Relapsing fever is transmitted by lice or ticks infected with Lyme disease bacteria. The disease can usually be treated well with antibiotics, but there is still an obligation to report the disease to the appropriate authorities if it is suspected or diagnosed.
What is relapsing fever?
Relapsing fever is a bacterial infection caused by Borrelia bacteria. While the disease was common throughout the world in the early 19th century, nowadays it is found only in areas where hygiene conditions are very poor. There are two different types of relapsing fever: tick-borne and louse-borne. The former occurs in Central and South America, Asia and Africa, and in Spain and Portugal. The latter occurs mostly in refugee camps or prisons in Asia, South America, and Africa. Overall, the disease is found in tropical and subtropical areas. Louse relapsing fever is also called epidemic relapsing fever, and tick relapsing fever is called endemic. The disease belongs to the group of Lyme diseases. It was discovered in 1868 by the German physician Otto Obermeier.
Causes
Lice relapsing fever is caused by the bacteria Borrelia recurrentis. They are transmitted to humans via lice. The pathogens can enter the body through small injuries to the skin, such as fine scratches. Injuries that are so small that the person does not even notice them are sufficient for the pathogens. Infection from person to person is not possible. Tick-borne relapsing fever is transmitted by bites from leather ticks. Here, the pathogens are other Borrelia species, for example Borrelia hermii. The pathogens can also enter the body through laboratory infection or infected blood transfusions, but this is very rare. After the pathogens enter, they spread throughout the body via the blood and lymph channels. They can enter various organs, remain there, and continue to multiply.
Symptoms, complaints, and signs
After an infection with Lyme disease pathogens, the typical fever symptoms appear first: An elevated body temperature, chills, aching limbs, muscles and headache, and fatigue. As a result of the enlargement of the liver and spleen, jaundice occurs. Icterus is manifested by itching, skin changes and an increasing feeling of illness. The typical feature of relapsing fever is its repeated occurrence. After a strong fever with occasional febrile convulsions occurs in the first phase of the disease, weakening episodes of fever occur subsequently. In lice relapsing fever, four bouts of fever usually occur with decreasing intensity and duration. In tick-borne relapsing fever, up to eleven fever attacks are possible. Regardless of the trigger, the first signs of illness appear three to four days after infection. After 18 days at the latest, the disease reaches its peak. In individual cases, there is a risk of a severe course of the disease with further complications. In such cases, there is always a loss of consciousness and inflammation of the meninges and heart muscle. Physically weakened people are at risk of life-threatening organ failure. Externally, relapsing fever cannot be distinguished from a normal fever. However, the symptom picture of elevated body temperature, jaundice, and impaired consciousness indicates a serious infection that requires urgent clarification.
Diagnosis and course
An initial indication of relapsing fever is provided by recurrent episodes of fever lasting three to seven days. A definitive diagnosis is made by blood examination with a microscope. However, the Borrelia bacteria can only be seen in the blood during the fever episodes. The fever-free periods become longer after each fever attack, and the fever attacks become shorter and lighter. In lice relapsing fever, four fever attacks are normal; in tick relapsing fever, up to eleven recurrences may occur. Associated symptoms include headache and aching limbs, a pinhead-sized skin rash, chills, and jaundice. The spleen and liver often enlarge as well. The first symptoms appear about four to 18 days after infection. Possible complications include clouding of consciousness and, in the worst cases, inflammation of the meninges, brain or heart. Liver failure or failure of multiple organs can also be serious complications.
Complications
As a rule, relapsing fever can be treated relatively well, so that complications do not occur until the disease is not treated. In this case, the affected person suffers from a high fever and the usual symptoms of flu or a cold. There is severe pain in the head and also pain in the limbs. As the disease progresses, jaundice may also develop, accompanied by chills. Likewise, the affected person suffers from a skin rash due to the disease, which is associated with itching. If the affected person scratches himself frequently, this can lead to the formation of scars. The liver and spleen are also enlarged in relapsing fever, so pain may occur in these regions. Furthermore, the disease can lead to inflammation of the brain, which can cause irreversible damage to the brain. As a rule, relapsing fever can be treated easily and without complications. However, the affected person should be isolated from other fellow human beings. If treatment is successful, there is no decreased life expectancy for the affected person. In severe cases, relapsing fever can also lead to circulatory shock, requiring the affected person to be hospitalized.
