Trench fever

Trench fever (synonym: Volyn, five-day, trench fever, paroxysmal rickettsiosis) is an acute infectious disease characterized by sudden onset, short repeated bouts of fever and muscle pain localization.
Etiology. The causative agent of trench fever - rickettsiae. Multiply rickettsiae on the surface of epithelial cells of the gastrointestinal tract lice and constantly excreted in faeces.
Epidemiology. The source of infection is only a sick person; carrier - a louse. Human infection is due to hit the faeces of an infected from a sick person lice in superficial wounds, formed by scratching the skin where her bite. Sporadic cases occur in different parts of the globe, in unfavourable conditions (war, famine and other possible epidemic.
Pathogenesis. In the pathogenesis of trench fever lot in common with typhus and other ricketsiosis (see). When ingested, the infection penetrates the blood flow that affects mainly the endothelium of capillaries, small arteries and veins. Of great importance in the pathogenesis of trench fever, intoxication and toksikoallergicheskie reactions that cause the disorder serverelement regulation of body functions. Immunity after the disease of short-term and unstable.
The clinical picture. The incubation period-9-17 days. The disease begins abruptly, with chills and a rapid rise of temperature up to 39-40 degrees and above. The temperature curve is often paroxysmal (recurrent) type. Temperature of 1-3 days, then decreases to normal within 3-7 days. The total number of episodes of fever usually 2-5, sometimes up to 12. Possible typhoidal and rudimentary types of fever. Typhoidal fever usually remitting or intermittently, type up to 12 to 16 days. In milder forms of the disease may be rudimentary type with small and transient fever. In the first three days of illness can appear on the skin single roseola. Constantly there have severe headaches, pain in the calf and other muscles and joints without changing their form; possible pain in Shin bone and ribs. Characteristic vascular injection scleral and conjunctival, hyperemia person. Often enlarged spleen. Leukocytosis to 10 000-20 000 with stab shift to the left. The disease is favorable; the average duration of 3-6 weeks. Recover slowly.
Diagnosis of trench fever is based on the clinical picture of the disease with consideration of epidemiological history.
Treatment. Prescribe antibiotics tetratziklinovogo stimulants in the generally accepted dosage for 6-7 days and symptomatic funds (analgin, amidopyrine, kordiamin, caffeine and other).
Prevention. Hospitalization of patients is mandatory. Recovering discharged under normal body temperature is not earlier than 12 th day after the last attack. Spend disinsection in the hearth, and activities for the prevention of domestic lice.

Trench fever (febris wolhynica, s. quintana; synonym: Volyn fever, paroxysmal rickettsiosis, five-day fever), acute infectious disease rickettsioses etiology, characterized by sudden onset, bouts of fever, sometimes the enlargement of the spleen and polymorphic roseolous rash on the skin.
Etiology. The causative agent of trench fever, rickettsiae (R. Wolhynica, s. quintana) oval bestvideopsoy forms, amounting to 0.3-0.5 MK. The causative agent of trench fever breeds on the surface of epithelial cells lining the gastrointestinal tract is infected lice that can lifetime to spread the infection; rickettsiae are excreted in the faeces of infected fleas.
Human infection occurs when brushing the skin where the bite of a lice and rubbing in wound faeces of infected lice. From the entrance gate of rickettsiae infection penetrate in blood flow where and circulate throughout the hectic period of illness. The source of infection is only a sick person; carrier - a louse is inspired from a sick person. The spread of trench fever contribute to overcrowding and a higher prevalence among them lice.
The clinical picture. The incubation period lasts from 9 to 17 days. The disease starts acutely with chills and a rapid rise of temperature up to 39-40,5 degrees. The temperature curve may have a different form, but often characterized by paroxysms with duration from 1 to 2-3 days. Periods of remission between attacks continue 3 - 7 days. The total number of attacks from 3 to 10, in rare cases to 12. Especially often there are three attack (38,8% of the hydrographic system of Masingu), and rare cases of two febrile seizures; occasionally the disease can be limited to a single attack. As options temperature curves described remitting and intermittently curves with a total duration of fever up to 12-16 days. In milder forms of the disease may occur rudimentary febrile seizures with minor and transient fever. First febrile seizure usually is the most enduring.

In addition febrile reactions, there are extreme headaches, mainly in the forehead. Typical pain in the gastrocnemius muscles, more rarely, pain in other muscles in the lumbar region. Constant pain in various joints, not accompanied by changes in their size and configuration. Arthralgia may occur not only at the height of feverish attack, but in the interictal period. Some patients were prolonged pain in the tibial bone and ribs due periostitis. Feeling these bones painful. Marked hyperesthesia skin, many patients sweating. Eye movements, in particular their diversion to the outside and painful.
In addition to these typical symptoms of the disease is observed vascular injection scleral and conjunctival. The man's face often hyperemic. Approximately half of all cases on the skin of the chest appears polymorphic roseolous rash, persistent 1 - 3 days. In half of all cases of trench fever spleen moderately increased. Blood picture often characterized by leukocytosis, reaching 10 000-20 000 cells in 1 blood, with stab shift to the left and minor neutrophilia.
The total duration of the disease 5-6 weeks, but it may end with 10 - to 12-day low grade fever. In the recovery period is very slow recovery of the patient. Transferred disease leaves short-term, low voltage immunity.
Recognition of trench fever is based on the clinical picture of the disease and epidemiological history. Methods serological diagnosis to date not been developed. For special purposes diagnostics can be used feeding lice citrate blood of patients through a biomembrane by A. C. Pshenichnova, but this method is not suitable for ordinary laboratories. The differential diagnosis should be carried out with a group riccetsios diseases, including typhoid fever, endemic rat typhus, and return typhoid, malaria. When carrying out differential diagnosis using the appropriate methods of laboratory diagnostics.
The pathogenetic and symptomatic treatment using antibiotics tetratziklinovogo stimulants. Adult tetracycline prescribed in a dose of 0.3 g 4 times a day; course duration - 6-7 days.
Hospitalization is required. Recovering write out not earlier than the 12th day after completion of the last attack of fever.
Prevention includes hospitalization of patients, held in the hearth of disinsection, and activities for the prevention of domestic lice. Cm. also Ricketsiosis.