Borrelia recurrentis; louse-borne relapsing fever; epidemic relapsing fever

Epidemiology

• body louse (Pediculus humanus humanus) is a vector
  • lice that feed on infected humans acquire B recurrentis that subsequently multiply in the gut of the louse
  • when an infected louse feeds on an uninfected human, B recurrentis gains access when the victim crushes the louse or scratches the area where the louse is feeding
  • B recurrentis then invades the bloodstream
  • no animal reservoir exists.
• epidemic in poor living conditions, famine, war
• prevalent in Ethiopia & Sudan

Clinical manifestations

• generally more severe than tick-borne relapsing fever (Lyme disease)
• jaundice
• mental status changes
• hemorrhage

Diagnostic procedures

• electrocardiogram
  • prolonged QT interval portends poor prognosis

Complications

• mortality ~ 1% with treatment & 30-70% without treatment

Management

• tetracyclines are most effective
• in about 1/2 of treated patients, a Jarisch-Herxheimer reaction occurs
  • TNF-alpha may be resposible

More general terms

• Borrelia

Additional terms

• borreliosis (relapsing fever)
• louse (Anoplura)-borne infection