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Trench fever (His-Werner disease, Wolhynia fever) was first described as an epidemic disease in the First World War and many cases occurred also in the Second World War. Subsequently, this disease seems to have disappeared in its classical form. Instead, it reappeared in the 1990s, then causing bacteraemia and endocarditis among homeless men in France, USA. and Finland. The causative organism, Bartonella quintana, is closely related to the rickettsiae but is not an obligate intracellular parasite and can thus be cultured on blood agar although it is slow-growing. It is transmitted by the human body louse, Pediculus humanus. No non-human vertebrate reservoir has yet been identified.

Clinical description

Classical trench fever is described as a fever of sudden onset, often, but not always, accompanied by severe headache, leg and lumbar muscle pains, dizziness, nausea and vomiting. However, the illness can be fairly mild, which is believed to be the situation in a …