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| | __NOTOC__ |
| '''For patient information click [[Relapsing fever(patient information)|here]]''' | | '''For patient information click [[Relapsing fever(patient information)|here]]''' |
| {{Infobox_Disease |
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| Name = Relapsing fever |
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| Image = |
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| Caption = |
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| DiseasesDB = 1547 |
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| ICD10 = {{ICD10|A|68||a|65}} |
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| ICD9 = {{ICD9|087}} |
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| ICDO = |
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| OMIM = |
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| OMIM_mult = |
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| MedlinePlus = |
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| eMedicineSubj = emerg |
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| eMedicineTopic = 590 |
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| eMedicine_mult = {{eMedicine2|med|1999}} |
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| MeshID = D012061 |
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| }}
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| {{Relapsing fever}} | | {{Relapsing fever}} |
| | {{About1|Borrelia}} |
| {{CMG}} | | {{CMG}} |
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| | {{SK}} Tick-borne relapsing fever, louse-borne relapsing fever；Recurrent fever； Recurrent fever due to Borrelia； Relapsing fever due to Borrelia |
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| ==[[Relapsing fever overview|Overview]]== | | ==[[Relapsing fever overview|Overview]]== |
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| ==[[Relapsing fever historical perspective|Historical Perspective]]== | | ==[[Relapsing fever historical perspective|Historical Perspective]]== |
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| | ==[[Relapsing fever classification|Classification]]== |
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| ==[[Relapsing fever pathophysiology|Pathophysiology]]== | | ==[[Relapsing fever pathophysiology|Pathophysiology]]== |
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| ==[[Relapsing fever epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Relapsing fever causes|Causes]]== |
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| ==[[Relapsing fever risk factors|Risk Factors]]== | | ==[[Relapsing fever differential diagnosis|Differentiating Relapsing fever from other Diseases]]== |
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| ==[[Relapsing fever screening|Screening]]== | | ==[[Relapsing fever epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Relapsing fever causes|Causes]]== | | ==[[Relapsing fever risk factors|Risk Factors]]== |
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| ==[[Relapsing fever differential diagnosis|Differentiating Relapsing fever]]==
| | ==[[Relapsing fever natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==[[Relapsing fever natural history|Complications & Prognosis]]== | |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Relapsing fever history and symptoms|History and Symptoms]] | [[Relapsing fever physical examination|Physical Examination]] | [[Relapsing fever laboratory tests|Laboratory tests]] | [[Relapsing fever electrocardiogram|Electrocardiogram]] | [[Relapsing fever x ray|X Rays]] | [[Relapsing fever CT|CT]] | [[Relapsing fever MRI|MRI]] [[Relapsing fever echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Relapsing fever other imaging findings|Other images]] | [[Relapsing fever other diagnostic studies|Alternative diagnostics]] | | [[Relapsing fever history and symptoms|History and Symptoms]] | [[Relapsing fever physical examination|Physical Examination]] | [[Relapsing fever laboratory findings|Laboratory Findings]] | [[Relapsing fever other imaging findings|Imaging Findings]] | [[Relapsing fever other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| [[Relapsing fever medical therapy|Medical therapy]] | [[Relapsing fever surgery|Surgical options]] | [[Relapsing fever primary prevention|Primary prevention]] | [[Relapsing fever secondary prevention|Secondary prevention]] | [[Relapsing fever cost-effectiveness of therapy|Financial costs]] | [[Relapsing fever future or investigational therapies|Future therapies]] | | [[Relapsing fever medical therapy|Medical Therapy]] | [[Relapsing fever primary prevention|Prevention]] | [[Relapsing fever cost-effectiveness of therapy|Cost-effectiveness of Therapy]] | [[Relapsing fever future or investigational therapies|Future or Investigational Therapies]] |
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| == Diagnosis ==
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| [[Image:Borrelia spirochetes.jpg|right|thumb|Borrelia spirochetes]]
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| [[Image:Peripheral blood smear from Schwan, Policastro et al.jpg|right|thumb|Peripheral blood smear from Schwan, Policastro et al 2003]]
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| *The definitive diagnosis of TBRF is based on the observation of Borrelia spirochetes in smears of peripheral [[blood]], [[bone marrow]], or [[cerebrospinal fluid]] in a symptomatic person. Although best visualized by dark field microscopy, the organisms can also be detected by Wright-Giemsa or acridine orange-stained preparations.
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| *The organisms are best detected in blood obtained while a person is [[febrile]]. With subsequent febrile episodes, the number of circulating spirochetes decreases, making it harder to detect spirochetes on a peripheral blood smear. Even during the initial episode spirochetes will only be seen 70% of the time.
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| Blood samples obtained before [[antibiotic]] treatment can be cultured using BSK medium or by inoculating immature mice. The spirochete will usually be evident within 24 hours if the blood was drawn during a febrile episode.
