Skip to main content

Health Encyclopedia

Search the Health Encyclopedia

Relapsing fever

Definition

Relapsing fever is an infection transmitted by a louse or tick. It is characterized by repeated episodes of fever.

Alternative Names

Tick-borne relapsing fever; Louse-borne relapsing fever

Causes

Relapsing fever is an infection caused by several species of bacteria in the borrelia family.

There are two major forms of relapsing fever:

  • Tick-borne relapsing fever (TBRF) is transmitted by the ornithodoros tick. It occurs in Africa, Spain, Saudi Arabia, Asia, and certain areas in the western United States and Canada. The bacteria species associated with TBRF are Borrelia duttoni, Borrelia hermsii, and Borrelia parkerii.
  • Louse-borne relapsing fever (LBRF) is transmitted by body lice. It is most common in Asia, Africa, and Central and South America. The bacteria species associated with LBRF is Borrelia recurrentis.

Sudden fever occurs within 2 weeks of infection.

  • In TRBF, multiple episodes of fever occur, and each may last up to 3 days. People may not have a fever for up to 2 weeks, and then it returns.
  • In LBRF, the fever commonly lasts 3 to 6 days. It is often followed by a single, milder episode of fever.

In both forms, the fever episode may end in "crisis." This consists of shaking chills, followed by intense sweating, falling body temperature, and low blood pressure. This stage may result in death.

In the United States, TBRF often occurs west of the Mississippi River, particularly in the mountains of the West and the high deserts and plains of the Southwest. In the mountains of California, Utah, Arizona, New Mexico, Colorado, Oregon, and Washington, infections are usually caused by Borrelia hermsii and are often picked up in cabins in forests. The risk may now extend into the southeastern United States.

LBRF is mainly a disease of the developing world. It is currently seen in Ethiopia and Sudan. Famine, war, and the movement of refugee groups often results in LBRF epidemics.

Symptoms

Symptoms of relapsing fever include:

  • Bleeding
  • Coma
  • Headache
  • Joint aches, muscle aches
  • Nausea and vomiting
  • Sagging on one side of the face (facial droop)
  • Stiff neck
  • Sudden high fever, shaking chills, seizure
  • Vomiting
  • Weakness, unsteady while walking

Exams and Tests

Relapsing fever should be suspected if someone coming from a high-risk area has repeated episodes of fever. This is largely true if the fever is followed by a "crisis" stage, and if the person may have been exposed to lice or soft-bodied ticks.

Tests that may be done include:

  • Blood smear to determine the cause of the infection
  • Blood antibody tests (sometimes used, but their usefulness is limited)

Treatment

Antibiotics including penicillin and tetracycline are used to treat this condition.

Outlook (Prognosis)

People with this condition who have developed a coma, heart inflammation, liver problems, or pneumonia are more likely to die. With early treatment, the death rate is reduced.

Possible Complications

These complications may occur:

  • Drooping of the face
  • Coma
  • Liver problems
  • Inflammation of the thin tissue that surrounds the brain and spinal cord
  • Inflammation of the heart muscle, which may lead to irregular heart rate
  • Pneumonia
  • Seizures
  • Stupor
  • Shock related to taking antibiotics (Jarisch-Herxheimer reaction, in which the rapid death of very large numbers of borrelia bacteria causes shock)
  • Weakness
  • Widespread bleeding

When to Contact a Medical Professional

Contact your health care provider right away if you develop a fever after returning from a trip. Possible infections need to be investigated in a timely manner.

Prevention

Wearing clothing that fully covers the arms and legs when you are outdoors can help prevent TBRF infection. Insect repellent such as DEET on the skin and clothing also work. Tick and lice control in high-risk areas is another important public health measure.

References

Horton JM. Relapsing fever caused by borrelia species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 242.

Petri WA. Relapsing fever and other borrelia infections. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 322.

Review Date:11/14/2016
Reviewed By:Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.

Health
Outcome Data

No data available for this condition/procedure.

Health Encyclopedia

More Features

We Appreciate Your Feedback!
1. Did you find this information useful?
         Yes
         No
2. Would you recommend this website to family and friends?
         Yes
         No