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