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| Although not valuable for making an immediate diagnosis, serologic testing is available through public health laboratories and some private laboratories. Acute serum should be taken within 7 days of symptom onset and convalescent serum should be taken at least 21 days after symptoms start. Early [[antibiotic]] treatment may blunt the [[antibody]] response and the antibody levels may wane quickly during the months after exposure. To confirm the diagnosis of TBRF, Borrelia specific antibody titers should be increased between acute and convalescent serum samples and convalescent serum antibody levels should be at least two standard deviations above pooled negative controls. Serologic testing for TBRF is not standardized and results may vary by lab. Patients with TBRF may have false-positive tests for Lyme disease because of the similarity of proteins between the two organisms.
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| Incidental laboratory findings include normal to increased white blood cell count with a left shift towards immature cells, a mildly increased serum [[bilirubin]] level, mild to moderate [[thrombocytopenia]] (low platelet count), elevated [[ESR]] and slightly prolonged coagulation tests, [[PT]] and [[APTT]].
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| === Differential Diagnosis ===
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| The following infectious disease should be consider in someone with recurrent episodes of a febrile illness:
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| Colorado tick fever, Infectious [[mononucleosis]], Ascending (intermittent) [[cholangitis]], [[Yellow fever]], [[Viral hemorrhagic fever|African hemorrhagic fever]]s, Lymphocytic choriomengitis, [[Dengue fever]], [[Leptospirosis]], Infections with [[echovirus 9]], [[Malaria]], Chronic [[meningococcemia]], Infections with [[Bartonella]] species, [[Brucellosis]], [[Rat bite fever]].<ref>http://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_Symptoms.htmhttp://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_LabAnalysis.htm
| | ==Case Studies== |
| </ref>
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| == Treatment ==
| | [[Relapsing fever case study one|Case #1]] |
| === Pharmacotherapy ===
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| Erythromycin, tetracyclines, chloramphenicol, or penicillins have all been shown to be effective for treating TBRF. Although duration of therapy has not been well studied for TBRF, the current recommendation is seven days of antibiotic therapy. In contrast, LBRF caused by B. recurrentis can be treated with a single dose of antibiotics.
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| For young children and pregnant women either erythromycin and/or penicillin are recommended for treatment of TBRF.
| | ==Related Chapters== |
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| When initiating antibiotic therapy, a patient should be watched closely for a [[Jarisch-Herxheimer]] reaction for the first 4 hours after the antibiotic is given (Negussie, Remick et al. 1992). The reaction may be difficult to distinguish from a febrile crisis, with rigors and decreased blood pressure. Cooling blankets and appropriate use of antipyrectic agents may be indicated.
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| The Jarisch-Herxheimer reaction produces apprehension, [[diaphoresis]], fever, [[tachycardia]], and [[tachypnea]] with an initial pressor response followed rapidly by [[hypotension]]. Recent studies have shown that [[tumor necrosis factor-alpha]] (TNF-alpha) may be partly responsible for the reaction.
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| ==== Acute Pharmacotherapies ==== | |
| The CDC has not developed specific treatment guidelines for TBRF. Below are the treatment recommendations as outlined in Harrisons Principles of Internal Medicine. 16th edition. 2004. p 994.
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| [[Image:Treatment.jpg|left|Treatment]]
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| {{clr}}
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| <ref>http://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_Treatment.htm
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| </ref>
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| ==Prevention==
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| In order to prevent relapsing fever, one should:
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| *Avoid sleeping in rodent infested buildings.
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| *Limit tick bites by using insect repellent containing DEET (on skin or clothing) or permethrin (applied to clothing or equipment).
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| *Rodent-proof buildings in areas where the disease is known to occur.
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| *Identify and remove any rodent nesting material from walls, ceilings and floors.
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| *In combination with removing the rodent material, fumigate the building with preparations containing pyrethrins and permethrins. More than one treatment is often needed to effectively rid the building of the vectors, the soft-ticks. Always folllow product product instructions, and consider consulting a liscensed pest control specialist.<ref>http://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_Prevention.htm
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| </ref>
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| ==See also==
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| *[[Lyme disease]] | | *[[Lyme disease]] |
| *[[Typhus]] | | *[[Typhus]] |
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| == Acknowledgements ==
| | ==External Links== |
| The content on this page was first contributed by: [[C. Michael Gibson]] M.S., M.D.
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| List of contributors:
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| Pilar Almonacid
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| ==References==
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| {{Reflist|2}}
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| ==External links== | |
| * {{eMedicineDictionary|Relapsing+fever}}
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| * [http://www.cdc.gov/ncidod/dvbid/RelapsingFever/index.htm CDC: Relapsing Fever] | | * [http://www.cdc.gov/ncidod/dvbid/RelapsingFever/index.htm CDC: Relapsing Fever] |
| {{Spirochetal diseases}} | | {{Spirochetal diseases}} |
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| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Zoonoses]] | | [[Category:Zoonoses]] |
| [[Category:Infectious disease]] | | [[Category:Infectious diseases]] |
| [[Category:Overview complete]]
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| [[pl:Dur powrotny]] | | [[pl:Dur powrotny]] |
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