A groundbreaking Canadian study reveals the return of trench fever—a louse-borne illness that plagued World War I soldiers—among homeless individuals. Tragically, a man under 50 recently died from infection with the causative bacterium Bartonella quintana.
As detailed in the MSD Manual, trench fever is transmitted by lice and caused by the gram-negative bacterium Bartonella quintana. First rampant among troops during World War I, it infected over a million soldiers between 1915 and 1918. This acute, recurrent febrile illness, often accompanied by rash, rarely proved fatal but left soldiers debilitated for months, sidelining them from combat.
Humans serve as the primary reservoir, with effective diagnostics and treatments available. Untreated, it can lead to endocarditis, a dangerous inflammation of heart valve linings. Researchers from the University of Manitoba reported this resurgence in a December 7, 2020, study in the Canadian Medical Association Journal.
The study highlighted a homeless patient who survived severe heart infection after B. quintana exposure. In contrast, a May 2020 report described a homeless man under 50 who succumbed to the same condition. This trend has popularized the term "urban trench fever."
These cases underscore the dire lack of resources facing homeless populations. Affordable antibiotics like doxycycline effectively treat the infection, but must be paired with delousing therapy.
Study authors advocate for routine access to anti-lice treatments in shelters, improved living conditions, and systematic B. quintana screening for those with prolonged lice exposure. Ultimately, they argue, eradicating poverty and homelessness is key to eliminating this threat.
