Relapsing fever

What it is

From: Orphanet

An infectious disease, rare in Europe, characterized by relapsing fever accompanied by headaches, vomiting and myalgia lasting 2-7 days, with afebrile intervals of up to 10 days. It is caused by bacterial species of the genus Borrelia, and transmitted by ticks (tick-borne relapsing fever; TBRF) and lice (louse-borne relapsing fever; LBRF).

Reported clinical features and what the terms mean

The following findings are associated with this condition in Orphanet. They are not a checklist for diagnosing yourself, and they do not all occur in every affected person. Some are examination, imaging or laboratory findings that cannot be recognised at home.

The frequency labels describe how often a finding was reported among people with the condition in the source. They do not give the chance that a person with that symptom has the condition. Definitions below reproduce HPO terminology; they explain the term, not the likely severity in an individual.

Elevated circulating C-reactive protein concentration · Very frequent (99-80%)

The concentration of C-reactive protein in the blood circulation is above the upper limit of normal.

Fever · Very frequent (99-80%)

Body temperature elevated above the normal range.

Increased total bilirubin · Very frequent (99-80%)

Increased concentration of total (conjugated and unconjugated) bilirubin in the blood.

Thrombocytopenia · Very frequent (99-80%)

A reduction in the number of circulating thrombocytes.

Anemia · Frequent (79-30%)

A reduction in erythrocytes volume or hemoglobin concentration.

Elevated circulating hepatic transaminase concentration · Frequent (79-30%)

Elevations of the levels of SGOT and SGPT in the serum. SGOT (serum glutamic oxaloacetic transaminase) and SGPT (serum glutamic pyruvic transaminase) are transaminases primarily found in the liver and heart and are released into the bloodstream as the result of liver or heart damage. SGOT and SGPT are used clinically mainly as markers of liver damage.

Headache · Frequent (79-30%)

Cephalgia, or pain sensed in various parts of the head, not confined to the area of distribution of any nerve.

Increased circulating lactate dehydrogenase concentration · Frequent (79-30%)

An elevated level of the enzyme lactate dehydrogenase in the blood circulation.

Increased total leukocyte count · Frequent (79-30%)

An abnormal increase in the number of leukocytes in the blood.

Jaundice · Frequent (79-30%)

Yellow pigmentation of the skin due to bilirubin, which in turn is the result of increased bilirubin concentration in the bloodstream.

Myalgia · Frequent (79-30%)

Pain in muscle.

Abdominal pain · Occasional (29-5%)

An unpleasant sensation characterized by physical discomfort (such as pricking, throbbing, or aching) and perceived to originate in the abdomen.

Abnormal bleeding · Occasional (29-5%)

An abnormal susceptibility to bleeding, often referred to as a bleeding diathesis. A bleeding diathesis may be related to vascular, platelet and coagulation defects.

Abnormality of the urinary system · Occasional (29-5%)

An abnormality of the urinary system.

Other findings in the same source

From: Orphanet

Additional reported features include Acute kidney injury (Occasional (29-5%)); Arthralgia (Occasional (29-5%)); Chills (Occasional (29-5%)); Cough (Occasional (29-5%)); Elevated circulating creatinine concentration (Occasional (29-5%)); Fatigue (Occasional (29-5%)); Hypotension (Occasional (29-5%)); Leukopenia (Occasional (29-5%)); Nuchal rigidity (Occasional (29-5%)); Tachycardia (Occasional (29-5%)). This is a selected summary, not a complete description of the condition.

When it may begin

From: Orphanet

All ages

Inheritance in the source

From: Orphanet

Not applicable

Which doctor should you see?

The suggested department for discussing Relapsing fever is Infectious Diseases, with a general physician / infectious disease specialist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Which exposure or organism is suspected, and what evidence would confirm it?
• Are precautions, vaccination or advice for close contacts relevant to this infection?
• What should happen if symptoms worsen or do not improve as expected?

Treatment discussions and follow-up

The material gathered for this draft does not provide a complete condition-specific treatment pathway for Relapsing fever. That gap does not mean that treatment is unavailable. A clinician needs to establish the diagnosis and review current guidance before recommending medicines, procedures, rehabilitation or other support.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.