A message is written on a door outside a tent at a homeless encampment at Strathcona Park, in Vancouver, on Wednesday, October 7, 2020. Residents of the neighbourhood were used to a few people sleeping overnight in a park before moving on, but they weren’t prepared for an entire village of homeless campers still occupying 400 tents after over three months. They have been demanding the city take action to house campers, especially as concerns have mounted about the spread of COVID-19 among hundreds of people living in tight quarters. THE CANADIAN PRESS/Darryl Dyck

A message is written on a door outside a tent at a homeless encampment at Strathcona Park, in Vancouver, on Wednesday, October 7, 2020. Residents of the neighbourhood were used to a few people sleeping overnight in a park before moving on, but they weren’t prepared for an entire village of homeless campers still occupying 400 tents after over three months. They have been demanding the city take action to house campers, especially as concerns have mounted about the spread of COVID-19 among hundreds of people living in tight quarters. THE CANADIAN PRESS/Darryl Dyck

Specialist who treated rare disease among homeless wants doctors to be aware of signs

Those four cases this year are the only ones known to have occurred in Canada since the mid-1990s

As an infectious diseases specialist, Dr. Carl Boodman has had a longtime interest in an illness that commonly afflicted soldiers during the First World War as well as people who now live in crowded refugee camps.

But Boodman had no idea when he encountered a case of trench fever in Winnipeg earlier this year that he’d soon be treating three more patients with the same condition and that all of them had spent time in a homeless shelter.

Trench fever is transmitted through the feces of body lice, which can be left on clothing and trigger an itchy reaction causing people to scratch their skin to the point that they end up with abrasions.

That is one of the signs of the misunderstood infectious disease, which could also cause fever, shin pain and a potentially fatal heart infection called endocarditis.

Those four cases this year are the only onesknown to have occurred in Canada since the mid-1990s, said Boodman, who is also training in medical microbiology at the University of Manitoba.

However, cases may go undiagnosed because doctors are unlikely to be aware of what to look for and therefore don’t order specific lab tests to detect a bacterium called Bartonella quintana, which was first linked to the condition a century ago, he said.

Boodman, who is the lead author of an article highlighting trench fever in Monday’s edition of the Canadian Medical Association Journal, said the neglected and preventable disease of poverty is known to strike people who are homeless and have little access to medical care.

“It’s a disease associated with wartime conditions and refugee camps and it’s found in Canada. If we didn’t have this degree of poverty in Canada we wouldn’t have this disease,” he said.

People living in shelters may share clothing on which the dried feces of body lice can survive for weeks, Boodman said, adding there’s a public health need for access to laundry facilities and showers as well as affordable housing to prevent spread of disease in general among people who are underhoused across Canada.

He treated his first case of trench fever in February when a patient visited an emergency department in Winnipeg.

The 48-year-old man with shortness of breath and chest pain had repeatedly sought medical care in the previous year and a half for episodes of chest pain and body lice infestation, said Boodman of the patient who was in ICU and spent a month in hospital following heart surgery for endocarditis. He has since recovered.

About two weeks after starting to treat that patient, Boodman was so “baffled” when he saw a second patient with what appeared to be trench fever that he had the lab tests repeated twice before confirming the diagnosis.

He treated a third patient for the same disease at a different hospital about a month later, before a colleague mentioned a mysterious case involving a man who had endocarditis. Lab tests confirmed he, too, had trench fever.

“You don’t know anything about it for 20 years or so and then you have this succession of cases,” Boodman said, adding some patients may have the bacterium associated with body lice in their bloodstream for months and be asymptomatic for the disease that could become serious, requiring surgery to replace a heart valve.

A combination of antibiotics is often prescribed but there is debate on treatment of the disease, and its prevalence is unknown because it is not reported to public health officials in Canada and the United States, Boodman said.

Small studies from cases in the south of France and cities in the United States including Seattle and San Francisco have estimated that up to 20 per cent of homeless people with body lice could have been exposed to the bacterium that causes trench fever, Boodman said.

Dr. Stephen Hwang, who holds a research chair in homelessness, housing and health at St. Michael’s Hospital and the University of Toronto, said that while there is a need to recognize the rare but potentially deadly trench fever, other conditions such as skin infections, respiratory illnesses as well as poorly controlled diabetes and high blood pressure are common among underhoused populations.

