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Relapsing Fever

Fevers Relapsing

Relapsing fever is a condition characterized by episodes of fever, headache, myalgias, arthralgias, and nausea followed by a few days of improvement after which there is a recurrence of symptoms. It is caused by some species of Borrelia spirochetes and can be of two types: the tick-borne relapsing fever and the louse-borne relapsing fever. Diagnosis depends on clinical features and identification of the causative organism.


Presentation

Relapsing fever (RF) is a condition caused by a spirochete and is characterized by typical features of episodic and recurrent high fever, headache, myalgias, and arthralgias. The symptoms last for approximately 3 days, then abate for a week but then recur for another 3 days. This process could continue unless treated. There are two types of RF: tick-borne RF (TBRF) and louse-borne RF (LBRF). TBRF occurs after individuals have lived or slept in rodent-infested mountain cabins while LBRF is transmitted by the body louse and happens in refugee camps or developing regions of the world.

Clinical presentation of TBRF is sudden onset of high fever lasting up to a week and ending with rigors, hypertension, and tachycardia [1]. The first episode is often accompanied by headaches, myalgias, arthralgias, neck stiffness, and nausea. Neurologic symptoms are more common in TBRF after the second episode of fever and include facial palsy, meningismus, myelitis, and radiculopathy followed in certain cases by deficits like hemiplegia and aphasia [1] [2]. Ophthalmic involvement is associated with a possibility of permanent visual impairment secondary to unilateral or bilateral iridocyclitis or panophthalmitis. Hepatosplenomegaly and myocarditis may be present in fatal cases. Infection of pregnant women has a higher incidence of miscarriages and stillbirths. Gravid women and children have a more serious form of the disease [3] [4]. During TBRF crises, adult respiratory distress syndrome is also known to develop [5].

The incidence of jaundice, petechiae, hemoptysis, epistaxis and CNS involvement is higher in LBRF [6]. Patients of LBRF have been reported to have mainly one relapse while those with TBRF have averagely 3 relapses [7]. Delirium and coma can arise in both TBRF and LBRF.

