Relapsing fever

Relapsing fever is a vector-borne disease caused by infection with certain bacteria in the genus Borrelia,[1] which is transmitted through the bites of lice, soft-bodied ticks (genus Ornithodoros), or hard-bodied ticks (Genus Ixodes).[2][3]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 2.1 Louse-borne relapsing fever
* 2.2 Soft tick-borne relapsing fever
* 2.3 Hard tick-borne relapsing fever
* 3 Diagnosis
* 4 Treatment
* 5 Research
* 6 History
* 7 See also
* 8 References
* 9 External links

## Signs and symptoms

Most infected people develop sickness between 5 and 15 days after they are bitten. The symptoms may include a sudden fever, chills, headaches, muscle or joint aches, and nausea. A rash may also occur. These symptoms usually continue for 2 to 9 days, then disappear. This cycle may continue for several weeks if the person is not treated.[4]

## Causes

### Louse-borne relapsing fever

Along with Rickettsia prowazekii and Bartonella quintana, Borrelia recurrentis is one of three pathogens of which the body louse (Pediculus humanus humanus) is a vector.[5] Louse-borne relapsing fever is more severe than the tick-borne variety. Louse-borne relapsing fever occurs in epidemics amid poor living conditions, famine, and war in the developing world.[6] It is currently prevalent in Ethiopia and Sudan.

### Soft tick-borne relapsing fever

* Borrelia crocidurae – occurs in Egypt, Mali, Senegal, Tunisia; vectors – Carios erraticus, Ornithodoros sonrai; animal host – shrew (Crocidura stampflii)
* Borrelia duttoni, transmitted by the soft-bodied African tick Ornithodoros moubata, is responsible for the relapsing fever found in central, eastern, and southern Africa.
* Borrelia hermsii
* Borrelia hispanica
* Borrelia parkeri
* Borrelia turicatae
* Borrelia persica

### Hard tick-borne relapsing fever

Borrelia miyamotoi, which is transmitted by Ixodes ticks, was reported as a cause of tick-borne relapsing fever in 2011.[7][3]

## Diagnosis

The diagnosis of relapsing fever can be made on blood smear as evidenced by the presence of spirochetes. Other spirochete illnesses (Lyme disease, syphilis, leptospirosis) do not show spirochetes on blood smears. Although considered the gold standard, this method lacks sensitivity and has been replaced by PCR in many settings.[8]

## Treatment

## Research

## History

Relapsing fever has been described since the days of the ancient Greeks.[9] After an outbreak in Edinburgh in the 1840s, relapsing fever was given its name, but the etiology of the disease was not better understood for a decade.[9] Physician David Livingstone is credited with the first account in 1857 of a malady associated with the bite of soft ticks in Angola and Mozambique.[10] In 1873, Otto Obermeier first described the disease-causing ability and mechanisms of spirochetes, but was unable to reproduce the disease in inoculated test subjects and thereby unable to fulfill Koch's postulates.[9] The disease was not successfully produced in an inoculated subject until 1874.[9] In 1904 and 1905, a series of papers outlined the cause of relapsing fever and its relationship with ticks.[11][12][13][14] Both Joseph Everett Dutton and John Lancelot Todd contracted relapsing fever by performing autopsies while working in the eastern region of the Congo Free State. Dutton died there on February 27, 1905. The cause of tick-borne relapsing fever across central Africa was named Spirillum duttoni.[15] In 1984, it was renamed Borrelia duttoni.[16] In 1907, Frederick Percival Mackie discovered that human body louse can transmit Borrelia recurrentis, which causes relapsing fever as well.[17] The first time relapsing fever was described in North America was in 1915 in Jefferson County, Colorado.[18]

Sir William MacArthur suggested that relapsing fever was the cause of the yellow plague, variously called pestis flava, pestis ictericia, buidhe chonaill, or cron chonnaill, which struck early Medieval Britain and Ireland, and of epidemics which struck modern Ireland in the famine.[19][20] This is consistent with the description of the symptoms experienced by King Maelgwn of Gwynedd as recorded in words attributed to Taliesin and with the "great mortality in Britain" in 548 CE noted in the Annales Cambriae.[21][self-published source]

## See also

* Lyme disease
* Typhus
* Continuous fever
* Intermittent fever
* Remittent fever