Hwang treats homeless people in Toronto’s shelters and encampments once a week as a member of a group called the Inner City Health Associates, the largest such organization in Canada, with 100 physicians as well as nurses providing care to the underhoused in multiple locations including respite centres and hotels.

The aim is to provide better primary care to people who also experience more mental health and addictions issues, he said, adding secure housing is key to better health, especially as more families and seniors are becoming homeless.

“Without that stability it’s very difficult to deal with any of the acute or chronic conditions that they’re dealing with. We really do need to invest in creating affordable housing or else we’ll have to pay with the cost of the health consequences of that.”

Camille Bains, The Canadian Press


Like us on Facebook and follow us on Twitter.

Want to support local journalism during the pandemic? Make a donation here.

Homelessness

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Alberta Premier Jason Kenney said the Canadian government should consider sanctions on the U.S. if they refuse to reconsider the decision to cancel the Keystone XL Pipeline. (THE CANADIAN PRESS/Sean Kilpatrick
Keystone XL officially cancelled, Kenney vows to fight on

U.S. President Joe Biden cancelled the presidential permit for the pipeline on first day of office

Alberta’s chief medical officer of health Dr. Deena Hinshaw said province’s test positivity rate for COVID-19 is steadily declining. (Photo by Chris Schwarz/Government of Alberta)
669 new COVID-19 cases in Alberta, 21 additional deaths

COVID-19 test positivity rate down to 4.5 per cent

The Calnash Ag Event Centre will be closed for competitions until at least Jan. 21, 2020. (Emily Jaycox/Ponoka News)
Outlook for Calnash in 2021 a waiting game

Ag event centre losing thousands during shutdown

Alberta Chief Medical Officer of Health Dr. Deena Hinshaw reported an additional 456 COVID-19 cases over the past 24 hours. (photography by Chris Schwarz/Government of Alberta)
Five new COVID-19 deaths in Central zone, two in Red Deer

Province reports 456 new cases of COVID-19

The team that disconnected, lifted and loaded the old Bobtail Road bridge. (Photo submitted)
Bobtail Road bridge moves to new home in Meridian Beach

The 100-year-old bridge was moved Jan. 14

Kyla Gibson with her boyfriend Gavin Hardy. (Photo used with permission)
Sylvan Lake couple lose ‘fur babies’ to house fire

‘They were our world and nothing will ever replace them,’ Kyla Gibson said of her three pets

(Thesendboys/Instagram)
Video of man doing backflip off Vancouver bridge draws police condemnation

Group says in Instagram story that they ‘don’t do it for the clout’

Toronto’s Mass Vaccination Clinic is shown on Sunday January 17, 2021. THE CANADIAN PRESS/Frank Gunn
Canadian malls, conference centres, hotels offer up space for COVID vaccination centres

Commercial real estate association REALPAC said that a similar initiative was seeing success in the U.K.

Kamala Harris and Joe Biden are sworn into office on Wednesday, Jan. 20, 2021, at the U.S. Capitol in Washington, D.C. (Saul Loeb/Pool Photo via AP)
Joe Biden has been sworn in as the 46th president of the United States

About 25,000 National Guard members have been dispatched to Washington

A memorial for the fatal bus crash involving the Humboldt Broncos hockey team at the intersection of Highways 35 and 335 near Tisdale, Tuesday, October 27, 2020. THE CANADIAN PRESS/Liam Richards
‘End of the road:’ Truck driver in Humboldt Broncos crash awaits deportation decision

Sidhu was sentenced almost two years ago to eight years after pleading guilty to dangerous driving

In this March 28, 2017, file photo, a dump truck hauls coal at Contura Energy’s Eagle Butte Mine near Gillette, Wyo. Public opposition to the Alberta government’s plans to expand coal mining in the Rocky Mountains appears to be growing. THE CANADIAN PRESS/AP/Mead Gruver, File
Alberta cancels coal leases, pauses future sales, as opposition increases

New Democrat environment critic Marlin Schmidt welcomed the suspension

COVID update Jan. 19
Ponoka County COVID-19 numbers on steady decline

Numbers of active cases of COVID-19 have continued to drop in Ponoka… Continue reading

File photo
Wetaskiwin Crime Reduction Unit recovers valuable stolen property

Property valued at over $50,000 recovered by Wetaskiwin Crime Reduction Unit.

Most Read