Relapsing Fever Differential Diagnoses

1. Barbour AG, Hayes SF. Biology of Borrelia species. Microbiol Rev. 1986 Dec. 50(4):381-400. [QxMD MEDLINE Link].

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

3. Kelly AL, Raffel SJ, Fischer RJ, Bellinghausen M, Stevenson C, Schwan TG. First isolation of the relapsing fever spirochete, Borrelia hermsii, from a domestic dog. Ticks Tick Borne Dis. 2014 Mar. 5 (2):95-9. [QxMD MEDLINE Link]. [Full Text].

4. Wynns HL. The epidemiology of relapsing fever. Moulton FR. A Symposium on Relapsing Fever in the Americas. American Association for the Advancement of Science. Washington, DC: 1942. 100-5.

5. Blevins SM, Greenfield RA, Bronze MS. Blood smear analysis in babesiosis, ehrlichiosis, relapsing fever, malaria, and Chagas disease. Cleve Clin J Med. 2008 Jul. 75(7):521-30. [QxMD MEDLINE Link].

6. Barbour AG, Bunikis J, Travinsky B, Hoen AG, Diuk-Wasser MA, Fish D, et al. Niche partitioning of Borrelia burgdorferi and Borrelia miyamotoi in the same tick vector and mammalian reservoir species. Am J Trop Med Hyg. 2009 Dec. 81 (6):1120-31. [QxMD MEDLINE Link]. [Full Text].

7. Cosson JF, Michelet L, Chotte J, Le Naour E, Cote M, Devillers E, et al. Genetic characterization of the human relapsing fever spirochete Borrelia miyamotoi in vectors and animal reservoirs of Lyme disease spirochetes in France. Parasit Vectors. 2014 May 20. 7:233. [QxMD MEDLINE Link]. [Full Text].

8. Krause PJ, Narasimhan S, Wormser GP, Barbour AG, Platonov AE, Brancato J, et al. Borrelia miyamotoi sensu lato seroreactivity and seroprevalence in the northeastern United States. Emerg Infect Dis. 2014 Jul. 20 (7):1183-90. [QxMD MEDLINE Link]. [Full Text].

9. Moursund WH. Historical introduction to the symposium on relapsing fever. Moulton FR. A Symposium on Relapsing Fever in the Americas. American Association for the Advancement of Science. Washington, DC: 1942. 1-6.

10. Barbour AG. Microbiology, pathogenesis, and epidemiology of relapsing fever. UpToDate. Available at http://www.uptodate.com/online/content/topic.do?topicKey=tickflea/11713&selectedTitle=2~15&source=search_result#references. Accessed: November 25, 2008.

11. Fuchs PC, Oyama AA. Neonatal relapsing fever due to transplacental transmission of Borrelia. JAMA. 1969 Apr 28. 208(4):690-2. [QxMD MEDLINE Link].

12. Krause PJ, Hendrickson JE, Steeves TK, Fish D. Blood transfusion transmission of the tick-borne relapsing fever spirochete Borrelia miyamotoi in mice. Transfusion. 2014 Sep 23. [QxMD MEDLINE Link].

13. Teegler A, Herzberger P, Margos G, Fingerle V, Kraiczy P. The relapsing fever spirochete Borrelia miyamotoi resists complement-mediated killing by human serum. Ticks Tick Borne Dis. 2014 Oct. 5(6):898-901. [QxMD MEDLINE Link].

14. Barbour AG. Antigenic variation of a relapsing fever Borrelia species. Annu Rev Microbiol. 1990. 44:155-71. [QxMD MEDLINE Link]. [Full Text].

15. Thein M, Bunikis I, Denker K, Larsson C, Cutler S, Drancourt M, et al. Oms38 is the first identified pore-forming protein in the outer membrane of relapsing fever spirochetes. J Bacteriol. 2008 Nov. 190(21):7035-42. [QxMD MEDLINE Link].

16. Hinnebusch BJ, Barbour AG, Restrepo BI, Schwan TG. Population structure of the relapsing fever spirochete Borrelia hermsii as indicated by polymorphism of two multigene families that encode immunogenic outer surface lipoproteins. Infect Immun. 1998 Feb. 66 (2):432-40. [QxMD MEDLINE Link].

17. Gelderblom H, Schmidt J, Londoño D, Bai Y, Quandt J, Hornung R, et al. Role of interleukin 10 during persistent infection with the relapsing fever Spirochete Borrelia turicatae. Am J Pathol. 2007 Jan. 170(1):251-62. [QxMD MEDLINE Link].

18. Londoño D, Marques A, Hornung RL, Cadavid D. Relapsing fever borreliosis in interleukin-10-deficient mice. Infect Immun. 2008 Dec. 76(12):5508-13. [QxMD MEDLINE Link].

19. 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. 2007 Oct 19. 56(41):1073-6. [QxMD MEDLINE Link].