Splenomegaly
  • Splenomegaly was the second most common finding reported. Diagnosis of relapsing fever was made in 20 cases by identifying spirochetes on peripheral blood smears.[ncbi.nlm.nih.gov]
  • Malaria and babesiosis cause hemolytic anemia and may be associated with hepatomegaly and splenomegaly. Recurring fever is typical of malaria and Borrelia infection.[mdedge.com]
  • Other manifestations include splenomegaly, hepatomegaly, jaundice, rash, respiratory symptoms, and central nervous system involvement. A primary febrile episode ends within 3 to 6 days and can culminate in fatal shock.[atsu.edu]
  • Other features include: Rash Jaundice Haemorrhage Scattered petechiae on the trunk and limbs Iritis and iridocyclitis Photophobia Neurological symptoms and signs Hepatomegaly splenomegaly Gastrointestinal symptoms including abdominal pain , nausea, vomiting[patient.info]
Cough
  • The fever attacks last from several hours to 4 days, and are accompanied by chills, headache, nausea and vomiting, sweating, abdominal pain, arthralgia, and cough; complications are rare.[ncbi.nlm.nih.gov]
  • Recurring high fever episodes may be accompanied by symptoms of: rash chills dysuria myalgia diarrhea bleeding arthralgia dizziness headache dry cough weakness photophobia unsteady gait abdominal pain nausea & vomiting neck pain, stiffness mental status[healthblurbs.com]
  • Fever, dizziness, head and muscle ache, coughing, and vomiting. Episodes (a total of 2-5) of fever lasting several days followed by several days without fever. Severe disease includes liver and spleen enlargement and breathing difficulties.[extension.entm.purdue.edu]
  • Symptoms may include headache, myalgias, arthralgias, nausea, vomiting, loss of appetite, conjunctivitis, and dry cough.[columbia-lyme.org]
Fever
  • Relapsing fever symptoms are variable, and the disease is commonly misdiagnosed as, for example, malaria.[ncbi.nlm.nih.gov]
  • External links [ edit ] CDC: Relapsing Fever Scientist and astronomer Larry Webster infected with relapsing fever[en.wikipedia.org]
  • The diagnosis of tick-borne relapsing fever requires an accurate characterization of the fever and a thorough medical, social, and travel history of the patient.[ncbi.nlm.nih.gov]
  • Tick borne relapsing fever is an endemic disease in Sengerema district, Mwanza region, Tanzania, East Africa. Five cases of neonatal relapsing fever occurring in this endemic area are described.[ncbi.nlm.nih.gov]
  • We report the case of a Protestant missionary who contracted tick-borne relapsing fever in 1979 while serving in the Sudan.[ncbi.nlm.nih.gov]
Chills
  • We discuss the case of a 44-year-old male residing in the San Juan Mountains of Western Colorado who presented with fever, myalgia, vomiting, and "violent chills" to an emergency department.[ncbi.nlm.nih.gov]
  • LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.[ncbi.nlm.nih.gov]
  • The fever attacks last from several hours to 4 days, and are accompanied by chills, headache, nausea and vomiting, sweating, abdominal pain, arthralgia, and cough; complications are rare.[ncbi.nlm.nih.gov]
  • […] changes After several cycles of relapsing fever, some develop: coma stupor hepatitis seizures meningitis pneumonia facial droop myocarditis arrhythmias widespread bleeding The recurrent fever episodes can cause a “crisis” consisting of shaking chills[healthblurbs.com]
  • Between 2000 and 2007, 148 cases of TBRF (each with fever, chills and headache) were passively detected in the town.[ncbi.nlm.nih.gov]
High Fever
  • The high fevers of presenting patients spontaneously abate and then recur. Here we report a 50-year-old woman having relapsing fever associated with thrombocytopenia.[ncbi.nlm.nih.gov]
  • Definitions of relapsing fever 1 n marked by recurring high fever and transmitted by the bite of infected lice or ticks; characterized by episodes of high fever and chills and headache and muscle pain and nausea that recur every week or ten days for several[vocabulary.com]
  • Definition of relapsing fever : a variable acute epidemic disease that is marked by recurring high fever usually lasting three to seven days and is caused by a spirochete (genus Borrelia ) transmitted by the bites of lice and ticks First Known Use of[merriam-webster.com]
  • In October 2015, a 19-year-old Somali male presented to the emergency department of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, with a 3-day history of high fever.[ncbi.nlm.nih.gov]
Camping
  • Before the camp, a professional pest control company had rodent proofed the cabin, but no acaricides had been applied. Cabin inspection after the camp found rodents and Ornithodoros ticks, the vector of TBRF.[ncbi.nlm.nih.gov]
