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apsing fever (borreliosis)
Relapsing fever (borreliosis)
R elap sing fever ( F R ) is caused by sp iro ch etes o f th e genus Borrelia, transm itted to
hum ans by arthro p o d vecto rs.
Louse-borne relapsing fever (LBRF)
L B R F is caused by Borrelia recurrentis. I t o ccurs in ep id em ic waves when co nd itio ns
favo urable to the transm issio n o f bo d y lice are m et: co ld clim ate/ seaso n, o vercro wd ing
and very p o o r sanitatio n (e.g. refugee cam p s, p riso ns). E nd em ic fo ci o f L B R F are
m ainly
the S ud an and the H o rn o f A frica (esp ecially E thio p ia). L B R F can be asso ciated with
lo use-bo rne ty p hus (see p age 1 8 5 ). T he m o rtality rate fo r untreated L B R F ranges
fro m
1 5 to 4 0 % .
Clinical features
– R elap sing fever is characteriz ed by febrile ep iso d es sep arated by afebrile p erio d s o f
ap p ro xim ately 7 d ay s (4 to 1 4 d ay s).
– T he initial febrile ep iso d e lasts up to 6 d ay s:
• S ud d en o nset o f high fever (> 3 9 °C ), severe head ache and asthenia, d iffuse p ain
( m uscle, jo int, back p ain) , o ften asso ciated w ith gastro intestinal d isturbances
(ano rexia, abd o m inal p ain, vo m iting, d iarrho ea).
• S p leno m egaly is co m m o n; bleed ing sig ns ( e.g . p etech iae, subco njunctival
haem o rrh age, ep istaxis, bleed ing gum s), jaund ice o r neuro lo gical sy m p to m s m ay
be o bserved .
• T he febrile ep iso d e term inates in a crisis with an elevatio n in tem p erature, p ulse
and blo o d p ressure, fo llo wed by a fall in tem p erature and blo o d p ressure, which
m ay last fo r several ho urs.
– F o llo wing the initial febrile ep iso d e, th e cy cle usually reccurs; each ep iso d e is less
severe than the p revio us o ne and the p atient d evelo p s tem p o rary im m unity .
– C o m p licatio ns:
• co llap se d uring d efervescence, m y o card itis, cerebral haem o rrhage;
• d uring p regnancy : abo rtio n, p reterm d elivery , in utero fo etal d eath, neo natal d eath.
jIoninpt rpaacintic, ec,hiinllsa,njaaupndpicliecaobrleseigpnsidoefmbleioedloingic(anlosseettionrgo(tsheeer abbleoevdein),ga) sour sap peactiecnatsewoithf high
LBRF
is, acco rd ing to the W H O , a patient with high fever and two of the following symptoms: severe
fever who is responding poorly to antimalarial drugs. C lo thing sho uld be check ed fo r th e
p resence o f bo d y lice and nits.
Relapsing fever (borreliosis)
R elap sing fever ( F R ) is caused by sp iro ch etes o f th e genus Borrelia, transm itted to
hum ans by arthro p o d vecto rs.
Louse-borne relapsing fever (LBRF)
L B R F is caused by Borrelia recurrentis. I t o ccurs in ep id em ic waves when co nd itio ns
favo urable to the transm issio n o f bo d y lice are m et: co ld clim ate/ seaso n, o vercro wd ing
and very p o o r sanitatio n (e.g. refugee cam p s, p riso ns). E nd em ic fo ci o f L B R F are
m ainly
the S ud an and the H o rn o f A frica (esp ecially E thio p ia). L B R F can be asso ciated with
lo use-bo rne ty p hus (see p age 1 8 5 ). T he m o rtality rate fo r untreated L B R F ranges
fro m
1 5 to 4 0 % .
Clinical features
– R elap sing fever is characteriz ed by febrile ep iso d es sep arated by afebrile p erio d s o f
ap p ro xim ately 7 d ay s (4 to 1 4 d ay s).
– T he initial febrile ep iso d e lasts up to 6 d ay s:
• S ud d en o nset o f high fever (> 3 9 °C ), severe head ache and asthenia, d iffuse p ain
( m uscle, jo int, back p ain) , o ften asso ciated w ith gastro intestinal d isturbances
(ano rexia, abd o m inal p ain, vo m iting, d iarrho ea).
• S p leno m egaly is co m m o n; bleed ing sig ns ( e.g . p etech iae, subco njunctival
haem o rrh age, ep istaxis, bleed ing gum s), jaund ice o r neuro lo gical sy m p to m s m ay
be o bserved .
• T he febrile ep iso d e term inates in a crisis with an elevatio n in tem p erature, p ulse
and blo o d p ressure, fo llo wed by a fall in tem p erature and blo o d p ressure, which
m ay last fo r several ho urs.
– F o llo wing the initial febrile ep iso d e, th e cy cle usually reccurs; each ep iso d e is less
severe than the p revio us o ne and the p atient d evelo p s tem p o rary im m unity .
– C o m p licatio ns:
• co llap se d uring d efervescence, m y o card itis, cerebral haem o rrhage;
• d uring p regnancy : abo rtio n, p reterm d elivery , in utero fo etal d eath, neo natal d eath.
jIoninpt rpaacintic, ec,hiinllsa,njaaupndpicliecaobrleseigpnsidoefmbleioedloingic(anlosseettionrgo(tsheeer abbleoevdein),ga) sour sap peactiecnatsewoithf high
LBRF
is, acco rd ing to the W H O , a patient with high fever and two of the following symptoms: severe
fever who is responding poorly to antimalarial drugs. C lo thing sho uld be check ed fo r th e
p resence o f bo d y lice and nits.