20. Forrester JD, Kjemtrup AM, Fritz CL, et al. Tickborne relapsing fever - United States, 1990-2011. MMWR Morb Mortal Wkly Rep. 2015 Jan 30. 64 (3):58-60. [QxMD MEDLINE Link]. [Full Text].

21. Platonov AE, Karan LS, Kolyasnikova NM, Makhneva NA, Toporkova MG, Maleev VV, et al. Humans infected with relapsing fever spirochete Borrelia miyamotoi, Russia. Emerg Infect Dis. 2011 Oct. 17(10):1816-23. [QxMD MEDLINE Link].

22. Brouqui P, Stein A, Dupont HT, Gallian P, Badiaga S, Rolain JM, et al. Ectoparasitism and vector-borne diseases in 930 homeless people from Marseilles. Medicine (Baltimore). 2005 Jan. 84(1):61-8. [QxMD MEDLINE Link].

23. Wilting KR, Stienstra Y, Sinha B, Braks M, Cornish D, Grundmann H. Louse-borne relapsing fever (Borrelia recurrentis) in asylum seekers from Eritrea, the Netherlands, July 2015. Euro Surveill. 2015 Jul 30. 20 (30):. [QxMD MEDLINE Link]. [Full Text].

24. Goldenberger D, Claas GJ, Bloch-Infanger C, Breidthardt T, Suter B, Martínez M, et al. Louse-borne relapsing fever (Borrelia recurrentis) in an Eritrean refugee arriving in Switzerland, August 2015. Euro Surveill. 2015 Aug 13. 20 (32):2-5. [QxMD MEDLINE Link]. [Full Text].

25. Loescher T, Wieser A, Fingerele V. Louse-borne relapsing fever—Germany: asylum seekers, ex East Africa. Promed. 2015-09-03. Archive Number: 20150903.3620174. [Full Text].

26. Frank C, Hendrik Wilking H. Louse-borne relapsing fever—Germany (02): asylum seekers. Promed. 2015-09-11. Archive Number: 20150911.3638819. [Full Text].

27. Seilmaier M, Guggemos W, Wieser A, Fingerle V, Balzer L, Fenzl T, et al. [Louse-borne-relapsing-fever in refugees from the Horn of Africa; a case series of 25 patients]. Dtsch Med Wochenschr. 2016 Jul. 141 (14):e133-42. [QxMD MEDLINE Link]. [Full Text].

28. Sarih M, Garnier M, Boudebouch N, Bouattour A, Rihani A, Hassar M, et al. Borrelia hispanica relapsing fever, Morocco. Emerg Infect Dis. 2009 Oct. 15 (10):1626-9. [QxMD MEDLINE Link]. [Full Text].

29. Krause PJ, Fish D, Narasimhan S, Barbour AG. Borrelia miyamotoi infection in nature and in humans. Clin Microbiol Infect. 2015 Jul. 21 (7):631-9. [QxMD MEDLINE Link]. [Full Text].

30. Barbour AG. Clinical features and management of relapsing fever. UpToDate. Available at http://www.uptodate.com/online/content/topic.do?topicKey=tickflea/11413#1. Accessed: November 25, 2008.

31. Rhee KY, Johnson WD Jr. Borrelia species (relapsing fever). Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005. Vol 2: 2795-8.

32. Ramos JM, Reyes F, Tesfamariam A, Malmierca E. Louse-borne relapsing fever and malaria co-infection in Ethiopia. Trop Doct. 2007 Apr. 37(2):121-2. [QxMD MEDLINE Link].

33. Nordstrand A, Bunikis I, Larsson C, Tsogbe K, Schwan TG, Nilsson M, et al. Tickborne relapsing fever diagnosis obscured by malaria, Togo. Emerg Infect Dis. 2007 Jan. 13(1):117-23. [QxMD MEDLINE Link]. [Full Text].

34. ANDERSON TR, ZIMMERMAN LE. Relapsing fever in Korea; a clinicopathologic study of eleven fatal cases with special attention to association with Salmonella infections. Am J Pathol. 1955 Nov-Dec. 31(6):1083-109. [QxMD MEDLINE Link].

35. Goubau PF. Relapsing fevers. A review. Ann Soc Belg Med Trop. 1984. 64(4):335-64. [QxMD MEDLINE Link].

36. Barbour AG. Kasper DL, Hauser SL, Longo DL, et al. Harrison's Principle of Internal Medicine. 19th. New York City: McGraw Hill; 2015.

37. Anderson TR, Zimmerman LE. Relapsing fever in Korea: a clinicopathologic study of eleven fatal cases with special attention to association with Salmonella infections. Am J Pathol. 1955. 31(6):1083. [QxMD MEDLINE Link]. [Full Text].

