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BORRELIOSIS RELAPSING FEVER

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Pediculus humanus corporus; P h capitus (body; head louse) Species (host) specific ... Vector biology: lice ... 12% of lice feeding on patient become infected ... – PowerPoint PPT presentation

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Title: BORRELIOSIS RELAPSING FEVER


1
BORRELIOSIS (RELAPSING FEVER)
  • Other names
  • febris recurrens
  • tick-borne/louse-borne relapsing fever
  • spirillum fever
  • vagabond fever
  • fowl nest fever (China)
  • gharib gez (Iran)
  • carapata (Africa)
  • kimputu/gorgoya (South America)

2
BORRELIOSIS
  • Rare in US, but many cases unreported or
    misdiagnosed
  • Occurs throughout world numerous deaths in Asia,
    Africa, Central and South America

3
BORRELIOSIS
4
BORRELIOSIS
  • Tick-borne
  • Ornithodoros spp (soft-bodied tick)
  • O. parkeri, hermsii, moubata, erraticus
  • feeding characteristics
  • Nocturnal feeders
  • Short feeding period (lt 1 hour) organism passed
    within minutes of attachment
  • ingest Borrelia with blood meal multiply in
    hemocele (celomic cavity) in 5-8 days

5
BORRELIOSIS
  • Vector biology ticks
  • Transovarial transmission
  • Remain infected for life (lifespan 2 yrs)
  • Live in caverns, rodent or owl burrows
  • transmitted by bite or bite wound contamination
    with coxal fluid expelled during engorgement
  • Numerous reservoir hosts (rodents wild and
    domestic animals)

6
BORRELIOSIS
  • Louse-borne
  • Pediculus humanus corporus P h capitus (body
    head louse)
  • Species (host) specific
  • Infest clothing
  • Sensitive to minimal temperature changes (leave
    febrile or dying hosts)
  • No transovarial transmission
  • No animal reservoir

7
BORRELIOSIS
  • Vector biology lice
  • ingest Borrelia with blood meal, multiply in
    hemocele (celomic cavity) in 5-8 days
  • 12 of lice feeding on patient become infected
  • remains infected entire life (3 weeks)
  • transmitted by crushing (organisms released from
    celomic cavity) not by biting or defecation

8
BORRELIOSIS
  • Pediculus humanus corporus

9
BORRELIOSIS
  • Ornithodoros spp.

Adult female
Larva
10
BORRELIOSIS
  • Biology of Borrelia spp.
  • Spirochete, unevenly coiled
  • lt 0.1-0.5 ? x 3-25 ?
  • Variation in appearance and antigenicity with
    subsequent attacks
  • Fibrillar structure and cell body rotate in
    opposite directions

11
BORRELIOSIS
  • Borrelia spp. fibrillar structure

12
BORRELIOSIS
  • Borrelia spp. in smear (acridine orange staining)

13
BORRELIOSIS
  • Epidemiology
  • Distribution
  • Louse-borne
  • US not endemic sporadic imported cases
  • Worldwide ubiquitous, particularly in areas of
    war, poverty, overcrowding
  • Tick-borne
  • U.S. primarily western states from Texas to
    Rocky Mountains to Washington
  • Worldwide Mediterranean (Spain), Middle East,
    Africa
  • Sex males gt females (60)

14
BORRELIOSIS
  • Epidemiology
  • Occurrence
  • Louse-borne
  • US rare, sporadic
  • Worldwide unknown
  • Mortality up to 70 if untreated 1 otherwise
  • Tick-borne
  • U.S. unknown
  • Worldwide unknown
  • Mortality lt10 if untreated

15
BORRELIOSIS
  • Pathogenesis
  • Spirochetemia
  • Reticuloendothelial cells
  • Thrombocytopenia/coagulopathy
  • Relapse

16
BORRELIOSIS
  • Clinical features
  • Incubation period 7 days (3-18)
  • Abrupt onset of symptoms
  • Fever
  • Headache
  • Myalgia, arthralgia
  • Weakness, anorexia
  • Vomiting, nausea associated with hepatic/spleen
    involvement more common with louse-borne
  • Transitory petechial rash may occur

17
BORRELIOSIS
  • Clinical features transitory petechial rash
    (tick bites)

18
BORRELIOSIS
  • Clinical features
  • Relapse
  • Initial febrile response lasts up to 6 days
  • Recurrence of fever in 7-10 days
  • Tend to be less severe
  • Normally fewer episodes with louse-borne
    tick-borne 3-10
  • Entire episode ranges from couple of weeks
    (louse-borne) to longer (tick-borne)

19
BORRELIOSIS
  • Clinical spectrum
  • Clinical illness
  • Improvement
  • recovery
  • Relapse
  • Pathogenesis
  • Clone formation
  • Destroy original
  • organisms
  • Clone replicates

20
BORRELIOSIS
  • Diagnosis
  • Lab findings
  • Anemia and thrombocytopenia
  • WBC normal
  • Elevated liver enzymes
  • Azotemia
  • Definitive diagnosis
  • Wright or Giemsa stain of blood smear to
    visualize spirochetes
  • Xenodiagnosis examination of hemolymph from
    ticks feeding on febrile patient

21
BORRELIOSIS
  • Prevention
  • Rodent control
  • Vector control
  • de-lousing of clothing
  • tick control
  • Vaccine not yet available
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