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7. Bacterial diseases
Laboratory
T he d iagno sis is co nfirm ed by d etectio n o f Borrelia in thick o r thin blo o d film s
(G iem sa
stain) . B lo o d sam p les m ust be co llected d uring febrile p erio d s. S p iro ch etes are no t
fo und in th e p erip h eral blo o d d uring afebrile p erio d s. I n ad d itio n, th e num ber o f
circulating sp iro chetes tend s to d ecrease with each febrile ep iso d e.
Treatment
– Adoxnytcibyicolintiec PtheOrap y (susp ect o r co nfirm ed cases and clo se co ntacts):
1
C hild ren: 1 0 0 m g as a single d o se
A d ults: 1 0 0 o r 2 0 0 m g as a single d o se
o r erythromycin P O
C hild ren ≤ 5 y ears: 2 5 0 m g as a single d o se
C hild ren > 5 y ears and ad ults: 5 0 0 m g as a single d o se
– T reatm ent o f p ain and fever ( p aracetam o l P O ) and p reventio n o r treatm ent o f
d ehy d ratio n in the event o f asso ciated d iarrho ea.
– E lim inatio n o f bo d y lice is essential in co ntro l o f ep id em ics (see p age 1 0 1 ).
Tick-borne relapsing fever (TBRF)
7
T B R F s are caused by d ifferent Borrelia sp ecies. T h ey are end em ic in tem p erate and
warm regio ns o f the wo rd , esp ecially in A frica (T anz ania, D R C , S enegal, M auritania,
M ali, the H o rn o f A frica) and m ainly in rural areas. T B R F is a m ajo r cause o f
m o rbid ity
and m o rtality in child ren and p regnant wo m en. T he m o rtality rate fo r untreated
TBRF
ranges fro m 2 to 1 5 % .
Clinical features
T he clinical m anifestatio ns and co m p licatio ns o f T B R F are sim ilar to tho se o f
L B R F but
neuro lo gical sy m p to m s (p articularly , cranial nerve p alsies and ly m p ho cy tic
m eningitis)
are m o re frequent than in L B R F and the num ber o f relap ses is higher.
T h e clinical d iagno sis is d ifficult, esp ecially d uring th e first ep iso d e: cases o ccur
sp o rad ically rath er th an in o utb reak s; th e tick b ite is p ainless and usually
unno ticed by th e p atient; sy m p to m s are very sim ilar to th o se o f m alaria, ty p h o id
fever, lep to sp iro sis, certain arbo viro sis ( y ello w fever, d engue) o r rick ettsio sis, and
m eningitis.
Doxycycline is usually contra-indicated in children under 8 years and pregnant women. However, if
1
erythromycin is not available, it may be used for the treatment of LBRF, the administration of a single dose
Laboratory
T he d iagno sis is co nfirm ed by d etectio n o f Borrelia in thick o r thin blo o d film s
(G iem sa
stain) . B lo o d sam p les m ust be co llected d uring febrile p erio d s. S p iro ch etes are no t
fo und in th e p erip h eral blo o d d uring afebrile p erio d s. I n ad d itio n, th e num ber o f
circulating sp iro chetes tend s to d ecrease with each febrile ep iso d e.
Treatment
– Adoxnytcibyicolintiec PtheOrap y (susp ect o r co nfirm ed cases and clo se co ntacts):
1
C hild ren: 1 0 0 m g as a single d o se
A d ults: 1 0 0 o r 2 0 0 m g as a single d o se
o r erythromycin P O
C hild ren ≤ 5 y ears: 2 5 0 m g as a single d o se
C hild ren > 5 y ears and ad ults: 5 0 0 m g as a single d o se
– T reatm ent o f p ain and fever ( p aracetam o l P O ) and p reventio n o r treatm ent o f
d ehy d ratio n in the event o f asso ciated d iarrho ea.
– E lim inatio n o f bo d y lice is essential in co ntro l o f ep id em ics (see p age 1 0 1 ).
Tick-borne relapsing fever (TBRF)
7
T B R F s are caused by d ifferent Borrelia sp ecies. T h ey are end em ic in tem p erate and
warm regio ns o f the wo rd , esp ecially in A frica (T anz ania, D R C , S enegal, M auritania,
M ali, the H o rn o f A frica) and m ainly in rural areas. T B R F is a m ajo r cause o f
m o rbid ity
and m o rtality in child ren and p regnant wo m en. T he m o rtality rate fo r untreated
TBRF
ranges fro m 2 to 1 5 % .
Clinical features
T he clinical m anifestatio ns and co m p licatio ns o f T B R F are sim ilar to tho se o f
L B R F but
neuro lo gical sy m p to m s (p articularly , cranial nerve p alsies and ly m p ho cy tic
m eningitis)
are m o re frequent than in L B R F and the num ber o f relap ses is higher.
T h e clinical d iagno sis is d ifficult, esp ecially d uring th e first ep iso d e: cases o ccur
sp o rad ically rath er th an in o utb reak s; th e tick b ite is p ainless and usually
unno ticed by th e p atient; sy m p to m s are very sim ilar to th o se o f m alaria, ty p h o id
fever, lep to sp iro sis, certain arbo viro sis ( y ello w fever, d engue) o r rick ettsio sis, and
m eningitis.
Doxycycline is usually contra-indicated in children under 8 years and pregnant women. However, if
1
erythromycin is not available, it may be used for the treatment of LBRF, the administration of a single dose
