Trench fever a risk for those experiencing homelessness

An article in the Canadian Medical Association Journal suggests that the disease 'likely remains underdiagnosed.'

Monika Warzecha 3 minute read December 7, 2020
Trench fever

Trench fever was rampant among soldiers in the First World War. anada. Dept. of National Defence/Library and Archives Canada

A disease that plagued soldiers in the First World War has been found in Canada, risking the lives of people experiencing homelessness, according to Canadian Medical Association Journal.

A practice article warns that the medical community should be on the lookout for the potentially fatal disease which is associated with homeless shelters and homelessness, suggesting trench fever “likely remains underdiagnosed.” Spread by body lice, the disease can eventually lead to a heart infection known as endocarditis, which can be fatal if untreated.

The CMAJ piece points to the case of a 48-year-old man in Winnipeg who went to an ER after experiencing chest pain and shortness of breath. Over the course of 18 months, he had suffered from chest pain and body lice infestations. He was found to be infected with B. quintana, or trench fever, which is believed to have infected more than 1 million soliders over a hundred years ago during the Great War.

Symptoms of the disease include fever, headache and malaise. Health Canada says that it can also feature a rash on the trunk and abdomen. According to a CMAJ press release, it can be hard to detect without molecular testing.

The article points to three additional patients in Winnipeg, who had accessed resources at the same homeless shelter as the 48-year-old, and were also found to be infected with trench fever over a six-month period.

“Our public health message is that this disease is present in Canada and that people and physicians aren’t always aware,” says Dr. Carl Boodman, an infectious disease physician at the University of Manitoba, Winnipeg, Manitoba.

The bacteria in lice was first accepted as the cause of trench fever in the 1920s and the disease is largely associated with the unsanitary conditions soldiers faced in the First World War: rain, rats and mud, not to mention other soldiers and animals.  However, recent studies suggest that the illness has a much, much longer history. Traces of the bacteria have also been found in ancient Rome, and linked to soldiers who fought in the Napoleonic Wars.

More recently, trench fever was found in  Denver, Colorado this year. According to Kaiser Health, it’s been considered a “reemerging disease” since the 1990s.

“Old infectious diseases always still have the potential to come back,” Dr. Michelle Barron, medical director of infection prevention and control at UCHealth University of Colorado Hospital, told Kaiser Health.

“Even though we live in a society that we consider very modern and very safe on so many levels, these organisms, at the end of the day, have been here longer than us and plan to survive,” she said.

Monika Warzecha is a homepage editor at

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