  • The camp was instructed to close immediately, and the health department, in collaboration with local university experts, investigated to identify additional cases, determine the cause, and prevent further infections.[ncbi.nlm.nih.gov]
  • During the summer of 2014 an outbreak of tickborne relapsing fever (TBRF) occurred in a group of high school students and staff at a youth camp, which was reported to Coconino County Public Health Services District.[ncbi.nlm.nih.gov]
  • A 12-year-old boy with two weeks of relapsing fevers 10 days after camping in remote eastern Oregon was examined. Borrelia hermsii immunoglobulin M and G levels were markedly elevated.[ncbi.nlm.nih.gov]
  • Diagnosis of LBRF cases and prevention of autochthonous transmission in asylum seeker camps are important steps for the near future.[ncbi.nlm.nih.gov]
Malaise
  • She presented with a 2 day history of fever, headache, general body malaise and vomiting. She was misdiagnosed as having severe malaria and was treated with quinine. The blood slide showed Borrelia duttoni.[ncbi.nlm.nih.gov]
  • Clinical illness is characterized by relapsing fever, myalgias, and malaise. On May 10, 2011, CDC and the Colorado Department of Public Health and Environment were notified of two patients with TBRF: a young woman and her newborn child.[ncbi.nlm.nih.gov]
  • Clinical illness is characterized by recurrent bouts of fever, headache, and malaise. Although TBRF is usually a mild illness, severe sequelae and death can occur.[ncbi.nlm.nih.gov]
  • Borrelia miyamotoi, a relapsing fever spirochete transmitted by ixodid ticks, is able to cause infections associated with systemic complaints, including malaise and fever, as well as meningoencephalitis in immunocompromised patients.[ncbi.nlm.nih.gov]
  • A 13-year-old girl presented with recurrent fevers, with temperatures up to 104 F (40 C), over a 3-week period, with associated headache, chills, and malaise.[nejm.org]
Nausea
  • Tickborne relapsing fever (TBRF) is a bacterial infection characterized by recurring episodes of fever, headache, muscle and joint aches, and nausea.[ncbi.nlm.nih.gov]
  • LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.[ncbi.nlm.nih.gov]
  • The fever attacks last from several hours to 4 days, and are accompanied by chills, headache, nausea and vomiting, sweating, abdominal pain, arthralgia, and cough; complications are rare.[ncbi.nlm.nih.gov]
  • Definitions of relapsing fever 1 n marked by recurring high fever and transmitted by the bite of infected lice or ticks; characterized by episodes of high fever and chills and headache and muscle pain and nausea that recur every week or ten days for several[vocabulary.com]
  • Relapsing Fever is a tick spread illness that is characterized by relapsing or recurring episodes of fever, accompanied by headache, muscle and joint aches, and nausea.[health.utah.gov]
Vomiting
  • She presented with a 2 day history of fever, headache, general body malaise and vomiting. She was misdiagnosed as having severe malaria and was treated with quinine. The blood slide showed Borrelia duttoni.[ncbi.nlm.nih.gov]
  • We discuss the case of a 44-year-old male residing in the San Juan Mountains of Western Colorado who presented with fever, myalgia, vomiting, and "violent chills" to an emergency department.[ncbi.nlm.nih.gov]
  • Findings on physical examination are variable; abdominal pain, vomiting, and altered sensorium are the most common symptoms.[ncbi.nlm.nih.gov]
  • He presented with fever (39 C), soreness, headache and vomiting. The blood pressure was 120/80 mmHg. The rest of the examination was normal.[ncbi.nlm.nih.gov]
  • LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Findings on physical examination are variable; abdominal pain, vomiting, and altered sensorium are the most common symptoms.[ncbi.nlm.nih.gov]
  • The fever attacks last from several hours to 4 days, and are accompanied by chills, headache, nausea and vomiting, sweating, abdominal pain, arthralgia, and cough; complications are rare.[ncbi.nlm.nih.gov]
  • Abdominal pain. General feeling of illness (malaise). Rash (up to 50% of cases). Prescription medicine is used to treat relapsing fever. Current as of: November 18, 2017 Author: Healthwise Staff Medical Review: William H.[myhealth.alberta.ca]
  • Recurring high fever episodes may be accompanied by symptoms of: rash chills dysuria myalgia diarrhea bleeding arthralgia dizziness headache dry cough weakness photophobia unsteady gait abdominal pain nausea & vomiting neck pain, stiffness mental status[healthblurbs.com]
