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Clinical features, diagnosis, and management of relapsing fever

Alan G Barbour, MD
Section Editor
Daniel J Sexton, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Relapsing fever, caused by spirochetes of the Borrelia genus, is an arthropod-borne infection that occurs in two major forms: tick-borne (TBRF) and louse-borne (LBRF) [1,2]:

Tick-borne relapsing fever is a zoonosis that is enzootic in many countries. The two main Borrelia spp involved in North America are Borrelia hermsii (in the mountainous West) and Borrelia turicatae (in the Southwest and South Central region). Other tick-borne species cause relapsing fever on other continents.

Louse-borne relapsing fever is caused by Borrelia recurrentis. It is principally a disease seen in the developing world; it is spread from person to person by the body louse and can result in epidemics, including large ones involving millions of people.

As the name implies, relapsing fever is characterized by recurrent episodes of fever, which accompanies spirochetemia. The disease relapses are due to antigenic variation by the spirochetes.

The clinical manifestations, diagnosis, treatment, and prevention of relapsing fever will be discussed here. Topic reviews on the microbiology, pathogenesis, and epidemiology of relapsing fever, as well as Borrelia miyamotoi (a Borrelia species related to the agents of relapsing fever), are found elsewhere. (See "Microbiology, pathogenesis, and epidemiology of relapsing fever" and "Borrelia miyamotoi infection".)

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Literature review current through: Nov 2017. | This topic last updated: Jun 24, 2015.
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