Trench fever

Overview
Trench Fever is a moderately serious disease, transmitted by body lice. It infected the armies in Flanders, France, Poland, Galicia, Italy, Slonika, Macedonia, Mesopotamia, and Egypt in World War I (including J.R.R. Tolkien ) and the German army in Russia during World War II. From 1915-1918 between one-fifth and one-third of all British troops reported ill were caused by Trench Fever while about one-fifth of ill German and Austrian troops had the disease. The disease persists among the homeless. Outbreaks have been documented, for example, in Seattle, Washington and Baltimore, Maryland in the United States among injection drug users and in Marseille, France and Burundi.

Trench fever is also called Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever, His disease and His-Werner disease (after Wilhelm His, Jr. and Heinrich Werner).

The disease is caused by the organism Rickettsia quintana, found in the stomach walls of the body louse. Rickettsia is closely related to the more dangerous microbes of Rocky Mountain spotted fever and typhus

Pathology & transmission
Rickettsia quintana is transmitted by the by contamination of a skin abrasion or of a louse-bite wound with the faeces of an infected body louse (Pediculus humanus corporis), there has also been reports of an infected louse bite passing on the infection.

Symptoms
The disease is classically a five-day fever of the relapsing type, rarely with a continuous course instead. Latent period is relatively long (about two weeks). The onset of symptoms is usually sudden with high fever, severe headache, pain on moving the eyeballs, soreness of the muscles of the legs and back, and frequently hyperaesthesia of the shins. The initial fever is usually followed in a few days by a single short rise but there may be many relapses between periods without fever. The most constant symptom is pain in the legs. Recovery takes a month or more. Lethal cases are rare, but in a few cases "the persistent fever might lead to heart failure". After effects may include neurasthenia, cardiac disturbances and myalgia.

Diagnostics
Serological testing (e.g., the Weil-Felix test) is typically used to obtain a definitive diagnosis. Most serological tests would succeed only after a certain period of time past the symptom onset (usually a week). Differential diagnosis list includes typhus, Ehrlichiosis, leptospirosis, Lyme disease and virus-caused exanthema (measles, rubella).

Treatment
Tetracycline-group antibiotics (doxycycline, tetracycline) are commonly used. Chloramphenicol is an alternative medication recommended under circumstances that render tetracycline derivates usage undesirable (such as severe liver malfunction, kidney deficiency, in children under  nine years and pregnant women). The drug is administered for seven to ten days.

The treatment for bacillary angiomatosis is erythromycin given for three to four months.