Tick-Borne Relapsing Fever (TBRF)
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A bacterial infection caused by bacteria Borrelia duttonii, are known zoonoses transmitted to humans through the bite of infected “soft ticks” Ornithodoros spp that live within rodent burrows feeding on the rodent. Humans typically come into contact with soft ticks when they sleep in rodent-infested cabins.
Common Symptoms
- Recurring episodes of fever, Non-specific headache, Non-specific muscle pain, Non-specific joint pain, Non-specific chills, Non-specific vomiting, and Abdominal pain.
Bacteremia tends to be greater among pregnant women, and may sometimes result in more severe infection. Symptoms tend to develop within 7days after the tick bite. Long-term sequelae of TBRF are rare but include iritis, uveitis, cranial nerve and other neuropathies.
Clinical Diagnostic Criteria
- Recurring episodes of high fever, headache, muscle and joint aches, and nausea
- Recurring symptoms, producing a telltale pattern of fever lasting roughly 3 days, followed by 7 days without fever, followed by another 3 days of fever. Without antibiotic treatment, this process can repeat several times.
Laboratory Investigation
- Microscopy from the peripheral blood smear will reveal a long and spiral-shaped bacterium Spirochetemia (spirochetes in blood) in TBRF patients often reaches high concentrations (>106 spirochetes/ml). Direct microscopic observation of relapsing fever spirochetes using dark field microscopy or stained peripheral blood smears
Prevention
- Avoid sleeping in rodent-infested buildings whenever possible. Although rodent nests may not be visible, other evidence of rodent activity (e.g., droppings) are a sign that a building may be infested.
- Prevent tick bites. Use insect repellent (on skin or clothing) or permethrin (applied to clothing or equipment).
Pharmacological Treatment
A: erythromycin (PO) 500mg (or 12.5 mg/kg) 8 hourly for 14days
A: tetracycline (PO) 500mg 6hourly for 14days
C: ceftriaxone (IV or IM) 2 grams daily for 10-14days is preferred for patients with central nervous system involvement
Public Health Control
- Provide public education, awareness, preventive control measures, and avoidance of areas where infected ticks are most abundant.
- Assessing evidence of rodent activity in and around structures of infected people
- Removal of rodents and their nests
- Reduce tick exposures by removing tick infested structures with an appropriate pesticide applied by a professional pest control operator who is familiar with the types of “crack and crevice” treatments used to control cockroaches or other wall-dwelling pests