Trench fever: causes, symptoms, diagnosis, treatment, and prevention

Trench fever, also known as five-day fever, quintan fever, urban trench fever, or shin bone fever, is caused by Bartonella quintana and is characterized by acute, recurrent fever, occasionally with rash.


Humans are the only host of Bartonella. Human-to-human transmission is absent. Persons are infected by contact with pathogens in the feces of infected lice on the abraded skin or conjunctiva. Lice are infected and discharge infectious feces 5 to 12 days after ingestion of infectious blood, and the infectious feces discharge can last for lifetime. When lice leave the body with abnormal body temperature caused by fever or death and look for other hosts with normal body temperature, the disease is transmitted to the new host.

Pathogens can survive in the blood for weeks, months, or even years, which can lead to recurrence, with or without symptoms.

Signs and Symptoms

The incubation period is usually 7 - 30 days.

Clinical manifestations are repeated recurrent fever and persistent shin pain. Fever lasts for about 1 week initially, and repeatedly relapses every 5 days, so that the disease is also called five-day fever. Other symptoms include headache, neck pain, shin pain, and back pain, thereby also known as shin bone fever. In most cases, extensive maculopapular rashes occur with fever, mainly in the trunk, regressing within 1 to 2 days. Endocarditis can also occur.


The clinical diagnosis can be based on endemic, recurrent fever every 5 days, muscle pain, and shin bone pain. The definitive diagnosis is based on bacterial culture or serological examination.


The disease can be fully recovered within 1 - 2 months, basically without risk of death. However, bacteremia may be still present several months after clinical recovery. Therefore, more than one month of treatment with doxycycline or macrolides is necessary. Doxycycline 100mg orally twice daily for 4 - 6 weeks can be administered. If endocarditis is suspected, gentamicin 3mg/kg/day intravenously should be added for the first two weeks.


Effective insecticides can be used to kill the lice on the clothes and body.