Trench fever, a louse-borne disease first recognized in the trenches of World War I, again a major problem in the military in World War II, seen endemically in Mexico, N. Africa, E. Europe, and elsewhere. The cause, Rochalimaea quintana, is an unusual rickettsia that multiplies in the gut of the body louse. Transmission to people can occur by rubbing infected louse feces into abraded (scuffed) skin or outer layer of the whites of the eyes (conjunctiva). Onset of symptoms is sudden, with high fever, headache, back and leg pain and a fleeting rash. Recovery takes a month or more. Relapses are common. Also called shin bone fever, quintan fever, five-day fever, Meuse fever, His’ disease, His-Werner disease, Werner-His disease.

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