  • Nausea, vomiting, abdominal pain, and rash may also occur. TBRF is characterized by recurring ("relapsing") episodes of symptoms that usually last about three days, disappear for seven days, then return.[nps.gov]
Tachycardia
  • This reaction produces apprehension, diaphoresis, fever, tachycardia, and tachypnea, with an initial pressor response followed rapidly by hypotension. Erythromycin or chloramphenicol can be used in the treatment of pregnant women and children.[atsu.edu]
  • These can, however, induce a Jarisch–Herxheimer reaction in over half those treated, producing anxiety, diaphoresis , fever, tachycardia and tachypnea with an initial pressor response followed rapidly by hypotension .[en.wikipedia.org]
  • A Jarisch-Herxheimer reaction including aggravated hypotension, tachycardia and high-grade fever was only observed in patient 2.[bmcinfectdis.biomedcentral.com]
Jaundice
  • Jaundice was seen in four of the five cases, three of them died. Only twenty cases of neonatal relapsing fever were previously reported. Findings are discussed in comparison with those of former reports on relapsing fever in the literature.[ncbi.nlm.nih.gov]
  • Her condition deteriorated a few hours after admission when jaundice, hepatosplenomegaly, and hemorrhage appeared. Borrelia organisms were found on peripheral blood smear. The patient died 16 hours after admission.[jamanetwork.com]
  • About one-fourth of patients with babesiosis are coinfected with the Lyme disease bacterium ( Borrelia burgdorferi ) and often have more severe illness. 3 Hepatomegaly, splenomegaly, jaundice, and dark urine are common findings in patients with symptoms[mdedge.com]
  • The louse borne infections are more severe presented with jaundice, hemorrhage and fatality at times. The lice are not shed through excreta. The infection is not transmitted through the bite, but through the skin abrasions when they are crushed.[medibiztv.com]
  • There is intense thirst a dry brown tongue, bilious vomiting, tenderness over the liver and spleen, and occasionally jaundice. Sometimes a peculiar bronzy appearance of the skin is noticed, but there is no characteristic rash as in typhus.[encyclopedia.jrank.org]
Hepatomegaly
  • Malaria and babesiosis cause hemolytic anemia and may be associated with hepatomegaly and splenomegaly. Recurring fever is typical of malaria and Borrelia infection.[mdedge.com]
  • Other manifestations include splenomegaly, hepatomegaly, jaundice, rash, respiratory symptoms, and central nervous system involvement. A primary febrile episode ends within 3 to 6 days and can culminate in fatal shock.[atsu.edu]
  • Other features include: Rash Jaundice Haemorrhage Scattered petechiae on the trunk and limbs Iritis and iridocyclitis Photophobia Neurological symptoms and signs Hepatomegaly splenomegaly Gastrointestinal symptoms including abdominal pain , nausea, vomiting[patient.info]
Hepatosplenomegaly
  • Her condition deteriorated a few hours after admission when jaundice, hepatosplenomegaly, and hemorrhage appeared. Borrelia organisms were found on peripheral blood smear. The patient died 16 hours after admission.[jamanetwork.com]
  • It should be performed in patients with persistent or recurring fever or in those who have traveled to the developing world or who have a history of tick exposure, especially if accompanied by hemolytic anemia, thrombocytopenia, or hepatosplenomegaly.[mdedge.com]
  • There was no hepatosplenomegaly and lympadenopathy. The patient had petechial rash and hematuria. Clinical diagnosis was recurrent fever of unknown cause. She had history of fever few weeks back, for which she took symptomatic treatment.[ijpmonline.org]
  • Less frequently, patients may have jaundice, hepatosplenomegaly, stiff neck, and photophobia.[coloradoticks.org]
Myalgia
  • Clinical illness is characterized by relapsing fever, myalgias, and malaise. On May 10, 2011, CDC and the Colorado Department of Public Health and Environment were notified of two patients with TBRF: a young woman and her newborn child.[ncbi.nlm.nih.gov]
  • We discuss the case of a 44-year-old male residing in the San Juan Mountains of Western Colorado who presented with fever, myalgia, vomiting, and "violent chills" to an emergency department.[ncbi.nlm.nih.gov]
  • On August 10, 2014, the Coconino County Public Health Services District in Arizona was notified by a local hospital that five high school students who attended the same outdoor education camp had been hospitalized with fever, headache, and myalgias.[ncbi.nlm.nih.gov]
