Trench fever is the result of a bartonella quintana infection typically found in the feces of lice and the saliva of certain spiders, mites, fleas, and ticks. Also known as the five day fever, urban trench fever and quintan fever, it can last for up to three months. Symptoms include exceedingly high fever of up to 104° Fahrenheit (40° Celsius) and extreme leg pain. While trench fever is rare outside of the homeless population, it affected nearly one million soldiers during World War I.
Body lice, typically found where personal hygiene is lacking, is the most common transmitters of trench fever. Soldiers who served during WWI were often fighting in trenches for long periods of time, forgoing bathing and leaving themselves prone to body lice and the consequent infection. During both World War I and World War 2, trench fever among soldiers was extremely high, and typically caused the men to be incapacitated for months. Today, those without access to running water or personal hygiene items, especially homeless people and refugees, are most commonly afflicted with trench fever.
Symptoms can manifest by a high fever, severe headaches, leg pain, and oftentimes a rash on the upper body. While it can be confused with a regular fever, this illness is unique in that it causes the patient to continuously relapse over a five-day period. Symptoms typically come on quickly; the patient's condition can progressively get better for five days, at which point the symptoms appear again. This cycle can go on for upwards of three months, although the average recovery time is one month.
This disease is typically treated with a seven-to-10-day course of antibiotics, most commonly doxycycline. Since reported cases are rare, there is little research on what the best course of treatment might actually be. Outside of medication, those who contract the infection are usually advised to improve their living conditions and cleanliness in order to avoid becoming infected again.
Despite its long recovery time, the infection is only considered fatal among those suffering from alcoholism or severe heart problems. The high fever caused by this disease can, in rare cases, lead to heart failure — which alcoholics and those who already have heart issues are already prone to. There have been reported cases of trench fever on every continent, excluding Antarctica where the extreme cold makes transmission nearly impossible. Cases of trench fever are rare, however, and, if contracted, the disease is very treatable.