Relapsing Fever

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relapsing fever

[ri′laps·iŋ ‚fē·vər]
(medicine)
An acute infectious disease caused by various species of the spirochete Borrelia, characterized by episodes of fever which subside spontaneously and recur over a period of weeks.

Relapsing Fever

 

an acute infectious disease caused by spirochetes transmitted through bloodsucking insects (lice, ticks) and characterized by periodic paroxysms of fever alternating with periods of no fever. Epidemic, or louse-borne, and endemic, or tick-borne, relapsing fever are distinguished.

Only man suffers from epidemic relapsing fever. The causative agent is a spirochete discovered in 1868 by the German scientist O. Obermeier. It reproduces in the body cavity (coelomic fluid) of the body louse infected by Obermeier’s spirochetes. Epidemic relapsing fever was widespread during wars and famines, being aided by the migration of people and their infestation with lice. Relapsing fever was one of the commonest diseases in prerevolutionary Russia. In the USSR, the disease has been eradicated. It occurs mainly in countries with poor cultural and economic development. A louse can infect a human only after four days from the time it sucked the blood of someone with relapsing fever. A louse bite is not infectious in itself. Spirochetes enter the blood of a healthy person through small wounds and scratches in the skin after crushing the lice. After penetrating the skin and then passing through the lymphatic vessels into the general bloodstream, the spirochetes enter the spleen, liver, bone marrow, and central nervous system. The periodic entry of spirochetes from these organs into the bloodstream causes recurrences of febrile attacks. Most of the spirochetes are killed at the end of each attack by antibodies (spirochetolysins) and phagocytosis. The incubation period (time from the moment of infection to the appearance of the first symptoms of the disease) varies from two to 14 days. The onset of the disease is sudden, with chills and rapidly rising temperature, which climbs to 40°-41° C within a few hours. General weakness and severe muscle pain, especially in the region of the gastrocnemius, occur. Many patients suffer repeated nose bleeds. The skin is dry, hot to the touch, and slightly jaundiced. The pulse is rapid. The spleen and liver enlarge, the latter to a lesser extent. The first febrile attack lasts five to eight days, after which the temperature drops abruptly to normal while the patient sweats profusely. This is followed by a period of normal temperature—apyrexia—which continues six to eight days. Suddenly, after a chill, the temperature again rises to a high level and the second attack occurs, lasting three to five days. Again apyrexia develops and it continues eight to twelve days. Sometimes there is a third and shorter (one to three days) febrile period. In rare cases there may be as many as four or five recurrences.

Analysis of the blood taken during an attack reveals the presence of spirochetes. Relapsing fever may be complicated by inflammatory changes in the eyes (iridocyclitis), infarcts, and ruptures of the greatly enlarged spleen. Treatment is administered only in a hospital. Patients are discharged 15 days after the temperature drops. Prevention includes early detection and hospitalization of infected individuals and control of louse infestation (pediculosis).

Endemic relapsing fever is one of the natural endemic infections responsible for similar diseases in animals and man. It is caused by spirochetes transmitted by ticks. Natural seats are found in Africa, Asia (Iran, Iraq, Afghanistan, China, and other countries), North and South America, and Europe (Spain, the Balkans). In the USSR, it occurs in Kazakhstan, the Middle Asian republics, Transcaucasia, and southern Ukraine. Under natural conditions rodents (for example, mice, rats, hamsters, and jerboas) suffer from relapsing fever. The disease develops in human beings bitten by infected ticks. Once these insects are infected they remain capable of transmitting the disease to healthy persons throughout their lives. The disease occurs more often in the spring and summer in persons newly arrived in the locality of a natural seat of relapsing fever (expeditions, military units, and the like). The infection produces stable immunity. The course of endemic relapsing fever is similar to that of the epidemic form but is milder and characterized by numerous and irregular attacks. Treatment must be administered in a hospital. Prevention includes eradication of ticks in their habitats (disinsectization) and protection against their bites.

REFERENCES

Gromashevskii, L. V., and G. M. Vaindrakh. Vozvratnyi tif. Moscow, 1946.
Favorova, L. A., and E. A. Gal’perin. “Vozvratnyi tif epidemicheskii.” In Mnogotomnoe rukovodstvo po mikrobiologii, klinike i epidemiologii infektsionnykh boleznei, vol. 7. Moscow, 1966. (Bibliography.)
Pavlovskii, E. N. “Kleshchevoi vozvratnyi tif.” In ibid. (Bibliography.)

K. V. BUNIN

References in periodicals archive ?
This domain may also be useful for detection of other relapsing fever Borrelia spp.
Tickborne relapsing fever diagnosis obscured by malaria, Togo.
Molecular characterization of tickborne relapsing fever Borrelia, Israel.
Phylogenetic analysis of the spirochetes Borrelia parkeri and Borrelia turcatae and the potential for tick-borne relapsing fever in Florida.
Compatible clinical disease descriptions have been documented since the time of Hippocrates; however, the term relapsing fever was first used by David Craigie to describe an outbreak of the disease in Edinburgh in 1843 (1).
During the first half of the 20th century, relapsing fever was a disease of major worldwide importance; it caused epidemics affecting [approximately equal to] 50 million and was associated with death rates of 10% to 40% (1).
Relapsing fever can be acquired by travelers and brought back to regions where the disease is not epidemic (10,11) after eco-challenges or in association with military training or activities such as camping or caving, provided susceptible hosts and natural disease ecologic cycles coincide (8,9).
His research interests include the study of relapsing fever in urban Senegal.
1%) sustained the highest frequency of relapsing fever (Fig.
Tick-borne relapsing fever spirochetes were detected in Wright-stained blood smears from 97 patients.
An overview of tick-borne relapsing fever with emphasis on outbreaks in Texas.
Outbreak of tickborne relapsing fever in Spokane County, Washington.