It is a disease borne by body lice that was 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 again a major problem in the military in World War II and is seen endemically in Mexico, Africa, E. Europe, and elsewhere.
Urban trench fever occurs among the homeless people and people with alcoholism today. Outbreaks have been documented, for example, in Seattle, Baltimore (among injection-drug users), Marseilles (France) and Burundi.
The cause of trench fever is Bartonella quintana (also called Rochalimaea quintana), an unusual 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).
Recovery takes a month or more. Relapses are common.
It is now clear, that at least in its urban form among the homeless, trench fever can be associated with nonspecific symptoms or no symptoms (New England Journal of Medicine 340: 184-189, 1999).
The organism (B. quintana) that causes trench fever also has been found responsible for a disease called bacillary angiomatosis in people infected with HIV and for infection of the heart and great vessels (endocarditis) with bloodstream infection.