People are infected when they are bitten by an infected tick or come in contact with an infected louse.
People have sudden chills followed by a high fever, severe headache, vomiting, muscle and joint pain, and sometimes a rash.
Symptoms disappear, then return (relapse) several times.
Identifying the bacteria in a sample of blood confirms the diagnosis.
Antibiotics are usually effective.
(See also Overview of Bacteria Overview of Bacteria Bacteria are microscopic, single-celled organisms. They are among the earliest known life forms on earth. There are thousands of different kinds of bacteria, and they live in every conceivable... read more .)
Several species of Borrelia bacteria cause relapsing fever. A different species of Borrelia causes Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These... read more 
.
Relapsing fever is transmitted by soft-bodied ticks, hard-bodied ticks, and body lice.
Pregnant women with relapsing fever can pass on Borrelia to their unborn child or may miscarry. Although rare, Borrelia can also been transmitted during a blood transfusion Overview of Blood Transfusion A blood transfusion is the transfer of blood or a blood component from one healthy person (a donor) to a sick person (a recipient). Transfusions are given to increase the blood's ability to... read more 
.
Relapsing fever caused by ticks (tick-borne relapsing fever)
A soft-bodied tick becomes infected when it feeds on rodents (such as chipmunks and squirrels) that carry a species of Borrelia bacteria. The tick spreads the bacteria to a person when it bites.
Tick-borne relapsing fever caused by soft-bodied ticks occurs in the Americas, Africa, Asia, and Europe. In the United States, the disease occurs mainly in the Western states, particularly between May and September. People who sleep in a rodent-infested cabin in the mountains are more likely to be bitten by infected ticks. However, because the ticks feed at night and do not remain attached for very long, people often do not recall a tick bite. People who explore caves (spelunking) are also at risk of infection.
Did You Know...
Soft ticks differ from hard ticks (such as the dog tick and the deer tick) in the following ways:
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Hard-bodied ticks that transmit relapsing fever are the same ticks that transmit Lyme disease. Thus, relapsing fever caused by hard-bodied ticks occurs in the same places where Lyme disease occurs in the United States—the Northeast and upper Midwest. When these ticks transmit relapsing fever, they may also transmit Lyme disease, and people may have more than one infection at a time.
The ticks become infected when they feed on the blood of rodents (such as the white-footed mouse) that carry a species of Borrelia bacteria. The tick spreads the bacteria to a person when it bites.
People who live in wooded areas or who walk through tall grass or wooded areas are more likely to be bitten by infected ticks.
Relapsing fever caused by lice (louse-borne relapsing fever)
Louse-borne relapsing fever is transmitted by infected body lice Body lice Lice infestation is a parasitic skin infestation caused by tiny wingless insects. Lice spread most frequently through close person-to-person contact. People with lice usually have severe itching... read more 
. A louse becomes infected when it feeds on a human host who is infected with a species of Borrelia. The louse spreads the bacteria to another person when it is crushed. The Borrelia bacteria are then released on to the person's skin. Once released, the bacteria can enter the person's body, usually through a bite or broken skin. Lice that have not been crushed do not transmit the infection.
This fever is rare in the United States and occurs mainly in the highlands of Central and East Africa and the Andes of South America. Louse-borne relapsing fever has also occurred in Europe in refugees from Africa. This fever tends to occur in epidemics, particularly in regions affected by war, and in refugee camps. The louse infestation is usually obvious.
Symptoms of Relapsing Fever
People with relapsing fever have sudden chills followed by a high fever, severe headache, vomiting, and muscle and joint pain. A thick, black, crusty scab (eschar) may form at the site of the tick bite. Some people have a reddish rash on the trunk and limbs and red eyes. Some people become delirious.
After several days, fever stops suddenly, and people feel better. However, the fever and usually the other symptoms return and go away (relapse) at about 1-week intervals for up to 30 episodes. The episodes become progressively less severe, and people eventually recover as they develop immunity to the disease.