## References

1. ↑ Schwan T (1996). "Ticks and Borrelia: model systems for investigating pathogen-arthropod interactions". Infect Agents Dis 5 (3): 167–81. PMID 8805079.
2. ↑ Schwan T, Piesman J; Piesman (2002). "Vector interactions and molecular adaptations of Lyme disease and relapsing fever spirochetes associated with transmission by ticks". Emerg Infect Dis 8 (2): 115–21. doi:10.3201/eid0802.010198. PMID 11897061.
3. ↑ 3.0 3.1 Hoornstra, Dieuwertje; Azagi, Tal; van Eck, Jacqueline A; Wagemakers, Alex; Koetsveld, Joris; Spijker, René; Platonov, Alexander E; Sprong, Hein et al. (October 2022). "Prevalence and clinical manifestation of Borrelia miyamotoi in Ixodes ticks and humans in the northern hemisphere: a systematic review and meta-analysis". The Lancet Microbe 3 (10): e772–e786. doi:10.1016/S2666-5247(22)00157-4. PMID 36113496.
4. ↑ Ryan KJ; Ray CG (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 432–4. ISBN 978-0-8385-8529-0.
5. ↑ Fournier, Pierre-Edouard (2002). "Human Pathogens in Body and Head Lice". Emerging Infectious Diseases 8 (12): 1515–8. doi:10.3201/eid0812.020111. PMID 12498677. PMC 2738510. https://www.cdc.gov/ncidod/eid/vol8no12/02-0111.htm. Retrieved October 17, 2010.
6. ↑ Cutler S (2006). "Possibilities for relapsing fever reemergence". Emerg Infect Dis 12 (3): 369–74. doi:10.3201/eid1203.050899. PMID 16704771.
7. ↑ McNeil, Donald (19 September 2011). "New Tick-Borne Disease Is Discovered". The New York Times: pp. D6. https://www.nytimes.com/2011/09/20/health/20tick.html.
8. ↑ "Laboratory Diagnosis of Tick-Borne African Relapsing Fevers: Latest Developments". Frontiers in Public Health 3: 254. 2015. doi:10.3389/fpubh.2015.00254. PMID 26618151. Bibcode: 2015FrPH....3..254F.
9. ↑ 9.0 9.1 9.2 9.3 Cutler, S.J. (April 2010). "Relapsing fever – a forgotten disease revealed" (in en). Journal of Applied Microbiology 108 (4): 1115–1122. doi:10.1111/j.1365-2672.2009.04598.x. ISSN 1365-2672. PMID 19886891.
10. ↑ Livingstone D (1857) Missionary travels and researches in South Africa. London: John Murray
11. ↑ Cook AR (1904). "Relapsing fever in Uganda". J Trop Med Hyg 7: 24–26.
12. ↑ Ross, P. H.; Milne, A. D. (1904). "Tick Fever.". British Medical Journal 2 (2291): 1453–4. doi:10.1136/bmj.2.2291.1453. PMID 20761784.
13. ↑ "The nature of human tick-fever in the eastern part of the Congo Free State with notes on the distribution and bionomics of the tick". Liverpool School Trop Med Mem 17: 1–18. 1905.
14. ↑ Wellman FC (1905). "Case of relapsing fever, with remarks on its occurrence in the tropics and its relation to "tick fever"". J Trop Med 8: 97–99.
15. ↑ Novy, F. G.; Knapp, R. E. (1906). "Studies on Spirillum obermeieri and related organisms". Journal of Infectious Diseases 3 (3): 291–393. doi:10.1093/infdis/3.3.291. https://archive.org/details/jstor-30071844.
16. ↑ Kelly RT (1984) "Genus IV. Borrelia Swellengrebel 1907" in Krieg NR (ed.) Bergey's Manual of Systematic Bacteriology. Baltimore: Williams & Wilkins
17. ↑ Mullen, Gary Richard; Durden, Lance A. (2019). Medical and veterinary entomology (3rd ed.). London: Academic press, an imprint of Elsevier. pp. 2. ISBN 978-0-12-814043-7.
18. ↑ Davis, Gordon E. (1940-01-01). "Ticks and Relapsing Fever in the United States". Public Health Reports 55 (51): 2347–2351. doi:10.2307/4583554.
19. ↑ Bonser, Wilfrid; MacArthur, Wm (1944). "Epidemics during the Anglo-Saxon period, with appendix: Famine fevers in England and Ireland". Journal of the British Archaeological Association 9: 48–71. doi:10.1080/00681288.1944.11894687.
20. ↑ MacArthur, W (1947). "Famine fevers in England and Ireland". Postgraduate Medical Journal 23 (260): 283–6. doi:10.1136/pgmj.23.260.283. PMID 20248471.
21. ↑ "The Mystery of the Missing Plague" (in en) (video). Cambrian Chronicles. September 9, 2025. https://www.youtube.com/watch?v=nMA6SFyjO80.