38. Ramos JM, Reyes F, Tesfamariam A, Malmierca E. Louse-borne relapsing fever and malaria co-infection in Ethiopia. Trop Doct. 2007. 37(2):121. [QxMD MEDLINE Link]. [Full Text].

39. Nordstrand A, Bunikis I, Larsson C, Tsogbe K, Schwan TG, Nilsson M, et al. Tickborne relapsing fever diagnosis obscured by malaria, Togo. Emerg Infect Dis. 2007. 13(1):117. [QxMD MEDLINE Link]. [Full Text].

40. Southern PM, Sanford JP. Relapsing fever: a clinical and microbiological review. Medicine. 1969. 48:129-49.

41. Hovius JW, de Wever B, Sohne M, Brouwer MC, Coumou J, Wagemakers A, et al. A case of meningoencephalitis by the relapsing fever spirochaete Borrelia miyamotoi in Europe. Lancet. 2013 Aug 17. 382(9892):658. [QxMD MEDLINE Link]. [Full Text].

42. Perine PL, Parry EH, Vukotich D, Warrell DA, Bryceson AD. Bleeding in louse-borne relapsing fever. I. Clinical studies in 37 patients. Trans R Soc Trop Med Hyg. 1971. 65(6):776-81. [QxMD MEDLINE Link].

43. Dennis DT, Awoke S, Doberstyn EB, Fresh JW. Bleeding in louse-borne relapsing fever in Ethiopia; clinical and laboratory features in 29 patients. East Afr Med J. 1976 Apr. 53(4):220-5. [QxMD MEDLINE Link].

44. Parola P, Raoult D. Ticks and tickborne bacterial diseases in humans: an emerging infectious threat. Clin Infect Dis. 2001 Mar 15. 32(6):897-928. [QxMD MEDLINE Link].

45. Dupont HT, La Scola B, Williams R, Raoult D. A focus of tick-borne relapsing fever in southern Zaire. Clin Infect Dis. 1997. 25(1):139. [QxMD MEDLINE Link]. [Full Text].

46. Brahim H, Perrier-Gros-Claude JD, Postic D, Baranton G, Jambou R. Identifying relapsing fever Borrelia, Senegal. Emerg Infect Dis. 2005. 11(3):474. [QxMD MEDLINE Link]. [Full Text].

47. Halperin T, Orr N, Cohen R, Hasin T, Davidovitch N, Klement E, et al. Detection of relapsing fever in human blood samples from Israel using PCR targeting the glycerophosphodiester phosphodiesterase (GlpQ) gene. Acta Trop. 2006. 98(2):189. [QxMD MEDLINE Link]. [Full Text].

48. Barbour AG. Relapsing Fever and Other Borrelia Infections. Guerrant RL, Walker DH, Weller PF. Tropical Infectious Diseases: Principles, Pathogens and Practice. 3rd. Philadelphia: Saunders Elsevier; 2011. 295.

49. Elbir H, Henry M, Diatta G, Mediannikov O, Sokhna C, Tall A, et al. Multiplex real-time PCR diagnostic of relapsing fevers in Africa. PLoS Negl Trop Dis. 2013 Jan 31. 7(1):e2042. [QxMD MEDLINE Link]. [Full Text].

50. Boden K, Lobenstein S, Hermann B, Margos G, Fingerle V. Borrelia miyamotoi-Associated Neuroborreliosis in Immunocompromised Person. Emerg Infect Dis. 2016 Sep. 22 (9):1617-20. [QxMD MEDLINE Link]. [Full Text].

51. van Dam AP, van Gool T, Wetsteyn JC. Tick-borne relapsing fever imported from West Africa: diagnosis by quantitative buffy coat analysis and in vitro culture of Borrelia crocidurae. J Clin Microbiol. 1999 Jun. 37(6):2027-30. [QxMD MEDLINE Link].

52. Kelly R. Cultivation of Borrelia hermsi. Science. 1971 Jul 30. 173(995):443-4. [QxMD MEDLINE Link].

53. Schwan TG, Gage KL, Karstens RH, Schrumpf ME, Hayes SF, Barbour AG. Identification of the tick-borne relapsing fever spirochete Borrelia hermsii by using a species-specific monoclonal antibody. J Clin Microbiol. 1992 Apr. 30(4):790-5. [QxMD MEDLINE Link].

54. Fukunaga M, Okada K, Nakao M, Konishi T, Sato Y. Phylogenetic analysis of Borrelia species based on flagellin gene sequences and its application for molecular typing of Lyme disease borreliae. Int J Syst Bacteriol. 1996 Oct. 46(4):898-905. [QxMD MEDLINE Link].

55. Jiang J, Temenak JJ, Richards AL. Real-time PCR duplex assay for Rickettsia prowazekii and Borrelia recurrentis. Ann N Y Acad Sci. 2003 Jun. 990:302-10. [QxMD MEDLINE Link].

