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The disease is caused by Borrelia species (spirochetes). There are
two distinct forms of this disease:
- Louse borne relapsing fever (LBRF): Body lice (Pediculus humanus)
become infected with B. recurrentis by feeding on spirochetemic humans,
the only reservoirs of infection. Humans become infected when an infected
louce is crushed and their body fluids contaminate mucous membranes
or breaks in the skin.
- Tick borne relapsing fever (TBRF): The ticks become infected by
feeding on spirochetemic hosts (rats, mice, chipmunks, squirrels, rabbits,
hares and humans). The spirochetes are transmitted by ticks to humans
and animals via saliva and excretory fluids when the tick feeds.
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Clinical manifestations of relapsing fever
The clinical manifestations of LBRF and TBRF are similar. The mean
incubation period is 7 days, and the onset of illness is sudden, with
fever, headache, shaking chills, sweats, myalgias, and arthralgias. The
arthralgia of relapsing fever can be severe, involving small and large
joints, but there is no evidence of arthritis. Dizziness, nausea, and
vomiting are common. The fever is high from the first, with a usual temperature
of 40?C (104?F); fever is most often irregular in pattern and is sometimes
accompanied by delirium. Dissimated intravascular coagulation, hepatosplenomegaly
& jaundice are possible complications. The fever occurs while the organism
is circulating the blood. The organism then undergoes massive phagocytosis
to be followed by relapse after 5 days with different antigen.
Diagnosis of relapsing fever
The diagnosis of relapsing fever is confirmed most easily by the detection
of spirochetes in blood, bone marrow aspirates, or cerebrospinal fluid.
Motile spirochetes can be seen when fresh blood is examined by dark-field
Treatment of relapsing fever
Relapsing-fever types of borrelia are exquisitely sensitive to antibiotics.
Treatment with either erythromycin, a tetracycline, chloramphenicol, or penicillin
produces rapid clearance of spirochetes and a remission of symptoms.