Five Day Fever (Trench Fever)
Five-day fever (aka trench fever) is a disease caused by body lice first recognized in the trenches of World War I, when it is estimated to have affected more than a million people in Russia and on the fronts in Europe. Trench fever was a major problem in the military in World War II. It is endemic to Mexico, Africa, Eastern Europe, and elsewhere. Urban trench fever occurs among homeless people and people with alcoholism to this today. Outbreaks have been documented in Seattle, Baltimore (among injection-drug users), Marseilles (France) and Burundi. The cause of trench fever is Bartonella quintana, an unusual rickettsial organism that multiplies in the gut of the body louse. Transmission of the rickettsia to people can occur by rubbing infected louse feces into abraded (scuffed) skin or into the conjunctivae (whites of the eyes). The disease is classically a 5-day fever. The onset of symptoms is sudden with high fever, severe headache, back pain and leg pain and a fleeting rash. Recovery takes a month or more. Relapses are common.