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Patient Reports / LoginUnderstanding Relapsing Fever: Causes and Treatments
Written by Medicover Team and Medically Reviewed by Dr Rahul Gundem , Emergency Medicine
Table of Contents
Relapsing fever is a complex and potentially severe infectious disease characterized by recurring episodes of fever, headache, muscle and joint aches, and nausea. It is caused by certain species of Borrelia bacteria, which are transmitted to humans through lice or ticks. Understanding the causes, symptoms, complications, and treatments of relapsing fever is essential for effective diagnosis and management.
What Are the Types of Relapsing Fever?
Relapsing fever can be divided into two main types based on how the Borrelia bacteria are transmitted: tick-borne relapsing fever and louse-borne relapsing fever.
Tick-Borne Relapsing Fever (TBRF)
TBRF is transmitted through the bites of soft-bodied ticks of the genus Ornithodoros. These ticks are typically found in rustic cabins, caves, and other rodent-infested areas. The infection occurs when the tick feeds on a human host and introduces the bacteria into the bloodstream.
Louse-Borne Relapsing Fever (LBRF)
LBRF, on the other hand, is transmitted through the human body louse (Pediculus humanus corporis). This type of relapsing fever is more common in crowded, unsanitary conditions where lice can thrive and spread rapidly among people. The Borrelia bacteria can enter the body when an infected louse is crushed and its fluids come into contact with broken skin or mucous membranes.
What Are the Symptoms of Relapsing Fever?
Relapsing fever causes recurring episodes of illness that may vary in intensity. Symptoms commonly appear during periods of fever and may return after a temporary period of apparent recovery.
Initial Symptoms
Relapsing fever is characterized by recurring episodes of fever, which can last from three to seven days, followed by periods of apparent recovery. The initial symptoms often include:
- High fever
- Severe headache
- Muscle and joint aches
- Nausea and vomiting
Recurrent Episodes
Following the initial episode, the fever typically subsides for a few days before recurring. These relapses can occur several times if left untreated. During each relapse, the symptoms are generally similar to the initial episode but may vary in intensity.
Additional Symptoms
In some cases, patients may also experience additional symptoms such as:
- Abdominal pain
- Cough
- Rash
- Neurological symptoms like confusion or seizures
What Causes Relapsing Fever?
Relapsing fever is primarily caused by Borrelia bacteria, which are transmitted to humans through infected ticks or body lice. The type of disease depends on the vector responsible for transmitting the infection.
When Should You See a Doctor for Relapsing Fever?
Medical evaluation by an Emergency Medicine Specialist is important if you develop recurring episodes of fever after possible exposure to ticks or body lice. Early diagnosis and antibiotic treatment can clear the infection, reduce repeated fever episodes, and help prevent potentially serious complications affecting the nervous system or heart.
You should see a doctor if you have:
- Recurring episodes of high fever, headache, or muscle and joint aches.
- Fever after possible exposure to ticks, rodents, or body lice.
- Persistent nausea, vomiting, abdominal pain, or unexplained rash.
Get medical help immediately if:
- You develop confusion, seizures, severe headache, or loss of consciousness.
- You experience chest pain, severe shortness of breath, or an irregular heartbeat.
- You have significant bleeding or rapidly worsening symptoms.
These could be signs of a serious complication of Relapsing Fever that requires prompt medical care.
How is Relapsing Fever Diagnosed?
Diagnosing relapsing fever can be challenging due to its cyclical nature and similarity to other febrile illnesses. However, timely and accurate diagnosis is crucial for effective treatment.
Blood Tests
The most reliable method for diagnosing relapsing fever is through blood tests. During a fever episode, blood samples can be examined under a microscope to detect the presence of Borrelia bacteria. These bacteria are typically visible during the febrile phase of the illness.
Serological Tests
In addition to direct detection methods, serological tests can be used to identify antibodies against Borrelia bacteria. These tests can provide supportive evidence for the diagnosis, particularly in cases where the bacteria are not easily detected in blood samples.
