Relapsing fever


Relapsing fever is a bacterial infection characterized by repeated bouts of high fever, headache, muscle and joint pain, and nausea.

It is caused by certain types of Borrelia spirochetes. There are two types of relapsing fever, in the first type the vector of the spread of the disease is ticks, and in the second, fluff eaters or biting lice.

What is it caused by?

The disease is caused by certain strains of Borrelia, which are gram negative bacteria 0.2-0.5 microns wide and 5-20 microns long and have the shape of a screw plug, which is typical of all spirochetes.

They undergo a unique DNA rearrangement process that allows them to periodically change the molecules on their outer surface.

This process, called antigenic variation, provides the spirochete with the ability to evade its host’s immune system and cause recurrent bouts of fever and other symptoms.

Three strains of the bacterium cause the disease, Borrelia hermsii, B. Parkerii and B. Turicatae. The most common causative agent, however, is Borrelia hermsii.

Clinical disease

The disease is characterized by attacks of fever lasting several days, followed by a fever-free interval, but subsequently the affected person develops fever again.

This process can be repeated 1 to 4 times. Simultaneously with the increased temperature, patients may also complain of:

• generalized pains in the body – in the muscles, in the joints;
• headache, nausea, vomiting, anorexia, dry cough;
• sensitivity to light, rash, neck pain;
• eye irritation, confusion and dizziness;

Each febrile episode ends with a sequence of symptoms commonly known as a ‘crisis.’

During the “chilling phase” of the crisis, patients develop a very high temperature of up to 41.5 degrees Celsius and may become delirious, hyperexcited and develop tachycardia.

The duration is from 10 to 30 minutes. This phase is followed by a “hot flush” characterized by profuse sweating, patients may become temporarily hypotensive.

Typically, untreated patients develop febrile episodes 1 to 4 times before the disease resolves completely.

If you suspect that you have a recurring fever, seek medical attention.

Treatment of relapsing fever

Borrelia spirochetes are susceptible to penicillin and other beta-lactam antimicrobials, as well as tetracyclines, macrolides and possibly fluoroquinolones.

Experts usually recommend tetracycline 500 mg. every 6 hours for 10 days, this is the preferred oral regimen for adults.

When tetracyclines are contraindicated, an effective alternative is erythromycin 500 mg or 12.5 mg/kg. every 6 hours for 10 days.

Parenteral treatment with ceftriaxone 2 grams per day for 10-14 days is preferred in patients with onset of nervous system dysfunction similar to the onset of the neurologic phase of Lyme disease.

When initiating antibiotic therapy, all patients should be observed for the first 4 hours after initiation of therapy for a Jarisch-Herxheimer reaction.

This response of the body causes a worsening of symptoms, which is characterized by chills, hypotension, and in 50% of cases fever is also observed, which makes it difficult to distinguish it from the typical febrile crisis of relapsing fever.

In such a case, cooling blankets should be used and appropriate doses of antipyretics should be administered.

And in some of the patients undergoing treatment for the bacterial infection with Borrelia, the development of acute respiratory distress syndrome, which requires intubation, can also be observed.

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