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

A new fee structure for Agassiz’s Valley View Cemetery means that former residents will now be paying less for a plot than non-residents. (Grace Kennedy/The Observer)
Agassiz changes cemetery rates for locals

Former residents will now be able to pay slightly less than outsiders to have a plot at Valley View

Eva Pucci Couture in this file shot from May 29, 2019, when she came to Chilliwack asking for the public’s help in locating her missing son, Kristofer Shawn Couture. (Jenna Hauck/ Chilliwack Progress file)
Missing man’s mom still hopeful, 2 years after his car was found abandoned at Chilliwack trail

‘I wish someone would come forward with insight into your whereabouts,’ pleads mom of missing man

Chilliwack is expected to be among the province’s hottest real estate markets in 2021. (THE CANADIAN PRESS/Sean Kilpatrick)
Chilliwack housing market projected to be among B.C.’s hottest in 2021

B.C. Real Estate Association projects Chilliwack and District to grow by 17.1 per cent

District of Kent farmers brought truckloads of used plastic to the Schwichtenburg farm Oct. 26, 2018, for pickup by Kent Agricultural Plastics Recycling, a grassroots, farmer-initiated organization that collects and distributes used plastics for recycling. (Nina Grossman/The Observer)
Agassiz’s agricultural plastics program heading to the dump, unless province steps in

Kent Agricultural Plastics Recycling has nowhere to go, hopes B.C. will create a recycling program

Abbotsford tattoo artist Tanya Loewen has entered the Inked cover girl contest.
Abbotsford mother, tattoo artist enters Inked cover girl contest

Tanya Loewen, tattoo artist at Van Bree Tattoo, hoping to win big in magazine contest

Dr. Penny Ballem, a former deputy health minister, discusses her role in leading B.C.’s COVID-19 vaccination program, at the B.C. legislature, Jan. 22, 2021. (B.C. government)
B.C. holds steady with 407 new COVID-19 cases Tuesday

14 deaths, no new outbreaks in the health care system

A Cessna 170 airplane similar to the one pictured above is reported to be missing off the waters between Victoria and Washington State. Twitter photo/USCG
Canadian, American rescue crews searching for missing aircraft in waters near Victoria

The search is centered around the waters northeast of Port Angeles

Jonathon Muzychka and Dean Reber are wanted on Canada-wide warrants. (Courtesy of Victoria Police Department)
Convicted killer, robber at large after failing to return to facility: Victoria police

Dean Reber, 60, and Jonathon Muzychka, 43, may be together

B.C. Premier John Horgan listens during a postelection news conference in Vancouver on Sunday, Oct. 25, 2020. THE CANADIAN PRESS/Darryl Dyck
30% of B.C. recovery benefit applications held up in manual review

The province says 150 staff have been reassigned to help with manually reviewing applications

Join Black Press Media and Do Some Good
Join Black Press Media and Do Some Good

Pay it Forward program supports local businesses in their community giving

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

Adam Dergazarian, bottom center, pays his respect for Kobe Bryant and his daughter, Gianna, in front of a mural painted by artist Louie Sloe Palsino, Tuesday, Jan. 26, 2021, in Los Angeles. (AP Photo/Jae C. Hong)
Kobe Bryant’s presence remains strong a year after his death

Tuesday marks the grim anniversary of the crash that took their lives

Surrey RCMP are investigating after a pedestrian was struck and killed at 183 Street and Highway 10 Friday night. (File photo)
Modelling of predicted transmission growth from the B117 COVID-19 variant in British Columbia. (Simon Fraser University)
COVID-19 variant predicted to cause ‘unmanageable’ case spike in B.C: report

SFU researchers predict a doubling of COVID-19 cases every two weeks if the variant spreads

Most Read