Relapsing fever history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Symptoms of relapsing fever include sudden onset of high fever, chills, headache, myalgias, and weakness, occur within 3-7 days (up to 18 days) after exposure. Less common symptoms include anorexia, nausea, vomiting, abdominal pain, arthralgias, neck pain or back pain, confusion, lethargy, cough, rash, sore throat, and swollen lymph nodes.If left untreated, rapid defervescence usually occurs in 2-6 days (range 1-13 days), often with dramatic improvement in symptoms. Most cases eventually resolve spontaneously. Occasionally, resolution ensues by Crisis. During the crisis, patients may develop cerebral edema with seizures, cardiac failure, or death. This stage may result in death in up to 10% of people.Occasionally, crisis occurs after resolution,which is a classic series of stages that a person will go through and may result in death in up to 10% of patients.

History and Symptoms

Common symptoms

• The symptoms of Relapsing fever usually develop within 3-7 days after exposure and start with sudden onset of:
• High fever
• chills
• headache
• myalgias
• weakness

Less common symptoms

• Anorexia
• Nausea
• Vomiting
• Abdominal pain
• Arthralgias
• Neck or back pain
• Confusion
• Lethargy
• Cough
• Rash
• Sore throat
• Swollen lymph nodes

TBRF

In TRBF, multiple episodes of fever occur, and each may last up to 3 days. If left untreated, rapid defervescence usually occurs in 2-6 days (range 1-13 days), often with dramatic improvement in symptoms. Chronic relapsing fever may produce a clinical illness analogous to chronic Lyme disease.

• The afebrile interval usually lasts one week (up to 60 days) before relapse with symptoms similar to the first episode. Patients with louse-borne relapsing fever will typically have 1-2 relapses (range 0-6), with each subsequent relapse usually less severe than the previous one. Patients with tick-borne relapsing fever usually have 3-5 relapses (range 0-22).
• This cycle may continue for several weeks if the person is not treated. Most cases eventually resolve spontaneously. Occasionally, resolution ensues by Crisis. During the crisis, patients may develop cerebral edema with seizures, cardiac failure, or death. This stage may result in death in up to 10% of people.
• The clinical manifestations of tick-born and louse-born relapsing fever are similar but can be quite variable, depending on the infecting strain of Borrelia and the host's immunity.

Timing

Incubation period = time from tick bite to illness

• 7 days, range 2 to 18 days

Symptomatic period= Length of illness = time from symptom onset to resolution of symptoms

• 3 days, range 2 to 7 days
• In LBRF, the fever usually lasts 3-6 days and is usually followed by a single, milder episode. In TRBF, multiple episodes of fever occur, and each may last up to 3 days.

Afebrile period= Length of time before reoccurrence = time from the resolution of symptoms to reoccurrence of symptoms

• 7 days, range 4 to 14 days

Number of relapses = number of episodes of reoccurring/relapsing symptoms

• 3 times, can occur up to 10 times in persons who are not treated.

• During the crisis, patients may develop cerebral edema with seizures, cardiac failure, or death. This stage may result in death in up to 10% of people.

• The clinical manifestations of tick-borne and louse-borne relapsing fever are similar but can be quite variable, depending on the infecting strain of Borrelia and the host's immunity. Patients typically present 3-7 days (up to 18 days) after exposure with sudden onset of high fever, chills, headache, myalgias, and weakness.