World War I Trench Fever Found in Denver

DENVER - Dr. Michelle Barron, medical director of infection prevention and control at UC Health University of Colorado Hospital, received an unusual call last month from the microbiology lab: confirmation of the third case this year of trench fever, a rare condition transmitted by body lice that plagued soldiers during World War I.

Barron’s epidemiological training kicked in. "Two is always an outbreak, and then when we found a third." OK, we clearly have something going on, Barron recalled thinking.

Barron, who said she’d never before seen a case in her 20 years here, contacted state public health officials, who issued an advisory Thursday and said a fourth person with a suspected case had been identified. They asked physicians to be on the lookout for additional cases.

Trench fever is characterized by relapsing fever, bone pain (particularly in the shins), headache, nausea, vomiting and malaise. Some of those infected can develop skin lesions or a life-threatening infection of their heart valves.

The condition is caused by the bacterium Bartonella quintana, a close relative of the bug that causes cat scratch fever. Colonies of it live in the digestive systems of body lice and are excreted in their feces. The bugs can enter the body through a scratch in the skin or through the eyes or nose. Dried lice feces can be infectious for up to 12 months.

Trench fever is most commonly diagnosed among people experiencing homelessness or living in conditions where good hygiene is difficult. Those with compromised immune systems are particularly at risk.

Public health officials are trying to find a common thread among the four cases identified so far in Colorado. They occurred months apart, and the patients appear to have no connection other than having been homeless in the Denver area. In recent years, outbreaks have occurred in San Francisco and Seattle homeless camps.

https://khn.org/news/an-ickier-outbreak-trench-fever-spread-by-lice-is-found-in-denver/

https://www.yahoo.com/news/very-rare-world-war-illness-084752344.html