[Tick-borne relapsing fever in a rural area of southern Spain]

Abstract

Introduction: Tick-borne relapsing fever (TBRF) is a zoonotic disease caused by spirochetes of the genus Borrelia. This disease is underdiagnosed in our area due to a low index of suspicion among clinicians, as well as its difficult diagnosis. This study aims to present our experience in the diagnosis and therapeutic management of TBRF and a literature review.

Methods: A retrospective medical chart review was carried out on children diagnosed of TBRF from 2002 to 2012 in our hospital, and included clinical, epidemiological, microbiological, treatment, and outcome data.

Results: Nine children with TBRF were identified. Median age was 11 years. All cases occurred during warm months. The most frequent presenting clinical findings were fever, chills, headache, vomiting, myalgia and abdominal pain. Meningeal involvement was identified in 2 cases. In the case of 2 patients, Borrelia infection was identified in several relatives at the time of diagnosis. Mean C-protein reactive was 187 mg/L, and low platelet counts were observed in 56% of the cases. Borreliaspp. was visualized in peripheral blood smears in 67% of cases. All of the patients received antibiotic treatment. Doxycycline was used in children older than 8 years and erythromycin and penicillin in the younger ones. Jarisch-Herxheiner reaction occurred in one patient. All cases resolved without sequelae.

Conclusions: We emphasize the importance of maintaining a high level of suspicion in endemic regions of TBRF. Early diagnosis and a correct therapy can prevent the appearance of subsequent fever recurrences and potential complications.

Keywords: Borrelia; Fiebre recurrente; Garrapata; Relapsing fever; Tick borne.