Later in the illness, other symptoms may develop. They include jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more 
(a yellowish discoloration of the skin and whites of the eyes), an enlarged liver and spleen, inflammation of heart tissue (myocarditis Myocarditis Myocarditis is inflammation of the muscle tissue of the heart (myocardium) that causes tissue death. Myocarditis may be caused by many disorders, including infection, toxins and drugs that affect... read more ), and heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more 
. These symptoms are more common among people with louse-borne relapsing fever.
The eyes, brain, and spinal cord may be infected. For example, meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly developing inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid... read more may develop. These problems are more common among people with tick-borne relapsing fever.
Diagnosis of Relapsing Fever
Examination of a blood sample
Doctors suspect relapsing fever if people have recurring fevers, especially if they report spending the night in a cave or in a mountain cabin.
To diagnose relapsing fever, doctors take a sample of blood and examine it under a microscope to look for Borrelia bacteria. Measuring antibodies against the Borrelia bacteria that cause relapsing fever may help. Doctors measure them soon after the infection is diagnosed and again weeks after people have recovered. An increased amount of antibodies to Borrelia after recovery shows that Borrelia was the cause.
Sometimes polymerase chain reaction Polymerase chain reaction (PCR) Genetic diagnostic technologies are scientific methods that are used to understand and evaluate an organism's genes. (See also Genes and Chromosomes.) Genes are segments of deoxyribonucleic... read more (PCR) tests are done that detect genetic material from the bacteria.
Prognosis for Relapsing Fever
Most people recover, but some die. Death is more likely in the very young, pregnant women, older people, people who are undernourished or debilitated, and those who are infected during an epidemic of louse-borne relapsing fever.
For louse-borne relapsing fever, death occurs in 10 to 40% of untreated people and in 2 to 5% of treated people.
For tick-borne relapsing fever, the prognosis is better. Death occurs in less than 10% of untreated people and in less than 2% of treated people.
Treatment of Relapsing Fever
Antibiotics
Antibiotics such as tetracycline, doxycycline, or erythromycin are usually effective.
Within 2 hours after the first dose of the antibiotic, an uncomfortable reaction called Jarisch-Herxheimer reaction Jarisch-Herxheimer reaction Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. It can occur in three stages of symptoms, separated by periods of apparent good health. Syphilis... read more 
may occur, causing sweating, shaking chills, fever, and a fall in blood pressure. To reduce the severity of this reaction, doctors may give people acetaminophen before and after the first dose of the antibiotic. This reaction is not an allergic reaction to the antibiotic.
If people are dehydrated or have electrolyte imbalances because of vomiting, they are given fluids intravenously. Acetaminophen with oxycodone or hydrocodone may be given to relieve severe headaches, and prochlorperazine can relieve nausea and vomiting.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Centers for Disease Control and Prevention (CDC): Relapsing Fever: Information about relapsing fever, including links about transmission and symptoms
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
tetracycline |
Emtet-500, Panmycin, Sumycin |
doxycycline |
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs |
erythromycin |
A/T/S, Akne-mycin, E.E.S., Emcin Clear , EMGEL, E-Mycin, ERYC, Erycette, Eryderm , Erygel, Erymax, EryPed, Ery-Tab, Erythra Derm , Erythrocin, Erythrocin Lactobionate, Erythrocin Stearate, Ilosone, Ilotycin, My-E, PCE, PCE Dispertab , Romycin, Staticin, T-Stat |
acetaminophen |
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever |
oxycodone |
Dazidox , Endocodone , ETH-Oxydose, Oxaydo, OXECTA, OxyContin, Oxydose , OxyFast, OxyIR, Percolone, Roxicodone, Roxybond, XTAMPZA |
hydrocodone |
Hysingla ER, Zohydro |
prochlorperazine |
Compazine, Compazine Rectal, Compazine Solution, Compazine Syrup, Compro |
