Trench Fever: The British Medical Response in the Great War

Bartonella quintana, past, present, and future of the scourge of World War I

“…Military physicians tried to fight against Trench fever with a great variety of treatments, such as the use of acriflavine, antimony, galyl, intramine, kharsivan, mercury (with or without iodide of potassium), methylene blue, salvarsan, and trypan red as well as immunotherapy with serum of convalescent patients, all without success . Only quinine and aspirine showed a symptomatic effect in reducing fever and pain during episodes .…”

“…Only quinine and aspirine showed a symptomatic effect in reducing fever and pain during episodes . In addition, an unsuccessful experimental vaccine based on emulsion of louse excreta, sterilized by heat or phenol was also tested .…”

“…Vaccines are probably the best option to fight against B. quintana infections. However, despite the efforts to obtain a vaccine during World War I , at present only studies to determine the antigenic potential of different proteins have been performed . It should be highlighted that the above mentioned prolonged treatments and the possible implementation of vaccines are challenged by the fact that most affected patients are homeless or live in geographical areas with deficient sanitary conditions.…”

Five millennia of Bartonella quintana bacteraemia

“…The causative agent, Rickettsia quintana , was isolated from a patient in Mexico City by Vinson in 1961 and was reclassified in the genus Rochalimaea . In 1993, Rochalimaea merged with Bartonella [ 2 , 3 ]. The vector for transmission is the human body louse ( Pediculus humanus corporis ), the gastrointestinal tract of which is colonised by B .…”

“…The typical cycle of fever occurred at five-day intervals (hence its other name, the “five-day fever”), resulting in prolonged disability so that affected soldiers were unfit for at least two months, many of them suffering from chronic fatigue [ 2 ]. Morbidity rates were not revealed by the authorities at the time, and no deaths were reported [ 2 , 3 ]. The clinical manifestations of B .…”