Bacteria

Trench Fever

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Trench Fever, Bartonella Quintana, Rickettsia Quintana, Rochalimaea Quintana

  • See Also
  1. Bartonella
  • Epidemiology
  1. Affected 1 million during World War I (1914 to 1918)
  • Pathophysiology
  1. Bartonella Quintana
    1. Small Gram Negative Rod
    2. Previously known as Quintana or Rochalimaea Quintana
    3. However, reclassified as it is not an obligate intracellular Parasite (unlike Rickettsia)
    4. Species name "Quintana" is derived from the fever that recurrs every 5 days
  2. Transmission
    1. Louse-Borne Illness (Body Lice)
  • Risk Factors
  1. Homelessness
    1. Under-recognized infections, with delayed diagnosis and treatment
  2. Alcoholism
  3. Crowded living conditions with poor sanitation practices
    1. Outbreaks have occurred in War (hence the name "Trench Fever")
  • Findings
  1. Relapsing Fever (every 5 days)
    1. May present as Fever of Unknown Origin
  2. Headaches
  3. Myalgias
    1. Back and Leg Pain
  4. Splenomegaly
  5. Rash (variable)
  • Labs
  1. Blood Cultures
  2. Bartonella Quintana PCR
  3. Indirect Immunofluorescence Assay (IFA) for Bartonella Quintana
    1. Cross reactivity with Bartonella Henselae
  • Differential Diagnosis
  1. Epidemic Typhus (Rickettsia prowazekii)
    1. Also spread via Body Lice in crowded, low sanitation conditions
  • Management
  1. Two Drug Antibiotic Regimen
    1. Doxycycline 100 mg orally twice daily AND
    2. Gentamicin 3 mg/kg IV daily for first 2 weeks
      1. Alternative: Rifampin 300 mg orally twice daily for first 2 weeks
  • Complications
  1. Bacteremia
  2. Bacterial Endocarditis
    1. Primary cause of mortality in Bartonella Quintana
  3. Bacillary Angiomatosis
    1. AIDS (CD4 Count <100 cells/mm3)
    2. Other Immunocompromised patients
  • References
  1. (2023) Sanford Guide, accessed on IOS 2/14/2025
  2. Angelakis (2014) Int J Antimicrob Agents 44(1):16-25 +PMID: 24933445 [PubMed]
  3. Boodman (2024) Pathogens 13(12):1071 +PMID: 39770331 [PubMed]