  • He complained of myalgia and secondarily presented fever. Blood smears revealed spirochetes later identified as Borrelia recurrentis. LBRF should be considered in countries hosting refugees, particularly those who transit through endemic regions.[ncbi.nlm.nih.gov]
  • LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.[ncbi.nlm.nih.gov]
Arthralgia
  • LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.[ncbi.nlm.nih.gov]
  • The fever attacks last from several hours to 4 days, and are accompanied by chills, headache, nausea and vomiting, sweating, abdominal pain, arthralgia, and cough; complications are rare.[ncbi.nlm.nih.gov]
  • Definitions for relapsing fever Medical Definition of relapsing fever : a variable acute infectious disease that is marked by sudden recurring episodes of high fever which usually last from three to seven days, are typically accompanied by myalgia, arthralgia[merriam-webster.com]
  • Recurring high fever episodes may be accompanied by symptoms of: rash chills dysuria myalgia diarrhea bleeding arthralgia dizziness headache dry cough weakness photophobia unsteady gait abdominal pain nausea & vomiting neck pain, stiffness mental status[healthblurbs.com]
Lower Leg Pain
  • A previously healthy 20-year-old woman presented to our hospital on October 8, 2010, because of recurrent fever and lower leg pain.[ncbi.nlm.nih.gov]
Petechiae
  • Papules (small lumps), petechiae (small red or purple spots due to bleeding into the skin), purpura (bleeding into the skin, includes petechiae and bruises), and facial flushing have been described. Petechiae may also occur on mucous membranes.[dermnetnz.org]
  • Clinical manifestations are severe for most tick-borne relapsing fever; headache, neck stiffness, arthralgia, myalgia, ecchymosis, epistaxis, and petechiae.[igenex.com]
  • Infection with Borrelia recurrentis : pathogenesis of fever and petechiae. J. Infect. Dis. 140 :665–675. PubMed CrossRef Google Scholar Davis, G. E. 1956.[link.springer.com]
  • Additional clinical features of borreliosis include headaches, general body pain, liver tenderness, petechiae, nausea and vomiting, chills and rigors and epistaxis. [4] In this case, marked thrombocytopenia was seen.[ijpmonline.org]
Purpura
  • Papules (small lumps), petechiae (small red or purple spots due to bleeding into the skin), purpura (bleeding into the skin, includes petechiae and bruises), and facial flushing have been described. Petechiae may also occur on mucous membranes.[dermnetnz.org]
Headache
  • Tickborne relapsing fever (TBRF) is a bacterial infection characterized by recurring episodes of fever, headache, muscle and joint aches, and nausea.[ncbi.nlm.nih.gov]
  • She presented with a 2 day history of fever, headache, general body malaise and vomiting. She was misdiagnosed as having severe malaria and was treated with quinine. The blood slide showed Borrelia duttoni.[ncbi.nlm.nih.gov]
  • Clinical illness is characterized by recurrent bouts of fever, headache, and malaise. Although TBRF is usually a mild illness, severe sequelae and death can occur.[ncbi.nlm.nih.gov]
  • A 13-year-old girl presented with recurrent fevers, with temperatures up to 104 F (40 C), over a 3-week period, with associated headache, chills, and malaise.[nejm.org]
  • He presented with fever (39 C), soreness, headache and vomiting. The blood pressure was 120/80 mmHg. The rest of the examination was normal.[ncbi.nlm.nih.gov]
Confusion
  • Given the high incidence of malaria in Mali, and the potential to confuse the clinical diagnosis of these two diseases, we initiated studies to determine if there were endemic foci of relapsing fever spirochetes that could pose a risk for human infection[ncbi.nlm.nih.gov]
  • The classic taxonomy based on the co-speciation concept is very complex and very confusing. For this reason, 16S rRNA and flaB genes were used for taxonomic clarification.[ncbi.nlm.nih.gov]
  • To minimize confusion among scientists and other health care professionals, we proposed that the species that are part of the Lyme disease Borrelia should be transferred to a new genus, Borreliella .[atlasofscience.org]
  • The patient may become dizzy and confused. The eyes may be bloodshot and very sensitive to light. A cough may develop. The heart rate is greatly increased, and the liver and spleen may be swollen.[medical-dictionary.thefreedictionary.com]
  • Typhus should not be confused with typhoid fever . Although there are some similarities between these two febrile illnesses, they are caused by different bacteria and typhoid is transmitted mainly in infected food, not by body lice.[open.edu]

