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

Crown prosecutors have stayed attempted murder charges against Kelowna’s Jesse Pez. (Phil McLachlan - Capital News)
Man accused in Kelowna Halloween stabbing has attempted murder charge stayed

The Crown only proceeds with charges when evidence provides ‘a substantial likelihood of conviction’

Toronto’s Mass Vaccination Clinic is shown on Sunday January 17, 2021. THE CANADIAN PRESS/Frank Gunn
Interior Health reports 2 more deaths, 83 new COVID-19 cases

Health authority also identifies new virus cluster in Fernie

A rendering of the proposed “Aqua” resort in Kelowna’s Lower Mission area. (Contributed)
Towering waterfront resort planned in Kelowna

Mission Group’s ‘Aqua’ resort has been in the works for more than a decade

A pair of Okanagan Regional Library reference librarians have created a podcast called Hard Cover that takes a zany but informative look at books, libraries and librarians. (File photo)
Okanagan reference librarians produce quirky podcast

Davin Helkenberg and Peter Critchley are behind Hard Cover

Okanagan Symphony Orchestra music director Rosemary Thomson in action at the podium. Photo by Lynda Miller.
Kelowna filmmaker gets funding to create new ‘Local Heroes’ documentary

The documentary will be focused on the director of the Okanagan Symphony Orchestra and Opera

British Columbia Health Minister Adrian Dix looks on as Provincial Health Officer Dr. Bonnie Henry addresses the media during a news conference at the BC Centre of Disease Control in Vancouver B.C. (THE CANADIAN PRESS/Jonathan Hayward)
B.C. announces 485 new COVID-19 cases, fewest deaths in months

‘The actions we take may seem small, but will have a big impact to stop the virus,” urges Dr. Henry

Keith Thorpe/Peninsula Daily News
Search called off for small plane that went down in rough water south of Victoria

Plane bound for Port Angeles from Alaska believed to have one occupant, an Alaskan pilot

RCMP released this photo on Jan. 27, 2021 of Terrance Jones, 40, a Caucasian man with a closely shaved head, brown eyes, dirty blonde or brown hair, and a thin mustache and beard. The inside of his right arm is covered in tattoos, including one of a face. (Kamloops RCMP photo)
RCMP want public’s help to locate Shuswap man wanted on charge of attempted murder

Sicamous man was arrested previously on Jan. 11 for allegedly breaching conditions of release

Royal B.C. Museum conservator Megan Doxsey-Whitfield kneels next to a carved stone pillar believed to have significance as a First Nations cultural marker by local Indigenous people. The pillar was discovered on the beach at Dallas Road last summer. Museum curatorial staff have been working with Songhees and Esquimalt Nation representatives to gain a clearer picture of its use. (Photo courtesy Royal BC Museum)
Stone carving found on Victoria beach confirmed Indigenous ritual pillar

Discussion underway with the Esquimalt and Songhees about suitable final home for the artifact

Former Vancouver Giants forward Evander Kane is seen here in Game 7 of the second round of the 2009 WHL playoffs against the Spokane Chiefs (Sam Chan under Wikipedia Commons licence)
Gambling debts revealed in details of bankruptcy filing by hockey star Evander Kane

Sharks left winger and former Vancouver Giants player owes close to $30 million total

Othman “Adam” Hamdan, pictured in front of Christina Lake’s Welcome Centre, was acquitted of terrorism related charges in 2017. He has been living in Christina Lake since November 2020. Photo: Laurie Tritschler
Man acquitted on terrorism charges awaits deportation trial while living in Kootenays

Othman Ayed Hamdan said he wants to lead a normal life while he works on his upcoming book

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

B.C. Premier John Horgan wears a protective face mask to help prevent the spread of COVID-19 prior to being sworn in by The Honourable Janet Austin, Lieutenant Governor of British Columbia during a virtual swearing in ceremony in Victoria, Thursday, November 26, 2020. THE CANADIAN PRESS/Jonathan Hayward
Premier Horgan calls jumping COVID vaccine queue ‘un-Canadian’

Horgan says most people in B.C. are doing their best to follow current public health guidelines

Most Read