Febris quintana A79.0

Five-day fever (Febris quintana =Wolhynian fever) is a rare bartonellosis transmitted by B. quintana. It is transmitted by lice and was originally seen in soldiers of World War 1 and 2. Fifth-day fever occurs endemically in Mexico, Tunisia, Eritrea, Poland, and the CIS countries, and has also been found in homeless people in the United States.

Bartonella quintana (see Bartonellose below).

Incubation period up to 2 months. Fevers repeating about every 5 days with chills and sweats. Number of fever attacks: 3-12. paraesthetic symptoms: shin pain.

Skin lesions: Volatile macular, possibly haemorrhagic exanthema. Also symptoms of pediculosis corporis.

Serologically (Weil-Felix reaction, CBR, IFT).

Malaria; relapsing fever; drug exanthema.

Blande, symptomatic therapy, e.g. with Lotio alba or Lotio Cordes

Tetracycline (e.g. achromycin), initially 25 mg/kg bw/day p.o. on 3-4 doses. Alternatively, doxycycline (e.g. Doxy Wolff) 200 mg/day p.o. or i.v., duration of therapy 10-12 days.

Equally effective are gyrase inhibitors such as ofloxacin (e.g. Tavanic) 2 times/day 200-400 mg p.o. or i.v. and rifampicin (e.g. Rifa) 450-600 mg/day p.o. (depending on the bw).

The disease takes its name from Volhynia, an area on the eastern front of the two world wars, where it was first observed and at that time was also called trench fever.

1. Chian CA et al (2002) Skin manifestations of Bartonella infections. Int J Dermatol 41: 461-466
2. Fournier PE et al (2002) Human pathogens in body and head lice. Emerg Infect Dis 8: 1515-1518
3. Minnick MF et al (2003) Five-member gene family of Bartonella quintana. Infect Immune 71: 814-821
4. Ohl ME et al (2000) Bartonella quintana and urban trench fever. Clin Infect Dis 31: 131-135
5. Raoult D et al (2001) Infections in the homeless. Lancet Infect Dis 1: 77-84
6. Tea A et al (2003) Occurrence of Bartonella henselae and Bartonella quintana in a healthy Greek population. At J Trop Med Hyg 68: 554-556