Classification: ICD-9 083.1; ICD-10 A79.0
Synonyms: Trench fever, quintana fever, quintan fever, shinbone fever, shank fever, His-Werner disease, and Wolhynia fever.
Agent: Bartonella quintana (formerly Rochalimaea quintana and Rickettsia quintana), a fastidious intracellular Gram-negative bacterium.
Reservoir: Humans and possibly cats.
Vector: The principle vector is the human body louse (Pediculus humanus corporis), which lives in clothes. B. quintana has also been detected in cat and monkey fleas.
Transmission: Transmission to humans occurs by rubbing infected louse feces into abraded skin or into the conjunctivae.
Cycle: B. quintana multiplies in the louse’s intestine and is excreted in the feces. Body lice feed several times per day that leads to itchiness and scratching, by which the skin is inoculated with louses’ contaminated feces. Chronic B. quintana bacteremia facilitates infection in lice and further spread.
Incubation period: 5–20 days, with a median of 8 days.
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