When should you see a doctor?
Relapsing fever should always be treated by a doctor. Serious complications can occur with this condition if it is not treated properly. A doctor should be consulted if the affected person suffers from a very high fever. In this case, the usual complaints and symptoms of a flu or a cold also appear, which have a very negative effect on the quality of the affected person’s life. Likewise, there is a severe itching and in some cases jaundice. The liver and spleen may also enlarge due to relapsing fever. Those affected may suffer from disturbances of consciousness or even heart problems. If these symptoms occur, a doctor should be consulted immediately. Relapsing fever can be diagnosed by a general practitioner or in a hospital. Further treatment usually does not result in complications.
Treatment and therapy
Both forms of relapsing fever are treated with antibiotics; tetracycline and doxycycline have proven effective. The drugs are taken for about a week. Possibly, the affected person is isolated from fellow human beings. Without appropriate treatment, relapsing fever can lead to death. When the antibiotics are given, a so-called Jarisch-Herxheimer reaction can occur. After eliminating many bacteria at once, the organism releases endogenous substances that initiate inflammatory reactions of the body. These so-called “inflammatory mediators” include, for example, histamine and serotonin. Symptoms of a Jarisch-Herxheimer reaction include high fever, nausea, headache, joint and muscle pain, and skin rashes, symptoms that are very similar to those of relapsing fever. For the most part, these intensified symptoms last only a few hours, but they can last for several days. In particularly severe, rare cases, circulatory shock may occur. To prevent this reaction, or at least to attenuate it, glucocorticoids are administered before the antibiotic is given; these are certain hormones whose natural role is to influence sugar metabolism.
Prevention
There is currently no vaccine against relapsing fever. As a precaution, areas with low hygiene standards should be avoided, for example unclean hotels. To protect against tick bites, wear clothing with long sleeves and legs, socks and sturdy shoes. Insect repellent, available as lotion or spray, is also a good preventive measure. In the areas where lice relapsing fever is prevalent, the types of lice that can transmit the pathogens are controlled.
Follow-up
Such an infection is very stressful for the body of the affected patient, especially if antibiotic therapy could not be initiated immediately. Therefore, the patient is still in convalescence, even if symptoms such as fever or itching no longer appear. This means that the affected person should continue to take it easy during the follow-up period. The body’s own immune system must be rebuilt.This is best done through extended rest periods and a healthy, fresh diet that is prepared daily and contains many vitamins, minerals and fiber. Because eighty percent of all immune cells are located in the intestines, the administration of probiotics can be considered. There are corresponding dietary supplements available without prescription in pharmacies or drugstores. They contain living microorganisms (mostly lactic acid bacterial cultures) that are supposed to settle and multiply in the intestine and thus ensure a healthy immune system. Almost as important as intestinal care is the effect of sport in building up the immune system. A lot of exercise regulates the metabolism and stimulates the heart, circulation and immune system. If patients have also suffered from extensive skin rashes during relapsing fever, intensive skin care is recommended in these areas. Depending on the extent of the remaining discomfort, the skin may need to be resupplied with fat and/or moisture. In some cases, scar treatment with appropriate oils is also recommended.
What you can do yourself
To protect against infection, the affected person should take special care in everyday life. Since the pathogens can already start with minor injuries from one person to the next, open wounds are very special care to ensure that no transmission can take place. It is a notifiable disease that is highly contagious. The possibilities of self-help are limited to strengthening the body’s own defense system in addition to preventive measures. In order to support the organism in the healing process in the best possible way, attention should be paid to a healthy and balanced diet. A diet rich in vitamins strengthens the immune system and promotes recovery. The symptoms of relapsing fever include an increased body temperature. Cold compresses and an adequate intake of fluids can relieve the symptoms. The ill person needs an adequate supply of oxygen. Therefore, the rooms should be ventilated as well as possible at regular intervals. In addition, sleep hygiene should be optimized and adapted to natural needs. Overexertion, stress or additional strain should be kept away from the patient. Physical activities should be reduced to a minimum. These can otherwise lead to complications and further deterioration of health. If itching is present, particular attention should be paid to the possible risk of infection. If possible, scratching should be avoided.