Workup

The diagnosis of RF depends on identifying the typical characteristics of the fever along with a thorough medical, social, and travel history as findings of physical examination are not predictable. Spirochetes can be detected on thin and thick peripheral blood smears using Wright’s or Giemsa stain or by isolating them in Kelly culture medium in the period between onset of fever and its peak [8] [9] [10]. Peripheral blood smears have a sensitivity of 70% and are more sensitive in detecting TBRF than LBRF [11].

Direct and indirect immunofluorescence can be used to visualize spirochetes with a fluorescence microscope while polymerase chain reaction testing can identify most Borrelia species [12] [13]. Other laboratory findings include elevated erythrocyte sedimentation rate, anemia, proteinuria,leukocytosis, thrombocytopenia, increased serum unconjugated bilirubin levels, elevated hepatic transaminase levels, prolonged partial thromboplastin and prothrombin times and microhematuria. In TBRF myocarditis, an electrocardiogram may show a prolonged corrected Q-T interval [14] [15] [16]. Analysis of cerebrospinal fluid (CSF) in patients with neurological symptoms is likely to reveal mononuclear pleocytosis, an elevated protein level, and normal glucose levels [3] [7].

Features of pulmonary edema can be noticed on a plain chest X-ray when present. Other imaging studies are indicated only in cases where intracranial or other complications are suspected.

Histological studies help to detect spirochetes using silver stains like Warthin-Starry or modified Dieterle.

Treatment

  • Treatment with doxycycline was continued and finally all symptoms disappeared within 36 hours after starting this treatment.[ncbi.nlm.nih.gov]
  • Hard-tick-borne relapsing fever (HTBRF) is an emerging infectious disease throughout the temperate zone caused by the relapsing-fever spirochete Borrelia miyamotoi Antibiotic treatment of HTBRF is empirically based on the treatment of Lyme borreliosis[ncbi.nlm.nih.gov]
  • The patient continued treatment with procaine penicillin fortified for relapsing fever. Several hours later the woman died, probably due to JHR.[ncbi.nlm.nih.gov]
  • Therefore, single-dose antibiotic treatment should be avoided. Instead, treatment should cover a longer period, similar to the recommended regime for Lyme disease.[ncbi.nlm.nih.gov]
  • Treatment was complicated by severe Jarisch-Herxheimer reactions in both patients.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis In epidemics of LBRF, death rates among untreated victims have run as high as 30%. With treatment, and careful monitoring for the development of the Jarish-Herxheimer reaction, prognosis is good for both LBRF and TBRF.[medical-dictionary.thefreedictionary.com]
  • Outlook (Prognosis) People with this condition who have developed a coma, heart inflammation, liver problems, or pneumonia are more likely to die. With early treatment, the death rate is reduced.[leehealth.org]
  • […] sequelae due to microemboli Jaundice due to hepatitis Bleeding diathesis due to disseminated intravascular coagulation (potentially fatal in brain/GI tract) Death during acute severe bacteraemia due to septic shock (particularly epidemic relapsing fever) Prognosis[patient.info]

Etiology

  • […] disease is remarkable because the human host is unaware of the tick bite, usually becomes very ill, may experience an exacerbation of symptoms rather than improvement shortly after beginning appropriate treatment, and, despite often high numbers of the etiologic[ncbi.nlm.nih.gov]
  • Borrelia recurrentis, transmitted by Pediculus humanus humanus, is the etiological agent of louse-borne relapsing fever (LBRF). Currently the main focus of endemicity of LBRF is localized in East African countries.[ncbi.nlm.nih.gov]
  • Etiology The disease may be epidemic and transmitted by lice or endemic and transmitted by soft-bodied ticks (Ornithodoros and Argas).[orpha.net]
  • The first case linked with spirochetal etiology and body louse transmission occurred in late 19th –early 20th century. Soft tick-borne relapsing fever was first discovered to cause disease in humans in the early 20th century.[igenex.com]
  • Borrelia recurrentis is the etiologic agent of louseborne relapsing fever and is transmitted by the body louse. The vectors of tickborne relapsing fever are the soft ticks, and a number of Borrelia species can be transmitted by these arthropods.[link.springer.com]

Epidemiology

  • This report summarizes the epidemiology of 504 TBRF cases reported from 12 western states during 1990-2011. Cases occurred most commonly among males and among persons aged 10‒14 and 40‒44 years.[ncbi.nlm.nih.gov]
  • Three sporadic cases in 1977--tightly grouped geographically and temporally--prompted an epidemiologic review.[ncbi.nlm.nih.gov]
  • This routine prevented unnecessary examinations and hospitalization days and provided important information to regional epidemiology and public health authorities.[ncbi.nlm.nih.gov]
  • This report summarizes these three cases and the results of the subsequent epidemiologic investigations. The findings indicate that ARDS might occur more frequently in patients with TBRF than previously recognized.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology After exposure to an infected louse or tick, spirochetes enter the dermis and gain access to the bloodstream where they infect the endothelium.[patient.info]
  • Pathophysiology and immunology of the Jarisch-Herxheimer-like reaction in louse-borne relapsing fever: comparison of tetracycline and slow-release penicillin. J Infect Dis 1983 ;147: 898 - 909 14.[nejm.org]

