eMedicine Specialties > Emergency Medicine > Infectious Diseases

Tick-Borne Diseases, Relapsing Fever: Differential Diagnoses & Workup

Author: Jonathan A Edlow, MD, Associate Professor of Medicine, Department of Emergency Medicine, Harvard Medical School; Vice Chairman, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
Contributor Information and Disclosures

Updated: Dec 9, 2008

Differential Diagnoses

Abdominal Trauma, Penetrating

Other Problems to Be Considered

Typhoid
Typhus fever
Rat bite fever

Workup

Laboratory Studies

  • Hematologic studies occasionally reveal anemia and thrombocytopenia.
    • The white blood cell (WBC) count usually is normal.
    • The prothrombin time (PT) and partial thromboplastin time (PTT) frequently are elevated.
  • The hepatic transaminases and serum bilirubin levels can be elevated.
  • In louse-borne relapsing fever, azotemia can occur.
  • Definitive diagnosis of relapsing fever is established by visualizing spirochetes in smears of peripheral blood during a febrile episode.
    • Multiple smears (both thick and thin, using Wright and Giemsa stains) may need to be examined.
    • This is the best way to secure the diagnosis in the ED.
    • Organisms are not found between relapses.
Photomicrograph of a patient who presented to the...

Photomicrograph of a patient who presented to the ED with cyclical fevers and chills, which she developed while traveling in one of the recently formed Soviet Republics in 1990. A blood smear for malaria was obtained, and this is what the laboratory technician observed.

[ CLOSE WINDOW ]
Photomicrograph of a patient who presented to the...

Photomicrograph of a patient who presented to the ED with cyclical fevers and chills, which she developed while traveling in one of the recently formed Soviet Republics in 1990. A blood smear for malaria was obtained, and this is what the laboratory technician observed.

  • Injection of blood into laboratory animals followed by examination of their blood sometimes is useful.

Imaging Studies

  • Imaging studies are not routinely useful, although chest radiography and hepatobiliary ultrasonography might be indicated in isolated cases in which pulmonary or hepatic manifestations predominate.
  • CT scanning of the brain may be indicated in cases with predominant central nervous system (CNS) manifestations.

Other Tests

  • The electrocardiogram (ECG) may show a prolonged QTc interval.
  • Nonspecific antibody response to Proteus OXK antigens is elevated in about one third of tick-borne cases and most louse-borne cases.

More on Tick-Borne Diseases, Relapsing Fever

Overview: Tick-Borne Diseases, Relapsing Fever
Differential Diagnoses & Workup: Tick-Borne Diseases, Relapsing Fever
Treatment & Medication: Tick-Borne Diseases, Relapsing Fever
Follow-up: Tick-Borne Diseases, Relapsing Fever
Multimedia: Tick-Borne Diseases, Relapsing Fever
References
[ CLOSE WINDOW ]

References

  1. Southern PM, Sandford JP. Relapsing fever: a clinical and microbiological review. Med. 1969;48:129-43.

  2. [Best Evidence] Hasin T, Davidovitch N, Cohen R, et al. Postexposure treatment with doxycycline for the prevention of tick-borne relapsing fever. N Engl J Med. Jul 13 2006;355(2):148-55. [Medline].

  3. Fekade D, Knox K, Hussein K, et al. Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha. N Engl J Med. Aug 1 1996;335(5):311-5. [Medline].

  4. Anda P, Sanchez-Yebra W, del Mar Vitutia M, et al. A new Borrelia species isolated from patients with relapsing fever in Spain. Lancet. Jul 20 1996;348(9021):162-5. [Medline].

  5. Cadavid D, Barbour AG. Neuroborreliosis during relapsing fever: review of the clinical manifestations, pathology, and treatment of infections in humans and experimental animals. Clin Infect Dis. Jan 1998;26(1):151-64. [Medline].

  6. Centers for Disease Control and Prevention (CDC). Acute respiratory distress syndrome in persons with tickborne relapsing fever--three states, 2004-2005. MMWR Morb Mortal Wkly Rep. Oct 19 2007;56(41):1073-6. [Medline].

  7. Dworkin MS, Anderson DE Jr, Schwan TG, et al. Tick-borne relapsing fever in the northwestern United States and southwestern Canada. Clin Infect Dis. Jan 1998;26(1):122-31. [Medline].

  8. Dworkin MS, Schwan TG, Anderson DE Jr, Borchardt SM. Tick-borne relapsing fever. Infect Dis Clin North Am. Sep 2008;22(3):449-68, viii. [Medline].

  9. Horton JM, Blaser MJ. The spectrum of relapsing fever in the Rocky Mountains. Arch Intern Med. May 1985;145(5):871-5. [Medline].

  10. Nordstrand A, Barbour AG, Bergstrom S. Borrelia pathogenesis research in the post-genomic and post-vaccine era. Curr Opin Microbiol. Feb 2000;3(1):86-92. [Medline].

  11. Paul WS, Maupin G, Scott-Wright AO, et al. Outbreak of tick-borne relapsing fever at the north rim of the Grand Canyon: evidence for effectiveness of preventive measures. Am J Trop Med Hyg. Jan 2002;66(1):71-5. [Medline].

  12. Raoult D, Roux V. The body louse as a vector of reemerging human diseases. Clin Infect Dis. Oct 1999;29(4):888-911. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

tick-borne diseases, tick bite, relapsing fever, Borrelia, louse-borne relapsing fever, human body louse, Pediculus humanus, P humanus, Borrelia recurrentis, B recurrentis, lice, ticks, Ornithodoros, spirochetemia, Borrelia parkeri, B parkeri, Ornithodoros parkeri, O parkeri, Borrelia hermsii, B hermsii, Ornithodoros hermsii, O hermsii, soft tick

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jonathan A Edlow, MD, Associate Professor of Medicine, Department of Emergency Medicine, Harvard Medical School; Vice Chairman, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
Jonathan A Edlow, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dan Danzl, MD, Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital
Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.