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Trench fever


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trench fever disease.

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Trench fever

  2. 2. Trench Fever An acute febrile illness caused by a gram-negative bacterium known as Bartonella quintana (Relman, D. A., 1995) Trench fever first reported during World War 1, when approximately 1 million soldiers developed this disease (Byam, W., 1919)
  3. 3. PATHOGEN OF TRENCH FEVER ( B. quintana has typical gram- negative cell wall but stains poorly with Gram’s stain B. quintana is an aerobic, non- motile, short bacillary organism. It’s able to survive for prolonged period in dried louse feces (Relman, D. A., 1995)
  4. 4. PATHOPHYSIOLOGY The bacterium infects endothelial cells and can infect erythrocytes by binding and entering with a large vacuole Once inside, they begin to proliferate and cause nuclear atypia This leads to the suppression of cells apoptosis and result in chills, fever, bacteremia, lymphatic enlargement
  5. 5. Laser confocal microscopy showing the intraerythrocytic location of Bartonella quintana Magnification × 400 Source: Emerging Infectious Diseases. 2006; Centers for Disease Control and Prevention (CDC)
  6. 6. VECTORS of B. quintana Body lice (Pediculus humanus corporis) are the vectors of B. quintana B.quintana is transmitted when an infected louse excretes the bacterium onto the host’s skin The excretion is then scratched or rubbed into the skin (Vinson, J. W., et al., 1969)
  7. 7. LIFE CYCLE of P.humanus tes/lice/body/biology.html
  8. 8. RISKY GROUP Infection with B.quintana is associated with:  Homelessness  Alcoholism in poor people  Poor sanitation  Crowded population (Spach, D. H., et al., 1995)
  9. 9. GEOGRAPHICAL DISTRIBUTION OF CASES  Trench fever has appeared in every continent except Australia and Antartica since the first appearance in World War 1 (Maurin, M., et al., 1996)  In 1997, an epidemic of trench fever erupted in refugee camps in Burundi, Africa (Raoult, D., et al., 1998)
  10. 10. Prevalence of B.quintana infestation on homeless population in: Country Percentage (%) United States of America (San Francisco) 33.3% France 20.0% Japan 16.7% Russia 12.3% (Brouqui, P., et al., 1999)
  11. 11.  Some patients developed “classic trench fever symptoms”  Headache  Rash  Mild fever  Bone pain (mainly in shins)  Neck and back pain  Pain behind the eyes  Other clinical manifestations:  Relapsing febrile illness (recurrent fever, usually every fifth day)  Endocarditis (inflamed of endocardium usually involve heart valve)  Lymphadenopathy (swollen lymph nodes)  Bacteremia (bloodstream infection) SYMPTOMS (Foucault, C., et al., 2006)
  12. 12. SYMPTOMS
  13. 13. TREATMENT B.quintana is sensitive to antibiotics such as:  Penicillins  Deoxycycline  Tetracycline  Gentamicin  Erythromycin  Aminoglycosides – 1st line treatment for Bartonella infections because it has bactericidal effect ( (Myers, W. F., et al., 1984)
  14. 14. PREVENTION  Avoid exposure to human body lice typically in crowded condition and limited access to proper personal hygiene  Wear clean clothes and wash them regularly
  15. 15. REFERENCES  Vinson, J. W., Varela, G. and Molina-Pasquel, C. (1969) Trench Fever. 111. Induction of clinical disease in volunteers inoculated with Rickettsia quintana propagated on blood agar. The American Journal of Tropical Medicine and Hygiene, 18, 713-722.  Relman, D. A. (1995) Has trench fever returned? The New England Journal and Medicine, 332, 463-464.  Spach, D.H., Kanter, A. S., Dougherty, M. J. et al. (1995) Bartonella (Rochalimaea) quintana bacteremia in inner-city patients with chronic alcoholism. The New England Journal of Medicine, 332, 424- 428.  Byam,W. (1919) Trench fever. London: Henry Frowde and Hodder & Stoughton.  Raoult, D. Ndihokubwayo, J. B., Tissot-Dupont, H. et al. (1998). Outbreak of epidemic typhus associated with trench fever in Burundi. Lancet, 352, 353-358.
  16. 16. REFERENCES     1?IR=T&  Africa    
  17. 17. THANK YOU