Trench fever: the British medical response in the Great War

High prevalence and diversity of Bartonella in small mammals from the biodiverse Western Ghats

Bartonella species are recognized globally as emerging zoonotic pathogens. Small mammals such as rodents and shrews are implicated as major natural reservoirs for these microbial agents. Nevertheless, in several tropical countries, like India, the diversity of Bartonella in small mammals remain unexplored and limited information exists on the natural transmission cycles (reservoirs and vectors) of these bacteria. Using a multi-locus sequencing approach, we investigated the prevalence, haplotype diversity, and phylogenetic affinities of Bartonella in small mammals and their associated mites in a mixed-use landscape in the biodiverse Western Ghats in southern India. We sampled 141 individual small mammals belonging to eight species. Bartonella was detected in five of the eight species, including three previously unknown hosts. We observed high interspecies variability of Bartonella prevalence in the host community. However, the overall prevalence (52.5%) and haplotype diversity (0.9) was high for the individuals tested. Of the seven lineages of Bartonella identified in our samples, five lineages were phylogenetically related to putative zoonotic species–B. tribocorum, B. queenslandensis, and B. elizabethae. Haplotypes identified from mites were identical to those identified from their host species. This indicates that these Bartonella species may be zoonotic, but further work is necessary to confirm whether these are pathogenic and pose a threat to humans. Taken together, these results emphasize the presence of hitherto unexplored diversity of Bartonella in wild and synanthropic small mammals in mixed-use landscapes. The study also highlights the necessity to assess the risk of spillover to humans and other incidental hosts.

Zoonotic bacterial infections cause both economic and health burdens to humans, especially in developing countries. Bartonella is a diverse group with several species that are infectious to humans. There is limited knowledge of Bartonella diversity and subsequent risk for spillover in several tropical countries, including India. This study, set in a biodiversity hotspot with high human density, reveals a high prevalence and diversity of Bartonella in the most common, and synanthropic small mammals. Several lineages identified are phylogenetically related to zoonotic species known to cause infections in humans. We suggest that there is unexplored diversity of Bartonella in small mammals that reside in human-modified landscapes in India, demonstrating an urgent need for further investigation. By identifying the natural reservoirs of pathogens, their ecology, and their relationship and proximity to humans, we will be able to proactively survey for these under-detected bacterial infections and minimize the burden.

Five millennia of Bartonella quintana bacteraemia

During the two World Wars, Bartonella quintana was responsible for trench fever and is now recognised as an agent of re-emerging infection. Many reports have indicated widespread B. quintana exposure since the 1990s. In order to evaluate its prevalence in ancient populations, we used real-time PCR to detect B. quintana DNA in 400 teeth collected from 145 individuals dating from the 1^st to 19^th centuries in nine archaeological sites, with the presence of negative controls. Fisher’s exact test was used to compare the prevalence of B. quintana in civil and military populations. B. quintana DNA was confirmed in a total of 28/145 (19.3%) individuals, comprising 78 citizens and 67 soldiers, 20.1% and 17.9% of which were positive for B. quintana bacteraemia, respectively. This study analysed previous studies on these ancient samples and showed that the presence of B. quintana infection followed the course of time in human history; a total of 14/15 sites from five European countries had a positive prevalence. The positive rate in soldiers was higher than those of civilians, with 20% and 18.8%, respectively, in the 18^th and 19^th centuries, but the difference in frequency was not significant. These results confirmed the role of dental pulp in diagnosing B. quintana bacteraemia in ancient populations and showed the incidence of B. quintana in both civilians and soldiers.

Medical Words Linked to Places

Many medical terms come from places: towns, rivers, islands, forests, mountains, valleys, countries, and continents. These toponymous diseases, syndromes, descriptors, and other entities bring us colorful names that help us recall some of their history. Today we have Zika virus, its name coming from the Zika Forest in Ghana. Caucasian comes from the Caucasus Mountains, lesbian from the island of Lesbos, and Epsom salts from a mineral spring in Epsom, Surrey, England. Chapter 10.1007/978-3-319-50328-8_5 tells the stories behind these place-named diseases and how many of them affect us today.

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.