Cases reported "Relapsing Fever"

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1/15. Tick-borne relapsing fever imported from West africa: diagnosis by quantitative buffy coat analysis and in vitro culture of borrelia crocidurae.

    West African tick-borne relapsing fever (TBRF) is difficult to diagnose due to the low number of spirochetes in the bloodstream of patients. Previously, the causative microorganism, borrelia crocidurae, had never been cultured in vitro. TBRF was rapidly diagnosed for two patients returning from western africa with fever of unknown origin by quantitative buffy coat (QBC) analysis. diagnosis was confirmed by intraperitoneal inoculation of blood specimens from patients into laboratory mice. in vitro experiments showed that QBC analysis may be as much as 100-fold more sensitive than thick smear. Spirochetes were also cultured from blood samples from both patients in modified Kelly's medium and were identified as B. crocidurae by partial sequencing of the PCR-amplified rrs gene.
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2/15. Short report: diagnosis of tick-borne relapsing fever by the quantitative buffy coat fluorescence method.

    The quantitative buffy coat (QBC) parasite detection method is a sensitive and specific tool for the diagnosis of malaria parasites. It is also useful for the diagnoses of other hemoparasites, including trypanosoma, babesia, and leptospira. We report a case of relapsing fever diagnosed by this technique in a short-term traveler from senegal. The diagnosis was confirmed by the standard Giemsa hemoscopy and by the identification of significant titers of antibodies to borrelia spp. of tick-borne relapsing fevers by specific immunofluorescence and Western blot tests. The QBC technique seems to be useful in the diagnosis of tick-borne relapsing fever in blood samples and should be included in the management of fever in the traveler returning from tropical regions.
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3/15. Jarisch-Herxheimer reaction associated with ciprofloxacin administration for tick-borne relapsing fever.

    A 14-year-old girl was seen at a community clinic with a chief complaint of abdominal pain and fevers and was treated with oral ciprofloxacin for presumed pyelonephritis. She became tachycardic and hypotensive after her first dose of antibiotic, and she developed disseminated intravascular coagulation. She was admitted to our hospital for presumed sepsis. Her outpatient peripheral blood smear was reviewed, revealing spirochetes consistent with borrelia sp. To our knowledge this is the first reported case of the Jarisch-Herxheimer reaction to ciprofloxacin.
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4/15. Tick-borne relapsing fever.

    Tick-borne relapsing fever is characterized by recurring fevers separated by afebrile periods and is accompanied by nonspecific constitutional symptoms. It occurs after a patient has been bitten by a tick infected with a borrelia spirochete. The diagnosis of tick-borne relapsing fever requires an accurate characterization of the fever and a thorough medical, social, and travel history of the patient. Findings on physical examination are variable; abdominal pain, vomiting, and altered sensorium are the most common symptoms. Laboratory confirmation of tick-borne relapsing fever is made by detection of spirochetes in thin or thick blood smears obtained during a febrile episode. Treatment with a tetracycline or macrolide antibiotic is effective, and antibiotic resistance is rare. patients treated for tick-borne relapsing fever should be monitored closely for Jarisch-Herxheimer reactions. Fatalities from tick-borne relapsing fever are rare in treated patients, as are subsequent Jarisch-Herxheimer reactions. persons in endemic regions should avoid rodent- and tick-infested areas and use insect repellents and protective clothing to prevent tick bites.
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5/15. relapsing fever associated with ARDS in a parturient woman. A case report and review of the literature.

    We report a patient who survived acute respiratory failure associated with tick-borne relapsing fever in the third trimester of pregnancy. The fetus was delivered by cesarian section and did not have spirochetemia. The severity of the patient's illness may be related to the immunosuppressive effects of pregnancy.
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6/15. Can protracted relapsing fever resemble lyme disease?

    We report the case of a Protestant missionary who contracted tick-borne relapsing fever in 1979 while serving in the sudan. Despite tetracycline treatment, his acute illness ran a protracted course, with migratory polyarthralgias lasting approximately 10 months. Symptoms recurred in 1984 and have persisted. At regular intervals, the patient has experienced recurrent episodes of fever, generalized fatigue, bilateral upper and lower extremity muscle weakness, and asymetric large joint polyarthralgia. Indirect fluorescent antibody testing of sera demonstrated titers of 1:16 for B. burgdorferi and 1:64 for B. hermsii, and immunoblotting confirmed past exposure to relapsing fever, but not lyme disease. It is hypothesized that this individual's chronic symptoms have been related to relapsing fever, and that in certain situations or in select individuals, relapsing fever can be capable of producing a chronic clinical picture analogous to lyme disease.
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7/15. Tick-borne relapsing fever in a premature infant.

    relapsing fever is caused by the borrelia species of spirochetes. Louse-born epidemics of the disease may occur but the endemic disease is usually transmitted to humans by the bite of an infected tick (Ornithodorus). Transplacental infection was suggested more than 75 years ago (1) but has been rarely documented (2). We describe a case of neonatal relapsing fever where maternal infection was the probable cause of the premature delivery and infection in the infant.
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8/15. relapsing fever (borrelia) in an adolescent tourist in israel.

    A case of an adolescent tourist who contracted relapsing fever (borrelia) in israel is presented. travel in an infested area, a fever of irregular nature, and a strong history of tick bites are clues to diagnosis.
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9/15. Tick-borne relapsing fever in colorado. Historical review and report of cases.

    Since 1915 the front range of the colorado Rocky Mountains has been postulated as a focus of endemic tick-borne relapsing fever. However, the disease has rarely been identified: only two cases have been reported in colorado since 1944. Three sporadic cases in 1977--tightly grouped geographically and temporally--prompted an epidemiologic review. Tick-borne relapsing fever should be considered in the differential diagnosis of recurrent paroxysmal fever--with or without known presence of ticks--whenever exposure in an endemic area is part of a patient's history.
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10/15. The spectrum of relapsing fever in the Rocky Mountains.

    Between 1940 and 1976, two cases of tick-borne relapsing fever were reported in colorado, but since 1977, 23 confirmed cases have occurred. All patients had fever, with a mean of 2.8 febrile episodes (range, one to six). Complications included thrombocytopenia, endophthalmitis, meningitis, abortion, in utero infection, and erythema multiforme. All treated patients were eventually cured with antibiotics, although two pregnant patients failed to be cured by their initial courses of antibiotics. Seven of 21 treated patients had Jarisch-Herxheimer reactions, three of whom required intensive care. Five of nine patients who received tetracycline at an initial dose of 5 mg/kg or more had reactions v none of four patients treated with lower doses. Possible causes of the recent increased incidence include increased physician awareness and reporting, improved diagnostic techniques, and an actual increase due to a larger population at risk. Because summertime visits to the Rocky Mountains are becoming increasingly popular, physicians elsewhere should know how to recognize and treat this condition.
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