User:Ethanstashek/Trench fever

Epidemiology

Trench fever is a vector borne disease in which humans are primarily the main hosts. The vector through which the disease is typically transmitted is referred to as the human body louse “Pediculus humanus humanus”, which is better known as lice. The British Expeditionary Force Pyrexia of Unknown Origin Enquiry Sub-Committee concluded that the specific means by which the vector infected the host was louse waste entering the body through abraded skin. Although the disease is typically found in humans, the gram negative bacterium which induce the disease have been seen in mammals such as dogs, cats, and macaques in small numbers.

Being that the vector of the disease is human body louse, it can be determined that the main risk factors for infection are mostly in relation to contracting body louse. Specifically, some risk factors include: body louse infestation, overcrowded and unhygienic conditions, body hygiene, war, famine, malnutrition, alcoholism, homelessness, and intravenous drug abuse.

The identified risk factors directly correlate with the subpopulations of identified infected persons throughout the duration of the known disease. Historically, trench fever was found in young male soldiers of World War I, whereas recently the disease mostly has a prevalence in middle aged homeless men. This can be seen when looking at a recent outbreak of the disease in Denver, Colorado, where researcher David McCormick and his colleagues came across the gram negative bacterium in 15% of the 241 homeless persons who were tested. Another study done in Marseille, France found the bacterium in 5.4% of the 930 homeless individuals they tested.

History

Trench fever was first described and reported by British major John Graham in June, 1915. He reported symptoms such as dizziness, headaches, and pain in the shins and back. The disease was most common in the militaries, and because of this it took much longer to identify the disease. These cases were originally confused for dengue, sandfly, or paratyphoid fever. Because insects were the suspected vector of transmission, Alexander Peacock published a study of the body louse in 1916. Due in part to his findings, the louse was determined to be the primary cause of transmission by many, but this was still contested by multiple voices in the field such as John Muir who believed the disease was of the viral nature. In 1917, the Trench Fever Investigation Commission (TFIC) had its first meeting. The TFIC performed experiments with infected blood and louse, and learned a lot about the disease and louse behavior. Also in 1917 the American Red Cross started the Medical Research Committee (MRC). The MRC performed human experiments on trench fever, and their research was published in March of 1918. The MRC and TFIC findings were very similar essentially confirming the louse as the vector of transmission. It wasn’t until the 1920s the bacteria B Quintana was identified as the cause of trench fever.

Treatment

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The treatment of trench fever can vary from case to case, as the human body has the capability to  rid the disease naturally. Some patients will require treatment, and others will not. For those who do require treatment, the best treatment comes by way of doxycycline in combination with gentamicin.

Citations

Britannica, T. Editors of Encyclopaedia (2021, September 21). trench fever. Encyclopedia Britannica. https://www.britannica.com/science/trench-fever

Anstead, G. M. (2016). The centenary of the discovery of trench fever, an emerging infectious disease of World War 1 [Review]. Lancet Infectious Diseases, 16(8), E164-E172. https://doi.org/10.1016/s1473-3099(16)30003-2