medical problem among soldiers living in crowded, unsanitary trenches during World War I—hence the name trench fever.

Trench fever is spread from one person to another through contact with the feces of a body louse harboring the causative organism, the bacterium Bartonella quintana (formerly known as Rochalimaea quintana, or Rickettsia quintana). Louse feces can enter the body through scratched or broken skin or through contact with the conjunctiva of the eye (the mucous membrane that lines the eyelid). The incubation period is 14 to 30 days before sudden symptom onset.

Most persons recover within about two months; there may be relapses, however, and the disease becomes chronic in a small percentage of cases. The disease may be diagnosed through blood or serological tests, as well as through polymerase chain reaction (PCR) testing of tissue or blood samples. Effective treatments include doxycycline, a tetracycline antibiotic, and ceftriaxone, a cephalosporin antibiotic. These agents can bring permanent relief from symptoms but may require long-term use in persons with persistent bacteremia. Additional treatment may be needed to eliminate bacteria-carrying lice.

During World War I, trench fever affected more than one million soldiers. The disease reappeared in epidemic form among German troops on the Eastern front during World War II. Since that time, outbreaks have occurred only rarely, generally as small clusters of cases or as individual cases, mainly among those who live in unsanitary conditions. The control of body lice remains the chief means of prevention.