Background
Relapsing fever, as the name implies, is characterized by recurrent acute episodes of fever. These are followed by periods of defervescence of increasing duration. The infection is caused by various spirochete species of the Borrelia genus. Spirochetes are a unique species of bacteria that also cause syphilis, Lyme disease, and leptospirosis.
The fever relapses result from spirochetal antigenic variation. Relapsing fever, if untreated, may be fatal.
Relapsing fever is an arthropod-borne infection spread by lice (Pediculus humanus) and ticks (Ornithodoros species). Two main forms of this infection exist: tickborne relapsing fever (TBRF) and louse-borne relapsing fever (LBRF).
TBRF is caused by 8 or more Borrelia species (eg, Borrelia hermsii, Borrelia turicatae, Borrelia parkeri,Borrelia duttonii), while LBRF is caused solely by Borrelia recurrentis.
TBRF and LBRF vary significantly in terms of epidemiology. A soft-bodied tick (Ornithodoros) transmits multiple Borrelia species that cause endemic relapsing fever, whereas the human body louse transmits B recurrentis, which causes an epidemic form of relapsing fever. Unlike hard ticks, Ornithodoros adult ticks are able to live for many years, feed repeatedly on blood meals, lay eggs, and perpetuate their life cycle.
In addition, Ornithodoros ticks may survive long periods in a fasting state. In fact, Ornithodoros turicata ticks have been known to transmit spirochetes in the laboratory setting after 7 years without a blood meal.
Humans are the sole host of B recurrentis, while mammals (eg, cattle, pigs, prairie dogs, ground and tree squirrels, chipmunks) and reptiles (lizards, snakes, gopher tortoises) may serve as a reservoir for tickborne Borrelia species.
Relapsing fever is found in the United States in domestic dogs residing in forest cabins. B turicatae
and the recently identified B hermsii have also been reported in domesticated dogs.
The first reported case of TBRF in the United States was identified in 1905 in New York. The patient had previously traveled to Texas.
In the United States, where fewer than 30 cases of TBRF are diagnosed each year,
B hermsii and B turicatae cause most outbreaks. A recently discovered Borrelia species, Borrelia miyamotoi, has been found in hard-bodies ticks in regions where Lyme disease is endemic. B miyamotoi may coexist with Borrelia burgdorferi
and Babesia
.
TBRF is reported worldwide, except Antarctica, Australia, and the Pacific Southwest.
LBRF is uncommon in the United States but is occasionally observed in travelers returning from endemic regions (see International). The last reported outbreak of LBRF in the United States occurred in 1871.