The centenary of the discovery of trench fever, an emerging infectious disease of World War 1

Abstract

In 1915, a British medical officer on the Western Front reported on a soldier with relapsing fever, headache, dizziness, lumbago, and shin pain. Within months, additional cases were described, mostly in frontline troops, and the new disease was called trench fever. More than 1 million troops were infected with trench fever during World War 1, with each affected soldier unfit for duty for more than 60 days. Diagnosis was challenging, because there were no pathognomonic signs and symptoms and the causative organism could not be cultured. For 3 years, the transmission and cause of trench fever were hotly debated. In 1918, two commissions identified that the disease was louse-borne. The bacterium Rickettsia quintana was consistently found in the gut and faeces of lice that had fed on patients with trench fever and its causative role was accepted in the 1920s. The organism was cultured in the 1960s and reclassified as Bartonella quintana; it was also found to cause endocarditis, peliosis hepatis, and bacillary angiomatosis. Subsequently, B quintana infection has been identified in new populations in the Andes, in homeless people in urban areas, and in individuals with HIV. The story of trench fever shows how war can lead to the recrudescence of an infectious disease and how medicine approached an emerging infection a century ago.

Bartonella quintana, past, present, and future of the scourge of World War I

“…This finding leads to non-usefulness of biochemical tests for Bartonella identification. 4 Not in all cases. 5 Constitutive resistance to nalidixic acid.…”

“…As indicated above, the role of insect vectors was suspected early. The involvement of body lice and their capacity to vectorize the illness were demonstrated in several studies in which healthy lice became infected after feeding on infected volunteers and vice versa .…”

“…3 Including typical severe shin pain. 4 The name 'quintana' (of or belonging to the fifth) referring to the classically described 5-day interval between febrile episodes. Each new febrile episode tends to be less severe than the preceding episode.…”

“…In Poland, it was considered that 20% of the approximately 6000 employers in these institutions become chronic B. quintana carriers (16). 4 Used in the Western Ukraine in the early 20th century (13). 5 Related to battle areas of World War I. Meuse fever refers to the Meuse-Argonne battle at the Western front at the end of World War I; Polish and Russian fever refers to battlefields on the Eastern front.…”

Bartonella quintana type IV secretion effector BepE ‐induced selective autophagy by conjugation with K63 polyubiquitin chain

“…quintana ) or zoonotic Bartonella henselae ( B . henselae ; Anstead, ; Florin, Zaoutis, & Zaoutis, ), to life threatening disease, such as human infection by Bartonella bacilliformis ( B . bacilliformis ; Ihler, ; Karem, Paddock, & Regnery, ; Sanchez Clemente et al, ).…”