Trench fever observed among homeless individuals in Canada
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Bartonella quintana, the agent that caused trench fever among soldiers during World War I, has been observed among homeless populations in Canada, according to a small study of cases published in the Canadian Medical Association Journal.
The results also suggest B. quintana may cause culture-negative endocarditis and can be fatal in the absence of antimicrobial and surgical treatment.
Carl Boodman, MDCM, FRCPC, an R5 Chief Medical Resident of infectious diseases and medical microbiology at the University of Manitoba in Winnipeg, Manitoba, Canada, told Healio that the study is the largest description of Canadian B. quintana cases to date, and that the endocarditis cases occurred over the span of just a few months.
“This suggests that B. quintana, the etiology of trench fever, is likely underdiagnosed in Canada,” Boodman said. “Because B. quintana is transmitted by body lice, it is a disease of poverty, a disease typically associated with war and displacement. These cases demonstrate that much more needs to be done to improve the conditions of people experiencing homelessness in Canada.”
Boodman and colleagues examined a 48-year-old man admitted to an ED in Manitoba with chest pain and shortness of breath. The patient had sought care for body lice infestation and chest pain during the 18 months before his admission.
After the man’s admission, three more patients diagnosed with B. quintana were discovered during a 6-month period. All three patients had accessed resources at a single homeless shelter.
“Bartonella quintana should be on the differential diagnosis when caring for patients who are experiencing homelessness or who have had evidence of body lice infestation and present unwell,” Boodman said. “If diagnosed and treated early, we can prevent fatal endovascular complications such as endocarditis and mycotic aneurysms.”
According to the researchers, three of the four patients were admitted to the ED 3 months before hospital admission, and two of the four had links to the rural community. Additionally, two of the patients made a full recovery; one had mild neurologic deficits, including mild aphasia; and one had severe neurologic deficits including severe aphasia and paralysis.
Boodman said the study’s small sample size was one of its limitations and that further research is warranted.
“Larger seroprevalence studies and ectoparasite surveillance studies are needed to understand the true burden of this disease among underhoused people in Canada,” Boodman said.
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