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Section 3. Summaries of Infectious Diseases

Borrelia Infections

(Relapsing Fever)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS

Relapsing fever is characterized by the sudden onset of high fever, shaking chills, sweats, headache, muscle and joint pains, and nausea. A fleeting macular rash of the trunk and petechiae of the skin and mucous membranes sometimes occur. Complications include hepatosplenomegaly, jaundice, thrombocytopenia, iridocyclitis, cough with pleuritic pain, pneumonitis, meningitis, and myocarditis. Mortality rates are 10% to 70% in untreated louseborne relapsing fever (possibly related to comorbidities in refugee-type settings where this disease typically is found) and 4% to 10% in untreated tickborne relapsing fever, and death occurs predominantly in people with underlying illnesses, infants, and the elderly. Early treatment reduces mortality to less than 5%. Untreated, an initial febrile period of 2 to 7 days terminates spontaneously by crisis. The initial febrile episode is followed by an afebrile period of several days to weeks, then by one relapse or more. Relapses typically become shorter and milder progressively as afebrile periods lengthen. Relapse is associated with expression of new borrelial antigens, and resolution of symptoms is associated with production of antibody specific to those new antigenic determinants. Infection during pregnancy often is severe and can result in preterm birth, abortion, stillbirth, or neonatal infection.


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ETIOLOGY

Relapsing fever is caused by certain spirochetes of the genus Borrelia. Borrelia recurrentis is the only species that causes louseborne (epidemic) relapsing fever, and there is no animal reservoir of B recurrentis. Worldwide, at least 14 Borrelia species cause tickborne (endemic) relapsing fever, including Borrelia hermsii, Borrelia turicatae. . . [Go to Full Text]


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