Relapsing Fever in Emergency Medicine Follow-up

Updated: Jun 08, 2016
  • Author: Bobak Zonnoor , MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Follow-up

Further Outpatient Care

Refer patients to follow up with their primary care physician to address complete recovery, any malnutrition issues, and any laboratory or ECG abnormalities.

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Further Inpatient Care

Many patients with louse-borne relapsing fever are malnourished and will require inpatient care to correct their hypovolemia, coagulation abnormalities, and nutritional status.

Patients with abnormal mental status also require close observation with airway protection, as indicated.

Those with prolonged QTc intervals are best monitored with telemetry.

Be especially vigilant in monitoring for a JH reaction.

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Deterrence/Prevention

See Tick-borne Diseases, Introduction.

In 2006, Hasin et al published a study on postexposure prophylaxis with a 5-day course of doxycycline to prevent tick-borne relapsing fever. A 200-mg dose (day 1) followed by 100 mg daily for 4 more days had 100% efficacy (although the 95% confidence intervals were wide [46-100] because of small numbers of patients). [22]

In many situations (eg, a refugee camp), maintenance of personal hygiene is difficult or impossible.

Chemical delousing may be required in epidemic situations.

For louse-borne relapsing fever, maintaining personal hygiene to avoid lice prevents the disease.

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Complications

Bleeding is a common complication with both forms of relapsing fever. Bleeding in the skin, nose, eyes, lungs, urinary tract, GI tract, and brain can occur. The latter two can be fatal.

JH reaction may occur.

ARDS may occur.

In pregnant women, premature labor, spontaneous abortion, and transplacental spread with neonatal death have all been reported.

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Prognosis

The mortality rates of untreated louse-borne relapsing fever and tick-borne relapsing fever are range from 10%-70% and 4%-10%, respectively.

With prompt antibiotic treatment, the mortality rate of louse-borne relapsing fever and tick-borne relapsing fever decreases to 2%-5% and less than 2%, respectively. [18]

The following features are associated with a poor prognosis:

  • Stupor or coma on admission
  • Diffuse bleeding
  • Myocarditis
  • Poor hepatic function
  • Bronchopneumonia
  • Coinfection with malaria, typhoid, or typhus
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Patient Education

Educate patients about the vectors and how they can be avoided.

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

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