In depth symptom description for Bartonella. Thought I'd share..

I find this interesting because these were my exact symptoms after a tick bite.

Clinical Manifestations

Trench Fever

Trench fever, also known as 5-day fever, quintana fever, or
Wolhynia fever, is defined as infection of human blood by B.
quintana. The disease is communicable by means of Pediculus
humanus, the human body louse. Infection is thought to be
conveyed from lice to humans via the arthropod excreta, which
enters the body through broken skin. We have summarized in
the following section the various clinical aspects of trench fever
described by Byam et al. (18).
The incubation period for trench fever is between 15 and 25
days. This incubation period was reduced to less than 9 days
when infection was experimentally induced in volunteers following
their inoculation with a large volume of a preparation
of crushed infected lice. Reduction in the volume of the preparation
inoculated resulted in a longer incubation time of 16
days for the disease.

Clinical manifestations of trench fever may range from
asymptomatic infection to severe, life-threatening illness.
“Classical” trench fever, the presentation most often reported
among troops, corresponds to a febrile illness of acute onset
and of a periodic nature often accompanied by severe headache
and pain in the long bones of the legs.
However, the sudden development of a wide range of symptoms
can indicate the onset of trench fever. Such symptoms
include headache, weakness, pain in the legs, malaise, dyspnea,
giddiness, pain in the loins, shivering, abdominal pain, diarrhea,
constipation, anorexia, nausea, frequent micturition,
restlessness, and insomnia. The prodromal period may last for
2 days or more. The severity of symptoms increases gradually
over the first few days of disease. Headache is most often
severe, especially at the front of the head and behind the eyes.
When occipital, it is often accompanied by a stiffness of the
neck, and symptoms may therefore suggest meningitis. Pain
may spread to the back and limbs, with leg pain being the most
severe. This pain is often felt in the bones, specifically in the
tibia. The patient will suffer regular cycles of profuse sweating
and then shivering. On examination, the tongue is often slightly
furred, and conjunctival congestion and a decrease in the pulse
rate in relation to the severity of the fever may be present.
Areas of tenderness are associated with the pains involving
muscles, tendons, bones, and joints. The spleen often becomes
palpable.
The pyrexia associated with trench fever is often periodic,
although the cycles may be of irregular duration. The level of
the pyrexia is also variable, and there may be a relationship
between the degree of pyrexia and its duration. The interval
between attacks of pyrexia is usually between 4 and 8 days, with
5 days being the most commonly observed period. The term
“quintan fever” refers to the 5-day recurrences. Usually each
succeeding attack is less severe than its predecessor, although
in profound cases the patient becomes weaker and leg pains
become more persistent.

Major polymorphonuclear leukocytosis often accompanies
the febrile stages of the disease. Anemia may also occur, especially
in chronically ill patients.
Although trench fever often results in prolonged disability,
no fatalities have been recorded. Patients are most profoundly
ill during the early stages of the disease, which usually continues
for 4 to 6 weeks. A minority of illnesses will become
chronic, during which time the following signs and symptoms
may develop: exhaustion, headaches, recurrent limb pains, irritability,
nervous manifestations such as depression, abnormal
response to stimuli, tendency to sweat, coldness of extremities,
fever, anemia, and loss of weight. The chronically ill patient
often also complains of breathlessness on exertion, palpitations,
pain over the precordium, giddiness, and disordered
activity of the heart. Damp weather exacerbates all pain. In
some cases, the infection is very persistent and acute febrile
lapses occur months after quiescence. Byam et al. (18) defined
chronic trench fever as “a state of marked debility, with or
without attacks of slight fever and aching, and characterized by
a hyperexcitability of the nervous system in general.”

CLINICAL MICROBIOLOGY REVIEWS, July 1996, p. 273–292 Vol. 9, No. 3
0893-8512/96/$04.0010
Copyright q 1996, American Society for Microbiology
[This Message was Edited on 07/28/2008]