Clinicians | Relapsing fever

SkipdirectlytositecontentSkipdirectlytopageoptionsSkipdirectlytoA-ZlinkRelapsingFeverSectionNavigationCDCHomeFacebookTwitterLinkedInSyndicateInformationforCliniciansMinusRelatedPagesPresentationRelapsingFeverBacteriaRelapsingfeveriscausedbycertainspeciesofBorrelia,agramnegativebacteria0.2to0.5micronsinwidthand5to20micronsinlength.Theyarevisiblewithlightmicroscopyandhavethecork-screwshapetypicalofallspirochetes.RelapsingfeverspirocheteshaveauniqueprocessofDNArearrangementthatallowsthemtoperiodicallychangethemoleculesontheiroutersurface.Thisprocess,calledantigenicvariation,allowsthespirochetetoevadethehostimmunesystemandcauserelapsingepisodesoffeverandothersymptoms.ThreespeciescauseTBRFintheUnitedStates:Borreliahermsii,B.parkeri,andB.turicatae.ThemostcommoncauseiscauseisB.hermsii.Tick-bornerelapsingfeverischaracterizedbyrecurringfebrileepisodesthatlast~3daysandareseparatedbyafebrileperiodsof~7daysduration.Alongwithfever,patientsmayexperienceawiderangeofnonspecificsymptoms(Table1).Eachfebrileepisodeendswithasequenceofsymptomscollectivelyknownasa“crisis.”Duringthe“chillphase”ofthecrisis,patientsdevelopveryhighfever(upto106.7°For41.5°C)andmaybecomedelirious,agitated,tachycardicandtachypneic.Durationis10to30minutes.Thisphaseisfollowedbythe“flushphase”,characterizedbydrenchingsweatsandarapiddecreaseinbodytemperature.Duringtheflushphase,patientsmaybecometransientlyhypotensive.Overall,patientswhoarenottreatedwillexperienceseveralepisodesoffeverbeforeillnessresolves.GeneraltimelineforTBRFrelapseintervals.PhysicalExamFindingsonphysicalexamvarydependingontheseverityofillnessandwhenthepatientseeksmedicalcare.Regardless,therearenofindingsspecificforTBRF.Patientstypicallyappearmoderatelyillandmaybedehydrated.Occasionallyamacularrashorscatteredpetechiaemaybepresentonthetrunkandextremities.Lessfrequently,patientsmayhavejaundice,hepatosplenomegaly,meningismus,andphotophobia(Table1).Althoughlesscommon,infectionwithB.turicataeisespeciallylikelytoresultinneurologicinvolvement.Table1.Se

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