Relapsing Fever Follow-up

Updated: Mar 15, 2017
  • Author: Elina Bobkova, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Follow-up

Deterrence/Prevention

Louse-borne relapsing fever (LBRF) can be prevented by eliminating circumstances that promote louse infection (eg, crowding, homelessness) and good personal hygiene (eg, changing clothes at frequent intervals, bathing, boiling and washing clothes and bedding).

Delousing with 1% lindane, DDT powder, or Lysol is useful in shelters and in patients and household contacts.

Avoiding rodents can prevent tickborne relapsing fever (TBRF). This includes use of appropriate clothing and tick repellents when entering tick-infested areas.

Postexposure prophylaxis is recommended in individuals who have been exposed to ticks in a high-risk environment. An initial dose of doxycycline 200 mg the first day followed by 100 mg daily for 4 days was found to be 100% efficacious in a double-blind, placebo-controlled trial of 93 subjects. [56] If doxycycline is unavailable, tetracycline 500 mg 4 times daily for 4 days may be administered.

No vaccine is currently available for relapsing fever.

Vaccines are in development. [57]

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Complications

During episodes of spirochetemia, the organisms may invade the brain, eye, inner ear, heart, or liver. [5] CNS involvement is more common in TBRF than in LBRF [5] ; however, eschars, ARDS, cranial nerve palsies, focal neurologic deficits, uveitis, iritis or iridocyclitis, splenic rupture, and myocarditis may be seen in both TBRF and LBRF. [2, 58] Myelitis, radiculopathy, hemiplegia, stupor, and even coma have also been reported. [59, 60]

ARDS has been reported in both TBRF and LBRF and may have previously been underrecognized in TBRF. [19] From 1995-2004, two cases of ARDS were reported in patients with TBRF in Nevada and California. [2] In the state of Washington, 3 cases of ARDS were found in patients with TBRF from 1996-2005. [2]

Relapsing fever may be more dangerous in patients with impaired B-cell function or asplenia. T-cell deficiency/impairment does not seem to play a role in acute relapsing fever. [50]

Treatment of relapsing fever usually results in a Jarisch-Herxheimer reaction, especially following penicillin therapy. The reaction is characterized by fever, chills, rigors, diaphoresis, tachycardia, and hypotension. Cytokines, especially tumor-necrosis factor (TNF)–alpha, IL-6, and IL-8, have all been implicated. [30] The reaction usually occurs within 2-4 hours of administration of the antibiotic. Patients should be observed closely for this reaction, as it can mimic a febrile crisis and may be dangerous.

Relapsing fever in pregnant women increases the risk of spontaneous abortions and severe maternal infection, as well as the risk of ARDS and the Jarisch-Herxheimer reaction. [61] Only twelve cases of TBRF during pregnancy have been reported in North America. [62] Transplacental transmission of the bacteria is also a risk. [30]

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Prognosis

Several clinical features portend a poorer prognosis. These include stupor or coma, bleeding, myocarditis, [63] hepatic dysfunction, pneumonia, and coinfection with typhus, typhoid, or malaria. [30]

For more information, see Mortality/Morbidity.

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Patient Education

Patients should be educated on avoidance and/or elimination of arthropod vectors.

For excellent patient education resources, see eMedicineHealth's patient education article Ticks.

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