Abstract
Tick-borne relapsing fever (TBRF) is an infection caused by Borrelia spirochetes. In North America, Borrelia hermsii is the most common cause for TBRF. This vector-borne disease is transmitted by Ornithodoros hermsi, a soft-bodied tick found in high altitudes in northwestern United States and southwestern Canada. Once bitten by the tick and infected by B. hermsii, episodes of fever alternating with afebrile periods can occur. A case of TBRF in a pregnant host was complicated by Jarisch-Herxheimer reaction requiring critical care. This case emphasizes the importance of maintaining a high index of suspicion in TBRF. Clinician recognition, diagnosis and treatment of TBRF as well as public awareness of strategies to prevent tick bites should be strengthened.
Highlights
AffiliationsTick-borne relapsing fever (TBRF) can be challenging to diagnose because of difficulties in isolating the causative bacterium, Borrelia hermsii, in the laboratory
B. hermsii is a spirochete implicated in TBRF
TBRF is transmitted via the night-biting soft tick Ornithodoros hermsi [2]
Summary
Tick-borne relapsing fever (TBRF) can be challenging to diagnose because of difficulties in isolating the causative bacterium, Borrelia hermsii, in the laboratory. There was no exposure history consistent with rat bite fever, leptospirosis or louse-borne relapsing fever She reported multiple unknown insect bites across her torso, but no rash, during her holiday. On presentation, she was febrile (temperature 38.9°C), hypotensive (blood pressure 85/52) and tachycardic (heart rate 128 beats/minute). Two hours after penicillin initiation, the patient developed chills and worsened hypotension (blood pressure 70/50) despite administration of 6 L of crystalloid resuscitation. This is characteristic of a Jarisch-Herxheimer reaction. The patient was subsequently transferred to the intensive care unit for closer monitoring Her hypotension resolved within one day, and pancytopenia improved within the week.
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