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Tick-borne relapsing fever — Clinical Guidelines

Overview

Tick-borne relapsing fever (TBRF) is a febrile illness caused by spirochetes of the genus Borrelia, transmitted through the bite of infected ticks. It is characterized by recurrent episodes of fever due to periodic bacteremia 4.

Diagnosis

Clinical Presentation: Prolonged fever, often with leukopenia and cytopenias 4.

Laboratory Tests: Manual blood smear examination crucial for detecting spirochetes 4.

Serological Tests: Serologies for brucellosis and rickettsial diseases may be negative, necessitating consideration of TBRF 4.

Advanced Techniques: Mass spectrometry for urinary peptides can aid in diagnosis but is not routinely available 2.

Management

First-Line Treatment: Tetracycline (e.g., doxycycline) or penicillin for 10-14 days 4.

Alternative Agents: Fluoroquinolones (e.g., ciprofloxacin) may be used in penicillin-allergic patients 4.

Supportive Care: Focus on hydration, fever management, and monitoring for complications 4.

Special Populations

Elderly: Higher risk of severe complications; close monitoring required 7.

Comorbidities: Concurrent infections like babesiosis and ehrlichiosis can complicate management and prognosis 7.

Key Recommendations

Establish and sustain public health emergency operation centers to effectively coordinate responses to outbreaks, enhancing containment and reducing spread 1 (Evidence: Strong).

Utilize manual blood smear examination as a critical diagnostic tool for TBRF, especially in regions where TBRF is endemic 4 (Evidence: Moderate).

Consider tetracycline or penicillin as first-line treatments for TBRF, with fluoroquinolones as alternatives for penicillin-allergic patients 4 (Evidence: Moderate).

References

1 Chala TK, Abera EG, Tukeni KN, Didu GH, Abbagidi FA, Yesuf EA et al.. The Need to Establish and Sustain Public Health Emergency Operation Centers for Managing Infectious Disease Outbreaks: Lesson From Response to Louse-Borne Relapsing Fever Outbreak in Jimma, Ethiopia. Disaster medicine and public health preparedness 2023. link 2 Magni R, Almofee R, Yusuf S, Mueller C, Vuong N, Almosuli M et al.. Evaluation of pathogen specific urinary peptides in tick-borne illnesses. Scientific reports 2020. link 3 de Vries DH, Kinsman J, Takacs J, Tsolova S, Ciotti M. Methodology for assessment of public health emergency preparedness and response synergies between institutional authorities and communities. BMC health services research 2020. link 4 Fuchs I, Tarabin S, Kafka M. Relapsing Fever: Diagnosis Thanks to a Vigilant Hematology Laboratory. Vector borne and zoonotic diseases (Larchmont, N.Y.) 2015. link 5 Oliver JD, Chávez AS, Felsheim RF, Kurtti TJ, Munderloh UG. An Ixodes scapularis cell line with a predominantly neuron-like phenotype. Experimental & applied acarology 2015. link 6 Smith TA, Driscoll T, Gillespie JJ, Raghavan R. A Coxiella-like endosymbiont is a potential vitamin source for the Lone Star tick. Genome biology and evolution 2015. link 7 Javed MZ, Srivastava M, Zhang S, Kandathil M. Concurrent babesiosis and ehrlichiosis in an elderly host. Mayo Clinic proceedings 2001. link 8 Willadsen P, Kemp DH. Novel vaccination for control of the Babesia vector, Boophilus microplus. Transactions of the Royal Society of Tropical Medicine and Hygiene 1989. link90617-2)

Tick-borne relapsing fever