RELAPSING FEVER

Microbiology:-

Borrelia recurrentis causes louse-borne relapsing fever (LBRF) and is transmitted from person to person by the body louse. In this disease, spirochetes are introduced when the louse is crushed (e.g., by scratching) and the insect’s infected hemolymph contaminates the skin. Tick-borne relapsing fever (TBRF), a zoonosis usually transmitted via the bite of various Ornithodoros ticks, is caused by multiple Borrelia species.

Epidemiology TBRF is endemic in the western United States, southern British Columbia, the plateau regions of Mexico, Central and South America, the Mediterranean, Central Asia, and much of Africa. Only 13 counties have accounted for ~50% of all U.S. cases. Little is known about the epidemiology of LBRF, but it is well described in East Africa.

CLINICAL MANIFESTATION:-

Symptoms are similar, although not identical, in the two types of relapsing fever.

• In addition to fever, pts commonly develop headaches, myalgias, chills, nausea/vomiting, and arthralgias.

– Jaundice; CNS involvement; petechiae on the trunk, extremities, and mucous membranes; epistaxis; and blood-tinged sputum are more likely in LBRF.

– Neurologic findings (e.g., meningitis, focal deficits, paralysis, altered sensorium) may occur in 10–30% of cases and are more common in LBRF.

• For TBRF and LBRF, the mean incubation periods are 7 and 8 days, respectively; the average durations of the first episode are 3 and 5.5 days, respectively; and the average times between the first episode and the first relapse are 7 and 9 days, respectively. Relapsing febrile episodes are typically of shorter duration than the first episode.

DIAGNOSIS: -

Laboratory confirmation is made by the detection or isolation of spirochetes from blood during a febrile episode. Microscopic examination of Wright- or Giemsa stained thick or thin blood smears or buffy coat analysis is most common.

• PCR techniques offer greater sensitivity but are limited to research settings.
• Serologic confirmation of TBRF is possible but is hampered by lack of standardization. An ELISA or an indirect fluorescent antibody assay can be performed; if positive, the results of these tests are confirmed with an immunoblot.

HOMEOPATHIC MANAGEMENT: -

The medicines that can be thought of use are:-

• Aconite
• Apis mel
• Belladonna
• Bryonia
• Ferrum phos
• Gelsemium