56. Uhlmann EJ, Seed PC, Schwan TG, Storch GA. Tick-borne relapsing fever polymerase chain reaction of tick-borne relapsing fever caused by Borrelia hermsii. Pediatr Infect Dis J. 2007 Mar. 26(3):267-9. [QxMD MEDLINE Link].

57. Elbir H, Henry M, Diatta G, Mediannikov O, Sokhna C, Tall A, et al. Multiplex real-time PCR diagnostic of relapsing fevers in Africa. PLoS Negl Trop Dis. 2013. 7 (1):e2042. [QxMD MEDLINE Link]. [Full Text].

58. Magnarelli LA, Anderson JF, Johnson RC. Cross-reactivity in serological tests for Lyme disease and other spirochetal infections. J Infect Dis. 1987 Jul. 156(1):183-8. [QxMD MEDLINE Link].

59. Magnarelli LA, Meegan JM, Anderson JF, Chappell WA. Comparison of an indirect fluorescent-antibody test with an enzyme-linked immunosorbent assay for serological studies of Lyme disease. J Clin Microbiol. 1984 Aug. 20(2):181-4. [QxMD MEDLINE Link].

60. Bryceson AD, Parry EH, Perine PL, Warrell DA, Vukotich D, Leithead CS. Louse-borne relapsing fever. Q J Med. 1970 Jan. 39(153):129-70. [QxMD MEDLINE Link].

61. Pennington PM, Allred CD, West CS, Alvarez R, Barbour AG. Arthritis severity and spirochete burden are determined by serotype in the Borrelia turicatae-mouse model of Lyme disease. Infect Immun. 1997 Jan. 65(1):285-92. [QxMD MEDLINE Link]. [Full Text].

62. Guerrier G, Doherty T. Comparison of antibiotic regimens for treating louse-borne relapsing fever: a meta-analysis. Trans R Soc Trop Med Hyg. 2011 Sep. 105(9):483-90. [QxMD MEDLINE Link].

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

64. CHERRY JK. The prevention and treatment of tick-borne relapsing fever with special reference to aureomycin and terramycin. Trans R Soc Trop Med Hyg. 1955 Nov. 49(6):563-73. [QxMD MEDLINE Link].

65. Hasin T, Davidovitch N, Cohen R, Dagan T, Romem A, Orr N, et al. Postexposure treatment with doxycycline for the prevention of tick-borne relapsing fever. N Engl J Med. 2006 Jul 13. 355(2):148-55. [QxMD MEDLINE Link].

66. Krajacich BJ, Lopez JE, Raffel SJ, Schwan TG. Vaccination with the variable tick protein of the relapsing fever spirochete Borrelia hermsii protects mice from infection by tick-bite. Parasit Vectors. 2015 Oct 21. 8:546. [QxMD MEDLINE Link]. [Full Text].

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

68. Scott R. Neurological complications of relapsing fever. Lancet. 1944. 247:436-8.

69. 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. 1998 Jan. 26(1):151-64. [QxMD MEDLINE Link].

70. Guggenheim JN, Haverkamp AD. Tick-borne relapsing fever during pregnancy: a case report. J Reprod Med. 2005 Sep. 50 (9):727-9. [QxMD MEDLINE Link].

71. Centers for Disease Control and Prevention (CDC). Tickborne relapsing fever in a mother and newborn child--Colorado, 2011. MMWR Morb Mortal Wkly Rep. 2012 Mar 16. 61 (10):174-6. [QxMD MEDLINE Link].

72. Wengrower D, Knobler H, Gillis S, Chajek-Shaul T. Myocarditis in tick-borne relapsing fever. J Infect Dis. 1984 Jun. 149(6):1033. [QxMD MEDLINE Link].

Geneva E Guarin, MD, MBA Resident Physician, Department of Internal Medicine, Einstein Medical Center Philadelphia

Disclosure: Nothing to disclose.

Antonette B Climaco, MD Attending Physician, Division of Infectious Diseases, Department of Medicine, Einstein Healthcare Network

Antonette B Climaco, MD is a member of the following medical societies: American Academy of HIV Medicine, HIV Medicine Association, Infectious Diseases Society of America, Philippine Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, Infectious Diseases Society of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Pierre A Dorsainvil, MD Medical Director, HIV Specialist, Palm Beach County Main Detention Center; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Lake Ida Medical Center

Disclosure: Nothing to disclose.

John M Leedom, MD Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Kauser Akhter, MD Assistant Professor, Department of Internal Medicine, Florida State University College of Medicine; Associate Program Director, Infectious Diseases Fellowship Program, Orlando Health

Disclosure: Nothing to disclose.

Elina Bobkova, MD Fellow in Infectious Disease, Orlando Regional Medical Center

Elina Bobkova, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.

• Print this section
• Print the entire contents of
• Print the entire contents of article