What is Relapsing Fever?
Relapsing fever is a disease similar to malaria that regularly causes fever, chills, and a general feeling of discomfort or illness. It’s caused by a type of bacteria called spirochetes, specifically those in the Borrelia species. The exact type of bacteria and how it’s spread can vary based on where you’re located or where you’ve traveled.
What Causes Relapsing Fever?
Borrelia recurrentis is a type of bacteria that causes a disease known as epidemic relapsing fever. This disease is most commonly found in northern and eastern Africa. On the other hand, in the United States, a similar condition known as tick-borne relapsing fever can occur. This condition can be caused by multiple types of Borrelia bacteria including Borrelia hermsii, Borrelia turicatae, and Borrelia parkeri.
Risk Factors and Frequency for Relapsing Fever
Borrelia recurrentis, also known as epidemic relapsing fever, is usually seen in places with a lot of crowds and poor personal cleanliness. It’s typically linked to epidemics and has often been observed during times of war, poverty, and famines. The disease is spread by lice and its occurrences have significantly dropped since the early 1900s. However, it’s still commonly found in the Horn of Africa and amongst people who have recently moved from Africa to Europe.
Other similar types of relapsing fever in Africa are caused by Borrelia duttonii, Borrelia hispanica, and Borrelia crocidurae. In the United States, Borrelia hermsii or tick-borne relapsing fever is reported in places like Colorado, near Lake Tahoe, and near the Grand Canyon. Other types of tick-borne relapsing fever in the US are caused by Borrelia turicatae and Borrelia parkeri.
Then there’s Borrelia miyamotoi, which causes a relapsing fever similar to Lyme disease. This is predominantly seen in the northeastern United States, Japan, and Russia, though the symptoms can vary slightly depending on the specific location.
Signs and Symptoms of Relapsing Fever
Relapsing fever is a disease that takes about 4 to 18 days to show symptoms after being exposed to the bacteria Borrelia. The symptoms start suddenly and include fever and chills, a general feeling of discomfort, joint and muscle pain. Some other early signs are loss of appetite, nausea, vomiting, diarrhea, extreme exhaustion, confusion, and a rash with small red spots on the skin and inside the mouth.
The most common physical sign, which happens in 60% of the patients, is a tender, painful liver. Around 40% of patients show signs of meningism, which include sensitivity to light, headache and neck stiffness. Other physical signs that might be noticed include nosebleed, bleeding under the conjunctiva of the eye, coughing up blood, bleeding of the retina, liver and spleen enlargement, and symptoms of liver dysfunction like jaundice.
Neurological problems such as limb paralysis, cranial nerve palsies, mononeuritis multiplex, and focal convulsions, are more common in the type of relapsing fever transmitted by ticks. Life-threatening complications can occur such as cerebral hemorrhage, which is bleeding in the brain, and inflammation of the heart muscle.
After the first occurrence of the fever, which typically lasts for a week, patients may have several shorter and less severe episodes of fever every five to ten days. This cycle may continue for some time before finally stopping. Relapsing fever spread through lice usually causes only one or two episodes of fever. However, the type of relapsing fever spread through ticks can cause three to seven fever episodes before the symptoms finally resolve.
Pregnant women with relapsing fever are at a higher risk of having a miscarriage or a stillbirth.
Testing for Relapsing Fever
If you’re feeling unwell and your doctor suspects relapsing fever, a type of illness caused by bacteria called Borrelia, he or she will first take into account your travel history, living conditions, and how your symptoms have progressed over time. Tests in the lab might be needed to provide further clues for a correct diagnosis. These tests could review the level of white blood cells, called neutrophils in your body, as well as platelets, the cells that help in clotting. A reaction called Jarisch-Herxheimer can occur when antibiotics are given, leading to a decrease in white blood cells. Checks can also be made on your liver’s health by studying the level of certain enzymes in your blood, and likewise on your kidney’s functioning.
