Relapsing fever natural history, complications and prognosis

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

Natural History

• Sudden fever occurs within 2 weeks of infection. 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. Individuals may be free of fever for up to 2 weeks before it returns.

In both forms, the fever episode may end in "crisis." This consists of shaking chills, followed by intense sweating, falling body temperature, and low blood pressure. This stage may result in death in up to 10% of people.

After several cycles of fever, some people may develop dramatic central nervous system signs such as seizures, stupor, and coma. The Borrelia organism may also invade heart and liver tissues, causing inflammation of the heart muscle (myocarditis) and liver (hepatitis). Widespread bleeding and pneumonia are other complications.

Complications

• Coma
• Facial droop
• Liver dysfunction
• Meningitis
• Myocarditis -- may lead to arrhythmias
• Pneumonia
• Seizures
• Shock related to taking antibiotics (Jarisch - Herxheimer's reaction, in which the rapid death of very large numbers of Borrelia organisms induces shock)
• Weakness
• Widespread bleeding

Prognosis

The death rate for untreated LBRF ranges from 10 - 70%. In TBRF, it is 4 -10%. With early treatment, the death rate is reduced. Those who have developed coma, myocarditis, liver problems, or pneumonia are more likely to die.