Skip to main content
The reported case series of Bartonella quintana endocarditis provided a fascinating perspective on the modern presentation of a disease usually associated with World War I. A key point that warrants emphasis is that this disease is among the most easily preventable of infections. Persistence of the vector, Pediculus humanus corporis, the human body louse, which incidentally can also transmit two other life threatening pathogens, requires extreme conditions of squalor and privation. These conditions are typically combined with cold temperatures which necessitate continuous wearing of heavy clothing, and lack of access to even the most basic of hygiene and washing facilities. Such extreme conditions are characteristic of the trenches of World War I or more recently, some of the most awful refugee camps. This report illustrates how we are now replicating these conditions among unstably housed people in Canada who don’t have access to a safe place where they can bathe and clean their clothes in winter. This disease cluster should prompt us to ask how it is that the lives of some Canadians have so much in common with those of refugees or soldiers in the hellholes of WWI.