One of the surest ways to confirm relapsing fever is by detecting the Borrelia bacteria in your blood. This can be done by staining a blood sample with a special dye called Giemsa, which makes the bacteria visible under a microscope. During the early stages of the illness, the number of Borrelia in your blood can be as high as 100,000 per cubic millimeter. However, as the fever recurs, fewer and fewer bacteria may be visible. It is also possible to confirm the presence of Borrelia using a technique called PCR, which can detect the genetic material of the bacteria.
In cases where your doctor suspects you’ve had the illness for some time, blood tests can be used to measure the level of antibodies your body produces in response to the infection. One such antibody is Immunoglobulin G (IgG). However, these tests can sometimes produce a false positive result if you have other infections caused by similar bacteria, such as Leptospirosis and syphilis.
The process of diagnosing relapsing fever requires care and sometimes multiple tests, because it can look like a number of other conditions and the bacteria can be hard to detect as the illness progresses. Therefore, your doctor must always interpret test results considering the full picture of your symptoms.
Treatment Options for Relapsing Fever
Relapsing fever is a bacterial infection that can be treated with a type of medication called doxycycline. However, pregnant women and children under the age of eight would be given penicillin or erythromycin. This is because doxycycline has been known to cause issues with tooth staining.
It’s also essential to monitor people for a few hours after starting antibiotic therapy, as there can be a common reaction known as the Jarisch-Herxheimer reaction. This reaction causes flu-like symptoms due to the body’s inflammatory response to the bacteria being killed by the antibiotics. This reaction is generally not life-threatening and is managed with supportive care, like rest and fluids. This reaction tends to be more common in teenagers than in younger children.
Improving the patient’s nutrition can also have a significant impact on their recovery. The infection itself, known as Borrelia, can sometimes resolve without treatment in some cases, but it’s always recommended to seek medical advice for proper care.
What else can Relapsing Fever be?
There are numerous illnesses that could potentially exhibit similar symptoms to each other, making diagnosis sometimes challenging. These illnesses include:
- Falciparum Malaria
- Leptospirosis
- Trench fever
- Yellow fever
- Dengue fever
- Brucellosis
- Ehrlichiosis
- Anaplasmosis
- Rat-bite fever
- Ascending cholangitis
- Viral hemorrhagic fever
What to expect with Relapsing Fever
Using antibiotics helps reduce the death rate from epidemic relapsing fever excellently. It drops from a range of 10% to 40%, down to a more manageable 2% to 4%. Also, it’s worth noting that the chances of survival are higher in diseases spread by ticks compared to those spread by lice, particularly when treated.
Possible Complications When Diagnosed with Relapsing Fever
Here are the potential complications:
- Hyperpyrexia (extremely high fever)
- Meningitis (infection of the protective membranes covering the brain and spinal cord)
- Focal neurological deficits (problems with nerve, spinal cord, or brain function)
- Acute Respiratory Distress Syndrome (ARDS) – a severe lung condition causing shortness of breath
- Perivascular interstitial histiocytic myocarditis (inflammation of the heart’s muscle tissue)
- Acute Pulmonary Edema from myocarditis (buildup of fluid in the lungs due to inflammation of the heart’s muscle tissue)
- Gastrointestinal Bleed (bleeding in the digestive tract)
- Cerebral bleed (bleeding in the brain)
- Splenic Rupture (breakage of the spleen)
- Liver failure (condition where the liver stops functioning)
- Disseminated Intravascular Coagulation (DIC) – a condition that causes abnormal blood clotting
Preventing Relapsing Fever
To prevent lice, it’s important to maintain good personal cleanliness. This includes washing regularly and taking care of your hygiene. Additionally, in order to kill any lice that may be present, it’s necessary to sterilize your clothes and bedding. This can be done by washing them in hot water and drying on a high heat setting. In doing so, you will create an environment where lice are unable to survive.
