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Epidemic Relapsing Fever

Similar to epidemic typhus fever, epidemic relapsing fever has the potential to cause serious disease in large numbers of people under certain conditions that contribute to heavy infestations of body lice. For example, an epidemic in eastern Europe from 1919-1923 resulted in an estimated 13 million cases and 5 million deaths. During and immediately after World War II, more than a million persons were infected in Europe . Today, outbreaks of epidemic relapsing fever are limited primarily to Ethiopia, where 1000-5000 cases are reported yearly, but the disease has the potential to re-emerge among refugees during and following war and natural disasters.

Causative agent

  • A bacterium, specifically a spirochete with the scientific name Borrelia recurrentis.
  • It is a large, mobile bacterium that spreads into various parts of the body.

Geographical distribution of cases

  • Formerly temperate regions, but now limited to high elevations in the tropics, primarily Ethiopia.
  • NOTE: This disease does not occur in the U.S.

Symptoms of infection

  • Fever, dizziness, head and muscle ache, coughing, and vomiting.
  • Episodes (a total of 2-5) of fever lasting several days followed by several days without fever.
  • Severe disease includes liver and spleen enlargement and breathing difficulties.

Reservoir of Borrelia recurrentis

  • Humans are the only known reservoir.

Vectors of Borrelia recurrentis

  • The human body louse Pediculus humanus.

Mode of transmission

  • Via body fluids of crushed, infected body lice that are scratched into the skin.
  • NOTE: Spirochetes also may be able to penetrate intact human skin.

Diagnosis of infection

  • Symptoms together with infestation by human body lice.
  • Laboratory tests that detect antibodies to Borrelia recurrentis in a patient's blood.

Treatment of infection

  • An antibiotic prescribed by a physician.

Prevention of infection

  • There is no vaccine available.
  • Avoid human body louse infestations.
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