Trench fever may be prevalent in certain populations; researchers in Marseilles were able to culture B quintana from the blood of 14% of undomiciled patients presenting to their university hospital emergency department. Moreover, researchers in Tokyo found that 34.5% of undomiciled patients presenting to Saiseikai Central Hospital tested positive for immunoglobulin G (IgG) against B quintana.
Common symptoms and signs include headaches, retro-orbital pain, conjunctival injection, anterior tibial pain, myalgias, arthralgias, hepatosplenomegaly, truncal rash (80%-90% of patients), and fever, which cycles approximately every 5 days.
This disease is usually mild and self-limited; however, culture-negative endocarditis may develop, especially in those who are living with HIV, abuse alcohol, and/or are undomiciled.
Individuals may harbor the organism at a low level for many years, acting as a reservoir for new infections. Dental pulp stem cells may serve as sanctuaries for B quintana.
Individuals living in crowded, unhygienic conditions (eg, prisons, refugee camps, shelters) are at the highest risk for trench fever. Epidemic typhus occurs in the same at-risk populations and is carried by the same vector; cases of outbreaks of both diseases occurring simultaneously have been reported.
Individuals with HIV infection develop a more chronic presentation with weight loss and progressively higher fevers. Although uncommon, B quintana infection in these patients can also manifest as bacillary angiomatosis.
A79.0 – Trench fever
82214002 – Trench fever
Differential Diagnosis & Pitfalls
- Epidemic typhus patients may present with central nervous system (CNS) symptoms (seizures, coma), whereas CNS manifestations in trench fever are rare.
- The fever of brucellosis may wax and wane like that of trench fever, but marrow suppression is common with brucellosis and unusual with trench fever.
- Louse-borne relapsing fever may present similarly to trench fever but can progress to mucocutaneous hemorrhage and CNS involvement.
- Viral exanthem
- Typhoid fever
- Dengue fever
- Exanthematous drug eruption