Relapsing Fever

Question 1

Where do you find louse borne relapsing fever?

Answer 1

Northeast Africa

Question 2

What is the vector for LBRF?

Answer 2

Pediculus humanus corporis

Question 3

What causes LBRF?

Answer 3

Borrelia recurrentis

Question 4

What are the clinical features of LBRF?

Answer 4

Fever, arthralgia, headache
Bleeding
Jaundice and hepatosplenomegaly
Abortion

Question 5

What causes TBRF?

Answer 5

Over 20 different species of Borrelia

Question 6

What is the vector for TBRF?

Answer 6

Soft ticks

Ornithodoros species

Question 7

Where is TBRF found?

Answer 7

Tropical and temperate climates

Question 8

What are th features of TBRF?

Answer 8

Milder than LBRF
Fever, epistaxis, cough
Splenomegaly 
Transient Neuro problems
Miscarriage

Question 9

How do you diagnose relapsing fever?

Answer 9

Spirochetes seen in blood film (LBRF>TBRF)

PCR

Question 10

How do you treat relapsing fever?

Answer 10

Doxycycline
Single dose in LBRF
10days in TBRF

Question 11

What is a Jarisch-Herxheimer reaction and when do they happen?

Answer 11

Acute inflammatory exacerbation post Tx of spirochetes. Most frequent in LBRF.
Hours after Tx become restless, pyrexic with rigours, delirious and D+V.
Then flush phase with sweating and vasodilation-> hypovolaemic sock or pulmonary oedema from myocarditis

Question 12

How do you treat Jarisch-Herxheimer reactions?

Answer 12

Physical cooling
IV fluids
Nurse in bed for 48hrs
For myocarditis and pulmonary oedema: IV digoxin