TRENCH FEVERPREPARED BY:

NURFARAH AIN LIMIN (P74703)

Trench FeverAn 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)

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)

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

Laser confocal microscopy showing the intraerythrocytic location of Bartonella quintanaMagnification × 400

Source: Emerging Infectious Diseases. 2006; Centers for Disease Control and Prevention (CDC)

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)

LIFE CYCLE of

P.humanus

http://www.cdc.gov/parasites/lice/body/biology.html

RISKY GROUPInfection with B.quintana is associated with:

Homelessness Alcoholism in poor people Poor sanitation Crowded population

(Spach, D. H., et al., 1995)

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)

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)

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)

SYMPTOMS

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)

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

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.

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

THANK YOU