What is the Treatment for Relapsing Fever?
Effective treatment for relapsing fever involves the use of antibiotics to eliminate the Borrelia bacteria from the body. Early intervention is crucial to prevent complications and reduce the risk of recurrent episodes.
Antibiotic Therapy
The primary treatment for relapsing fever is antibiotic therapy. Commonly used antibiotics include:
- Doxycycline: This antibiotic is effective against both tick-borne and louse-borne relapsing fever. The dose and duration of treatment depend on the type of infection and the patient's condition.
- Tetracycline: Similar to doxycycline, tetracycline is also effective against Borrelia bacteria and is administered orally.
- Penicillin: In cases where tetracyclines are contraindicated, penicillin or other appropriate antibiotics may be used.
Supportive Care
In addition to antibiotic therapy, supportive care is essential for managing the symptoms and preventing complications of relapsing fever. This may include:
- Hydration: Ensuring adequate fluid intake to prevent dehydration, especially during fever episodes.
- Pain Management: Using analgesics to relieve headaches, muscle aches, and joint pain.
- Monitoring: Regular monitoring of vital signs and laboratory parameters to detect any complications early.
Preventive Measures
Preventing relapsing fever involves reducing exposure to the vectors that transmit the disease. This includes:
- Tick Control: Using insect repellents, wearing protective clothing, and avoiding tick-infested areas can help reduce the risk of tick-borne relapsing fever.
- Lice Control: Maintaining good personal hygiene and living conditions can prevent the spread of lice and reduce the risk of louse-borne relapsing fever.
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What Are the Complications of Relapsing Fever?
Relapsing fever, if left untreated, can lead to severe complications that may be life-threatening. Understanding these potential complications underscores the importance of prompt diagnosis and treatment.
Neurological Complications
One of the most serious complications of relapsing fever is neurological involvement. The infection can lead to meningitis, encephalitis, or other central nervous system disorders. Symptoms of neurological complications may include severe headaches, confusion, seizures, and even coma.
Hemorrhagic Complications
In some cases, relapsing fever can cause hemorrhagic complications, characterized by bleeding disorders. Patients may develop petechiae (small red or purple spots on the skin), nosebleeds, or gastrointestinal bleeding. These complications require immediate medical attention to prevent severe blood loss.
Cardiac Complications
Relapsing fever can also affect the heart, leading to myocarditis or pericarditis. These conditions are characterized by inflammation of the heart muscle or the surrounding sac, respectively. Symptoms may include chest pain, shortness of breath, and an irregular heartbeat.
Frequently Asked Questions
1. What are the symptoms of relapsing fever?
Symptoms include repeated episodes of high fever, chills, headache, muscle and joint pain, nausea, vomiting, and fatigue. Fever episodes may disappear and return several times.
2. What causes relapsing fever?
Relapsing fever is caused by infection with Borrelia bacteria, which are transmitted to humans by infected soft ticks or body lice.
3. How is relapsing fever diagnosed?
Diagnosis involves examining a blood sample during a fever episode to detect Borrelia bacteria. Blood tests and molecular tests such as PCR may also be used.
4. What are the treatment options for relapsing fever?
Treatment usually involves antibiotics such as doxycycline, penicillin, or other appropriate antibiotics. Patients may need monitoring for a temporary treatment reaction called the Jarisch-Herxheimer reaction.
5. What complications can occur with relapsing fever?
Complications may include jaundice, enlarged liver or spleen, neurological problems, inflammation of the heart, bleeding, pregnancy complications, and, in severe untreated cases, death.
6. How long does relapsing fever last?
Each fever episode typically lasts about 3 to 6 days, followed by a symptom-free period before the fever may return. Without treatment, several cycles can occur over several weeks.
7. What is the vector of relapsing fever?
Relapsing fever is transmitted by soft ticks of the genus Ornithodoros or the human body louse (Pediculus humanus corporis), depending on the type of infection.
