This is a disease that came to prominence in the first world war. The manifestations of trench fever ranged from a mild influenza-like illness to a debilitating protracted or recurrent disease. Onset may be insidious or abrupt. Recognised manifestations include fevers, headache, myalgia, conjunctivitis, bone pain (especially in the shins), splenomegaly, and a transient maculopapular rash. The spread of disease was associated with crowded, insanitary living conditions. The disease was rarely fatal.

A rickettsia-like organism Bartonella quintana is believed to be the organism responsible for trench fever. There have recently been outbreaks of B. quintana bacteraemia in homeless, alcoholic men reported in France and the USA. These groups showed features of the original first world war descriptions of trench fever. Some patients also had a bartonella endocarditis.