trench fever disease.

1. TRENCH
FEVER
PREPARED BY:
NURFARAH AIN LIMIN (P74703)

2. Trench Fever
An acute febrile illness caused by a gram-negative
bacterium known as Bartonella quintana
(Relman, D. A., 1995)
Trench fever first reported during World War 1, when
approximately 1 million soldiers developed this disease
(Byam, W., 1919)

3. PATHOGEN OF TRENCH FEVER
(http://idsc.nih.go.jp/iasr/31/370/tpc370.html)
B. quintana has typical gram-
negative cell wall but stains
poorly with Gram’s stain
B. quintana is an aerobic, non-
motile, short bacillary
organism. It’s able to survive
for prolonged period in dried
louse feces
(Relman, D. A., 1995)

4. PATHOPHYSIOLOGY
The bacterium
infects
endothelial
cells and can
infect
erythrocytes
by binding
and entering
with a large
vacuole
Once inside,
they begin to
proliferate
and cause
nuclear
atypia
This leads to
the
suppression of
cells
apoptosis and
result in chills,
fever,
bacteremia,
lymphatic
enlargement

5. Laser confocal
microscopy showing the
intraerythrocytic
location of Bartonella
quintana
Magnification × 400
Source: Emerging
Infectious Diseases. 2006;
Centers for Disease
Control and Prevention
(CDC)

6. VECTORS of B. quintana
Body lice (Pediculus humanus corporis) are
the vectors of B. quintana
B.quintana is transmitted when an infected
louse excretes the bacterium onto the
host’s skin
The excretion is then scratched or rubbed
into the skin
(Vinson, J. W., et al., 1969)

7. LIFE CYCLE
of
P.humanus
http://www.cdc.gov/parasi
tes/lice/body/biology.html

8. RISKY GROUP
Infection with B.quintana is associated with:
 Homelessness
 Alcoholism in poor people
 Poor sanitation
 Crowded population
(Spach, D. H., et al., 1995)

9. GEOGRAPHICAL DISTRIBUTION
OF CASES
 Trench fever has appeared in every
continent except Australia and
Antartica since the first appearance in
World War 1 (Maurin, M., et al., 1996)
 In 1997, an epidemic of trench fever
erupted in refugee camps in Burundi,
Africa (Raoult, D., et al., 1998)

10. Prevalence of B.quintana
infestation on homeless population
in:
Country Percentage (%)
United States of America
(San Francisco)
33.3%
France 20.0%
Japan 16.7%
Russia 12.3%
(Brouqui, P., et al., 1999)

11.  Some patients developed
“classic trench fever
symptoms”
 Headache
 Rash
 Mild fever
 Bone pain (mainly in shins)
 Neck and back pain
 Pain behind the eyes
 Other clinical
manifestations:
 Relapsing febrile illness
(recurrent fever, usually
every fifth day)
 Endocarditis (inflamed of
endocardium usually
involve heart valve)
 Lymphadenopathy
(swollen lymph nodes)
 Bacteremia (bloodstream
infection)
SYMPTOMS
(Foucault, C., et al., 2006)

12. SYMPTOMS

13. TREATMENT
B.quintana is sensitive to antibiotics such as:
 Penicillins
 Deoxycycline
 Tetracycline
 Gentamicin
 Erythromycin
 Aminoglycosides – 1st line treatment for Bartonella
infections because it has bactericidal effect
(http://wwwnc.cdc.gov/eid/article/12/2/05-0874_article.htm)
(Myers, W. F., et al., 1984)

15. PREVENTION
 Avoid exposure to human body
lice typically in crowded condition
and limited access to proper
personal hygiene
 Wear clean clothes and wash them
regularly

16. REFERENCES
 Vinson, J. W., Varela, G. and Molina-Pasquel, C. (1969) Trench Fever.
111. Induction of clinical disease in volunteers inoculated with
Rickettsia quintana propagated on blood agar. The American
Journal of Tropical Medicine and Hygiene, 18, 713-722.
 Relman, D. A. (1995) Has trench fever returned? The New England
Journal and Medicine, 332, 463-464.
 Spach, D.H., Kanter, A. S., Dougherty, M. J. et al. (1995) Bartonella
(Rochalimaea) quintana bacteremia in inner-city patients with
chronic alcoholism. The New England Journal of Medicine, 332, 424-
428.
 Byam,W. (1919) Trench fever. London: Henry Frowde and Hodder &
Stoughton.
 Raoult, D. Ndihokubwayo, J. B., Tissot-Dupont, H. et al. (1998).
Outbreak of epidemic typhus associated with trench fever in
Burundi. Lancet, 352, 353-358.

17. REFERENCES
 http://wwwnc.cdc.gov/eid/article/12/2/05-0874_article.html
 http://idsc.nih.go.jp/iasr/31/370/tpc370.html
 http://www.cdc.gov/parasites/lice/body/biology.html
 http://www.businessinsider.com/homeless-shelter-photos-2012-
1?IR=T&
 http://sniffandflehmen.tumblr.com/post/78993226/sanitation-in-
Africa
 http://www.skinsight.com/atlas/trenchFever.htm
 http://www.pharmacy-and-
drugs.com/Heart_diseases/Endocarditis.html
 http://wwwnc.cdc.gov/eid/article/12/2/05-0874_article.htm
 http://wwwnc.cdc.gov/eid/article/12/2/05-0874_article.htm

18. THANK YOU