Bartonella quintana, past, present, and future of the scourge of World War I.

During World War I, a mysterious new disease affected soldiers on both sides of battle field. The first reports described a relapsing fever of unknown origin with body lice being suggested as the vector. The outbreak affected >1 000 000 people, mostly soldiers fighting in front-line trenches. Shortly afterward, the illness was known as Trench fever, of which the causal infectious agent is currently classified as Bartonella quintana.

The centenary of the discovery of trench fever, an emerging infectious disease of World War 1.

In 1915, a British medical officer on the Western Front reported on a soldier with relapsing fever, headache, dizziness, lumbago, and shin pain. Within months, additional cases were described, mostly in frontline troops, and the new disease was called trench fever. More than 1 million troops were infected with trench fever during World War 1, with each affected soldier unfit for duty for more than 60 days. Diagnosis was challenging, because there were no pathognomonic signs and symptoms and the causative organism could not be cultured. For 3 years, the transmission and cause of trench fever were hotly debated. In 1918, two commissions identified that the disease was louse-borne. The bacterium Rickettsia quintana was consistently found in the gut and faeces of lice that had fed on patients with trench fever and its causative role was accepted in the 1920s. The organism was cultured in the 1960s and reclassified as Bartonella quintana; it was also found to cause endocarditis, peliosis hepatis, and bacillary angiomatosis. Subsequently, B quintana infection has been identified in new populations in the Andes, in homeless people in urban areas, and in individuals with HIV. The story of trench fever shows how war can lead to the recrudescence of an infectious disease and how medicine approached an emerging infection a century ago.

Regimental Medical Officer Charles McKerrow: saving lives on the Western Front.

Ayrshire general practitioner Charles McKerrow was appointed regimental medical officer (RMO) to the 10th Battalion Northumberland Fusiliers in 1915. At this time, fundamental restructuring of the military medical service on the Western Front had two main effects: surgical capability was moved forward as close to the front as possible and specialist stretcher bearers were trained to apply emergency first aid at the place of injury and to triage casualties appropriately. The specialist stretcher bearers were the equivalent of today's combat medical technicians. The reorganisation was undertaken in a rapid, improvised 'bottom-up' manner and there are very few official records to detail the process. McKerrow and RMOs of his calibre were integral to the successful implementation and operation of this reorganisation so their personal archives are the primary sources for its history. McKerrow's record is particularly detailed and insightful on the process; he was not only an extraordinarily fine medical officer but also provided expert testimony on a period of military medical change that was enduringly successful.

Brief communication: evidence of Bartonella quintana infections in skeletons of a historical mass grave in Kassel, Germany.

In 2008, a mass grave was found on the grounds of the University of Kassel, Germany. Historians hypothesized that the individuals died in a typhoid fever epidemic in winter 1813/14. To test this hypothesis, the bones were investigated on the presence of specific DNA of pathogens linked to the historical diagnosis oftyphoid fever. It was possible to prove the specific DNA of Bartonella quintana in three individuals, suggesting that their cause of death is linked to an epidemic background.

The Peacock versus the louse (pediculus humanus corporis): one soldier's contribution to combating trench fever in the First World War.

Trench fever became a major worry for the Allied High Command during the First World War because of its debilitating effects on troop performance. The causes of the fever were not previously known, but entomological research identified the body louse (pediculus humanus corporis) as the carrier, and the Royal Army Medical Corps developed effective methods of control through disinfestation. These were markedly influenced by the researches of a young entomologist, Alexander David Peacock, which were conducted under campaign conditions. Peacock subsequently occupied a Chair of Zoology at St. Andrews University for 30 years.

The response to the trench diseases in World War I: a triumph of public health science.

The recent 90-year anniversary of the Battle of the Somme presents an opportunity to examine the public health response to the trench diseases, new conditions which arose in the trenches of World War I. Throughout history, there have been two views of epidemic disease: the configurationist and contagionist perspectives. Most doctors responding to the trench diseases, 'contingent-contagionists', combined these two conceptions of disease. Because of the difficulty of finding a causative organism and the absence of effective treatment, the majority view became that these conditions were a product of the trench environment. Configurationism, with its emphasis on environmental and social determinants, seemed to provide the most obvious approaches for tackling the trench diseases. The diseases were effectively controlled using the tools of public health science: sanitary discipline and a battery of measures, such as improving trench construction, improving the diet, providing protective kit, regular bathing and treating lice infestation. The response demonstrates the triumph of public health science over new medical technologies. It also illustrates the importance of considering all the many determinants of health and of close surveillance, discipline and partnership working to counter ill-health. Although technology, training, doctrine and health beliefs change over time, the interaction between disease and environment remains the core challenge to public health practitioners.

Evidence for louse-transmitted diseases in soldiers of Napoleon's Grand Army in Vilnius.

BACKGROUND: Many soldiers in Napoleon's Grand Army died of infectious diseases during its retreat from Russia. Because soldiers were commonly infested with body lice, it has been speculated that louse-borne infectious diseases, such as epidemic typhus (caused by Rickettsia prowazekii), were common. METHODS: We investigated this possibility during recent excavations of a mass grave of Napoleon's soldiers in Vilnius, Lithuania. Segments of 5 body lice, identified morphologically and by polymerase chain reaction (PCR) amplification and sequencing, were found in earth from the grave that also contained fragments of soldiers' uniforms. RESULTS: DNA of Bartonella quintana (the agent of trench fever) was identified by PCR and sequencing in 3 of the lice. Similarly, PCR and sequencing of dental pulp from the remains of 35 soldiers revealed DNA of B. quintana in 7 soldiers and DNA of R. prowazekii in 3 other soldiers. CONCLUSIONS: Our results show that louse-borne infectious diseases affected nearly one-third of Napoleon's soldiers buried in Vilnius and indicate that these diseases might have been a major factor in the French retreat from Russia.

Trench fever in Belfast, and the nature of the 'relapsing fevers' in the United Kingdom in the nineteenth century.

Some evidence is assembled to suggest that trench fever, an infection with a strain of Rochalimaea, if not quintana, then vinsonii, was present in Belfast in the first half of the nineteenth century in endemic and epidemic form. It may have amounted at times to one half or more of 'fever'. This may account for the comparatively low mortality in some years from 'fever'. The phrase 'relapsing fever' in the nineteenth and twentieth century medical literature of the United Kingdom should not be taken necessarily to mean infection with Borrelia recurrentis. Much or most may have been infection with Rochalimaea, quintana or vinsonii. The newly discovered Irish vole should be examined to see if it carries a Rickettsia or Rochalimaea infection.