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tick-bourne relapsing fever
Etiology:
- most cases caused by Borrelia hermsii
Clinical manifestations:
- fever for 3-5 days
- recurrent fever about a week after apparent recovery
Laboratory:
- spirchetes in blood smear taken during a febrile episode stained with Wright-Giemsa stain or examined with dark field microscopy
- Borrelia hermsii antibody in serum
- not useful in during initial febrile episode [1]
- may be useful after recurrence of fever
- Borrelia hermsii culture
Management:
- when initiating antibiotic therapy, all patients should be observed during the first 4 hours of treatment for a Jarisch-Herxheimer reaction [2]
- tetracycline 500 mg every 6 hours for 10 days
- 500 mg (or 12.5 mg/kg) every 6 hours for 10 days (alternative)
- ceftriaxone 2 grams IV/IM QD for 10-14 days for patients with central nervous system involvement [2]
General
relapsing fever
tick borne infection
References
- Forrester JD et al
Tickborne Relapsing Fever - United States, 1990-2011
MMWR Weekly. January 30, 2015 / 64(03);58-60
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6403a3.htm
- Centers for Disease Control and Prevention (CDC)
Tick-borne Relapsing Fever
http://www.cdc.gov/relapsing-fever/clinicians/