## External links

* CDC: Relapsing Fever

Classification|

* ICD-11: 1C1J
* DiseasesDB: 4428

|

* v
* t
* e

* Infectious diseases
* Bacterial diseases: BV4]] non-proteobacterial G- (primarily A00–A79, 001–041, 080–109)

Spirochaete|

| Spirochaetaceae|

| Treponema|

* Treponema pallidum
* Syphilis/bejel
* Yaws
* Treponema carateum (Pinta)
* Treponema denticola

|

Borrelia|

* Borrelia burgdorferi/Borrelia afzelii
* Lyme disease
* Erythema chronicum migrans
* Neuroborreliosis

* Borrelia recurrentis (Louse borne relapsing fever)
* Borrelia hermsii/Borrelia duttoni/Borrelia parkeri (Tick borne relapsing fever)

Leptospiraceae|

| Leptospira|

* Leptospira interrogans (Leptospirosis)

|

Chlamydiaceae|

| Chlamydia|

* Chlamydia psittaci (Psittacosis)
* Chlamydia pneumoniae

|

Chlamydia|

* Chlamydia trachomatis
* Chlamydia
* Lymphogranuloma venereum
* Trachoma

Bacteroidetes|

* Bacteroides fragilis
* Tannerella forsythia
* Capnocytophaga canimorsus
* Porphyromonas gingivalis
* Prevotella intermedia

Fusobacteria|

* Fusobacterium necrophorum (Lemierre's syndrome)
* Fusobacterium nucleatum
* Fusobacterium polymorphum

* Streptobacillus moniliformis (Rat-bite fever/Haverhill fever)

* v
* t
* e

Tick-borne diseases and mite-borne diseases

Bacterial infection
(all G-)|

| Rickettsiales|

* Anaplasmosis
* Boutonneuse fever
* Ehrlichiosis (Human granulocytic, Human monocytotropic, Human E. ewingii infection)
* Scrub typhus
* Spotted fever rickettsiosis (includes Pacific Coast tick fever, Rickettsia parkeri]] rickettsiosis]], rickettsialpox, and Rocky Mountain spotted fever)

|

Spirochaete|

* Baggio–Yoshinari syndrome
* Lyme disease
* Relapsing fever borreliosis

Thiotrichales|

* Tularemia

Viral infection|

* Bhanja virus
* Bourbon virus
* Colorado tick fever
* Crimean-Congo hemorrhagic fever
* Heartland virus
* Kemerovo tickborne viral fever
* Kyasanur Forest disease
* Omsk hemorrhagic fever
* Powassan encephalitis
* Severe fever with thrombocytopenia syndrome (SFTS)
* Tete virus
* Tick-borne encephalitis

Protozoan infection|

* Babesiosis

Neurotoxin|

* Tick paralysis

Allergies|

* Alpha-gal allergy
* House dust mite allergy
* Oral mite anaphylaxis

Unknown Cause|

* Southern tick-associated rash illness

General|

| Ticks|

* Tick infestation

|

Mites|

* Acariasis
* Baker's itch
* Cheyletiellosis
* Demodicosis
* Feather pillow dermatitis
* Gamasoidosis
* Grain itch
* Grocer's itch
* Rodent mite dermatitis
* Scabies
* Trombiculosis

Vectors|

| Ticks|

* Amblyomma: Amblyomma americanum
* Amblyomma cajennense
* Amblyomma triguttatum

* Dermacentor: Dermacentor andersoni
* Dermacentor variabilis

* Ixodes: Ixodes cornuatus
* Ixodes holocyclus
* Ixodes pacificus
* Ixodes ricinus
* Ixodes scapularis

* Ornithodoros: Ornithodoros gurneyi
* Ornithodoros hermsi
* Ornithodoros moubata

* other: Rhipicephalus sanguineus

|

Mites|

* House dust mite
* Leptotrombidium deliense
* Liponyssoides sanguineus
* Mites associated with cutaneous reactions

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