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- Epidemic, louse-borne relapsing fever (LBRF): person-person transmission of Borrelial species such as B. recurrentis (like typhus) by human body louse (Pediculus humanus).
- Worldwide infection (ex. S’ Pacific)
- B. recurrentis only causes epidemic louse-borne RF.
- Spirochete, helical 5-40µm long with 3-10 spirals (see Figure).
- Sporadic endemic, tick-borne relapsing fever (TBRF): tick-borne (Ornithodoros soft ticks), reservoirs include rodents and small animals.
- >15 Borrelia spp. cause endemic tick-borne RF.
- TBRF vectors and Borrelia spp.:
- In North America, essentially all cases of TBRF have been associated w/ 2 spp. of ticks: O. hermsii and O. turicatae.
- The three main agents of TBRF in U.S. are B. hermsii, B. parkeri, and B. turicatae.
- Microscopic inspection cannot distinguish bacterial spp. B. hermsii can be identified by monoclonal antibody, and most Borrelia spp. can be sorted by PCR analysis using genome species-specific markers though neither of these are routinely available in most commercial laboratories.
- Borrelia duttoni, transmitted by the Ornithodoros moubata tick vectors is a cause of TBRF in Tanzania and other parts of Africa. It tends to be more severe than usual TBRF.
- Borrelia miyamotoi: recently described human pathogen that is tick-transmitted (Ixodes) and may cause febrile illness and meningoencephalitis.
- May cause febrile illness of nonspecific nature, but report from Russia described some with erythema migrans, but unclear if due to Lyme disease co-infection (with B. burgdorferisensu stricto).
- Easily confused with HGA, HME or acute Lyme disease without a rash.
- Cases seen in Europe and U.S.
- Same distribution as Lyme disease as appears spread in U.S. by Ixodes scapularis.
- Descriptions in New England, mid-Atlantic and upper Midwest states
- Subclinical infections likely as up to 5-10% seropositive in some New England communities.
- Borrelia mayonii (candidate name, 2016): member of B. burgdorferi sensu latu that has high spirochetemic load in blood. Found in Ixodes ticks.
- Six pts described to date.
- Febrile illness that may be severe enough to prompt hospitalization
- Rash: ranges from erythema migrans-like to diffuse maculopapular
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