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

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History This section has been translated automatically.

Rutty 1770; Craigie 1843; Obermeier 1873

Definition This section has been translated automatically.

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.

Pathogen This section has been translated automatically.

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

Occurrence/Epidemiology This section has been translated automatically.

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.).

Clinic This section has been translated automatically.

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 This section has been translated automatically.

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

Complication(s)(associated diseases This section has been translated automatically.

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

Therapy This section has been translated automatically.

  • 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 This section has been translated automatically.

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

Prophylaxis This section has been translated automatically.

Lice control. S.u. Pediculosis corporis.

Literature This section has been translated automatically.

  1. 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.
  2. Ciervo A et al (2016) Louseborne Relapsing Fever in Young Migrants, Sicily, Italy, July-September 2015, Emerg Infect Dis 22:152-153.
  3. Lucchini A et al. (2016) Louseborne Relapsing Fever among East African Refugees, Italy, 2015; Emerg Infect Dis 22:298-301.

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer