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Louse-borne relapsing fever
🧾 About
- The human body louse Pediculus humanus transmits Borrelia recurrentis.
- Spread is by contamination of skin with crushed infected lice → bacteria enter through bites or abrasions.
- Causes epidemic louse-borne relapsing fever, historically associated with war, famine, and poverty.
🦠 Aetiology
- Borrelia recurrentis (spirochete bacterium).
- Liberated from infected lice 🪳 and inoculated into the skin during scratching.
🩺 Clinical Features
- Incubation: 5–15 days.
- Febrile illness: sudden onset of high fever 🌡️, chills, tachycardia.
- Neurological: headache, meningitis-like symptoms.
- Abdominal: hepatosplenomegaly, jaundice.
- Haematological: thrombocytopenia → petechiae, epistaxis, serosal haemorrhage.
- Fever lasts 4–10 days, then subsides. ⚠️ Relapse may occur due to antigenic variation of Borrelia.
- Complications: myocarditis, pneumonia, meningoencephalitis.
🔬 Investigations
- FBC: thrombocytopenia, anaemia, raised inflammatory markers.
- Microscopy: Thick and thin blood films or dark-field microscopy → spirochetes visible during febrile episodes.
- Serology/PCR: confirmation (if available).
💊 Management
- First-line: Doxycycline 100 mg PO BD for 7–10 days.
- Alternative: Procaine penicillin (IM) or Tetracycline if doxycycline unsuitable.
- Jarisch–Herxheimer reaction: common (acute fever, rigors, hypotension within hours of treatment) → supportive management with fluids, antipyretics, and close monitoring.
- Supportive care: fluids, oxygen, monitoring for bleeding and neurological complications.
⚠️ Public Health
- Louse control (improved hygiene, insecticides) is critical for prevention.
- Relapsing fever is associated with refugee camps, war zones, and areas of poor sanitation.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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