Relapsing fever, epidemic A68.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Epidemic relapsing fever; Louseborne relapsing Fever; Relapsing fever epidemic; relapsing lice fever

History
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Rutty 1770; Craigie 1843; Obermeier 1873

Definition
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Notifiable, severe infectious disease caused by Borrelia bacteria, transmitted from person to person by lice ( Pediculosis corporis) with typical fever attacks as in endemic relapsing fever. Relapses in 30% of cases.

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Pathogen
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Borrelia recurrentis. Pathogen reservoir: human. Carrier: Pediculus humanus corporis.

Occurrence/Epidemiology
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Asia, East Africa, Ethiopia, Sudan, North and Central Africa, South America. In Europe, increasingly introduced by migrants, occurring (Bloch-Infanger C et al.; Ciervo A et al.).

Clinical features
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Incubation period 2-10 days. Acute onset of high fever (40-41 °C), headache, joint and muscle pain, abdominal pain, stiff neck, photophobia, splenomegaly, hepatomegaly, icterus, exanthema. The first fever period lasts about 6 days followed by a fever-free interval of about 8-10 days. Usually 2-6 further fever spurts occur in the further course of the disease. Massive bacteremia and infestation of almost all organs.0

The fever attacks decrease in severity in uncomplicated courses. Immunity up to 1 year after infection.

Complicated myocarditis can lead to death, as can disseminated intravascular coagulation.

Laboratory
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Pathogen detection in the blood (smear, thick drop, dark field microscopy). Serology (ELISA, CFT, agglutination). If necessary, detection in animal experiments.

Complication(s)
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Myocarditis (possibly life-threatening), nephritis, liver failure and adult respiratory distress syndrome, severe bleeding tendencies (epistaxis, conjunctival bleeding, gastrointestinal haemorrhages).

Therapy
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Benzylpenicillin (e.g. penicillin Grünenthal) 20 million IU/day i.v. over 14 days. Cave! Herxheimer reaction.
Alternatively: Doxycycline (e.g. Doxycycline 100 Heumann) 2 times/day 100 mg or Tetracycline (e.g. Tetracycline Wolff Kps.) 3-4 times/day 500 mg p.o. over 14 days.

Progression/forecast
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If left untreated, it is often lethal (about 50% of cases).

Prophylaxis
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Lice control. S.u. Pediculosis corporis.

Literature
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Bloch-Infanger C et al(2017) Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland. PLoS One 12:e0179537.
Ciervo A et al (2016) Louseborne Relapsing Fever in Young Migrants, Sicily, Italy, July-September 2015, Emerg Infect Dis 22:152-153.
Lucchini A et al. (2016) Louseborne Relapsing Fever among East African Refugees, Italy, 2015; Emerg Infect Dis 22:298-301.