143 Trench Fever

Trench fever is a nonfatal, acute disease first de­scribed in 1915 during World War I, when it afflicted at least 1 million soldiers on both sides of the conflict. Although initially known by several names, includ­ing Polish fever, Meuse fever, and Russian intermit­tent fever, the descriptive appellation trench fever given to the disease by the British armies in northern France has endured.

Clinical Manifestations

After an incubation period lasting between 14 and 30 days, trench fever elicits typical typhuslike symp­toms: sudden onset, chills, headache, dizziness, and body aches and pains. Two of its descriptive names, shin fever and shank fever, recall its characteristic leg pains. Although also known as 5-day fever or quintan fever, the disease usually disables its vic­tims for 5 or 6 weeks. About half of those afflicted suffer only one bout of fever, but the other half may have a number of relapses. Although trench fever is never fatal, it caused a greater loss of manpower during World War I than did any other malady ex­cept influenza.

History and Geography

Also known as Wolhynian fever and His-Wemer disease, trench fever occurred in Russia, England, France, the Middle East, Italy, Germany, and Aus­tria. It is carried by body lice; hence it follows the pattern of its more deadly relative, epidemic typhus fever, in plaguing armies where hygiene is substan­dard. The disease became quiescent after World War I ended, but it appeared again on the eastern Euro­pean front during the second global conflict.

Etiology

The etiological agent of this disease, Rochalima quin­tana, was first studied during World War I by a commission of the American Red Cross Medical Re­search Committee. Their report found that the organ­ism, unlike other rickettsiae, would pass through porcelain filters. Later, in another departure from typical rickettsial characteristics, the trench fever organism was cultivated on lifeless, cell-free, blood agar media. Because of these and other differences, in 1961 it was removed from the genus Rickettsia and placed in a separate genus, Rochalima.

Victoria A. Harden

Bibliography

American Red Cross. Medical Research Committee. 1918. Trench fever: Report of Commission, Medical Research Committee_lAmericanRedCross, ed. Richard P. Strong. Oxford.

Bruce, David. 1921. Trench fever: Final report of the War Office Trench Fever Investigation Committee. Jour­nal of Hygiene 20: 258-88.

Liu, Wei-tung. 1984. Trench fever: A resume of literature and a note on some obscure phases of the disease. Chinese Medical Journal 97: 179-90.

Swift, H. F. 1920. Trench fever. Archives of Internal Medi­cine 26: 76-98.

Warren, Joel. 1965. Trench fever Rickettsia. In Viral and rickettsial infections of man, 4th edition, ed. Frank L. Horsfall, Jr., and Igor Tamm. Philadelphia.