Prevention

  • Thirty-six cases of TBRF were estimated to be prevented at a cost of 526 per infection.[ncbi.nlm.nih.gov]
  • Diagnosis of LBRF cases and prevention of autochthonous transmission in asylum seeker camps are important steps for the near future.[ncbi.nlm.nih.gov]
  • Tick-bite screening and prophylactic treatment with doxycycline in endemic areas is a practical, safe, and highly effective policy for preventing TBRF.[ncbi.nlm.nih.gov]
  • This routine prevented unnecessary examinations and hospitalization days and provided important information to regional epidemiology and public health authorities.[ncbi.nlm.nih.gov]
  • Public health follow-up of reported TBRF cases should include a search for persons sharing an exposure with the patient and environmental investigation with remediation measures to prevent additional infections.[ncbi.nlm.nih.gov]

References

Article

  1. Dworkin MS, Schwan TG, Anderson DE Jr. Tick-borne relapsing fever in North America. Med Clin North Am. 2002;86:417-433.
  2. Cadavid D, Barbour AG. Neuroborreliosis during relapsing fever: review of the clinical manifestations, pathology, and treatment of infections in humans and experimental animals. Clin Infect Dis. 1998;26:151-164.
  3. Dworkin MS, Shoemaker PC, Fritz CL, Dowell ME, Anderson DE Jr. The epidemiology of tick-borne relapsing fever in the United States. Am J Trop Med Hyg. 2002;66:753-758.
  4. Jongen VH, van Roosmalen J, Tiems J, Van Holten J, Wetsteyn JC. Tick-borne relapsing fever and pregnancy outcome in rural Tanzania. Acta Obstet Gynecol Scand. 1997;76:834-838.
  5. Centers for Disease Control and Prevention (CDC). Acute respiratory distress syndrome in persons with tickborne relapsing fever--three states, 2004-2005. MMWR Morb Mortal Wkly Rep. 2007 Oct 19; 56(41):1073-1076.
  6. Goubau PF. Relapsing fevers. A review. Ann Soc Belg Med Trop. 1984; 64(4):335-364.
  7. Blevins SM, Greenfield RA, Bronze MS. Blood smear analysis in babesiosis, ehrlichiosis, relapsing fever, malaria, and Chagas disease. Cleve Clin J Med. 2008;75(7):521-530.
  8. Kelly R. Cultivation of Borrelia hermsi. Science. 1971; 173(995):443-444.
  9. Dworkin MS, Schwan TG, Anderson DE Jr, Borchardt SM. Tick-borne relapsing fever. Infect Dis Clin North Am. 2008; 22(3):449-468.
  10. Trevejo RT, Schriefer ME, Gage KL, et al. An interstate outbreak of tick-borne relapsing fever among vacationers at a Rocky Mountain cabin. Am J Trop Med Hyg. 1998;58:743-747.
  11. Parola P, Raoult D. Ticks and tickborne bacterial diseases in humans: an emerging infectious threat. Clin Infect Dis. 2001; 32(6):897-928.
  12. Fukunaga M, Okada K, Nakao M, Konishi T, Sato Y. Phylogenetic analysis of Borrelia species based on flagellin gene sequences and its application for molecular typing of Lyme disease borreliae. Int J Syst Bacteriol. 1996;46(4):898-905.
  13. Uhlmann EJ, Seed PC, Schwan TG, Storch GA. Tick-borne relapsing fever polymerase chain reaction of tick-borne relapsing fever caused by Borrelia hermsii. Pediatr Infect Dis J. 2007;6(3):267-269.
  14. Dworkin MS, Anderson DE Jr, Schwan TG, et al. Tick-borne relapsing fever in the northwestern United States and southwestern Canada. Clin Infect Dis. 1998;26:122-131.
  15. Horton JM, Blaser MJ. The spectrum of relapsing fever in the Rocky Mountains. Arch Intern Med. 1985;145:871-875.
  16. Cadavid D, Bundoc V, Barbour AG. Experimental infection of the mouse brain by a relapsing fever Borrelia species: a molecular analysis. J Infect Dis. 1993;168:143-151.

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Last updated: 2018-06-22 09:10