The document discusses borreliosis, including Lyme disease and relapsing fever, detailing their definitions, epidemiology, transmission methods, pathogenesis, clinical presentations, diagnosis, and management strategies. Lyme disease, caused by Borrelia species transmitted by ticks, shows three stages, while relapsing fever can be transmitted by lice and ticks with distinct treatment protocols. Effective treatment for both conditions significantly improves prognosis, but relapsing fever, particularly louse-borne types, presents a higher mortality risk if left untreated.

1. BORRELIOSIS (LYME DISEAE) AND
RELAPSING FEVER
PRESENTOR: AKELLO MODESTUS FAITH
2021-08-07165
SUPERVISOR: DR. ABSHIR

2. OUTLINE
• Definition
• Epidemiology
• Transmission
• Pathogenesis
• Clinical presentation
• Diagnosis
• Management

3. LYME DISEASE.
• Lyme disease is a tick-borne disease caused by
species of Borrelia bacteria, transmitted to
humans by an infected blood-feeding ticks of
the genus Ixodes.
• 1977- first recognized clinically by Dr. Allen Steere
• 1980s- identification of Borrelia spirochete and tick
vector by Dr. Willy Burgdorfer

4. Borrelia species associated with
lyme disease include;
•B.burgdoferi most common
•B.garinii
•B.mayonii
•B.afzelii
•B.spielmanii
•B.valaisiana

5. Borrelia spp associated with relapsing fever
include
• B.recurrentis (most common)
• B.duttonii
• B.hermsii
• B.parkeri
• B.turicatae

6. EPIDEMIOLOGY.
• For some unknown reason, Lyme disease is
commonly reported in the Caucasians but can
infect all races.
• It affects people of all ages.
• Appears to be slightly more common in
females.
• B. burgdoferi is distributed in USA, Russia,
Europe, Japan, Australia and china.

7. • B. afzelli and B. garinii are additionally found in
Europe and Asia.
NOTE;
Borrelia spp are large motile spirochete with
irregular wide open coils.
Gram negative and stained with Giemsa stain.
B. recurrentis- relapsing fever
B burgdorferi – lyme disease

8. TRANSMISSION.
• Lyme disease is spread by primarily 4 Ixodes
species worldwide;
I. scapularis (the deer tick) in the north US
I. pacificus in the western US
I. ricinus in Europe
I. persulcatus in Asia

9. PATHOGENESIS.
• The bacteria enter the skin at the site of the tick
bite. After 3-32 days, the bacteria migrate
locally in the skin around the bite causing
inflammation at the site characterized by
erythema migrans.
• They then spread via lymphatics causing
regional lymphadenopathy.

10. Pathogenesis cont.
• Or disseminate in blood causing bacteremia
and affects other organs.
Significant antibody response to infection
occurs at this stage due to activation of the
immune system

12. CLINICAL PRESENTATION.
• There are 3 stages of the disease. Progression
may be arrested at any stage.
EARLY LOCALIZED DISEASE.(lasts days to
months)
Main feature is a skin reaction around the site of
bite, known as erythema migrans , occurs in 80%
of all cases.
Initially, a red “bull’s eye” rash appears 2-30 days
post bite and it centrally enlarges

13. • Additionally the EM rash may also be
accompanied by non specific symptoms like
fatigue, myalgia, malaise, fever, headache,
rash and regional lymphadenopathy.

14. EARLY DISSEMINATED DISEASE.
• Progression to this stage occurs in untreated
individuals weeks to months following the
initial tick bite.
Complications during this stage include;
• Neurological involvement: it classically
presents with the triad of
 lymphocytic meningitis
cranial nerve palsies
peripheral neuropathy.

15. • Radiculopathy which is often painful may
present a year or more after initial infection
• Carditis sometimes accompanied by
atrioventricular conduction defects may occur
Lyme disease is one of the most common
cause of second degree heart block.
LATE DISEASE
• Occurs months to years post bite
• Arthritis (affecting long bones), polyneuritis
and encephalopathy causing neuropsychiatric
abnormalities

16. • Acrodermatitis chronica atrophicans is a rare
late complication characterized by doughy,
patchy discoloration on the peripheries that
later leads to shiny atrophic skin.

17. DIAGNOSIS.
Diagnosis is clinical but the following investigations
can be done:
• Culture from biopsy is rarely available, has low yield
and may take over 6 weeks.
• Antibody detection is frequently negative in early
course.
• Immunoblot (western blot) techniques are more
specific and should be used.
• ELIZA used to confirm the diagnosis.
• PCR for detection of microorganisms DNA in blood,
CSF and biopsies from skin and synovium.

18. MANAGEMENT.
• Asymptomatic patients with positive antibody
tests do not require treatment. However,
erythema migrans always requires therapy even
when the skin lesions resolve.
• Standard therapy is a 14-day course of
doxycycline (200mg daily) or amoxicillin
(500mg 3 times daily).

19. 2nd
line drugs
• Azithromycin 500mg for 5-10 days.
• Cefuroxime 500mg BD for 14 days.
• Cephalosporins can be used in severe disease.
Prognosis.
good outcome with treatment
Poor outcome as disease disseminates
Doxycycline is enough for the erythema
migrans.

20. RELAPSING FEVER.
Definition: Relapsing fever is a vector-borne disease
caused by bacteria Borrelia recurrentis
• Transmitted through the bites of lice, soft-bodied
ticks (genus Ornithodoros), or hard-bodied ticks
(Genus Ixodes).
Types of relapsing fever include:
Louse- borne relapsing fever
Tick borne relapsing fever

21. TRANSMISSION
Louse-borne relapsing fever.
• Louse –borne relapsing fever is spread from
person to person when the louse takes a
spirochete blood meal from an infected person.
• They then multiply in the lice body but are not
present in saliva
• Through human body louse (pediculus humanus),
B. recurrentis are released from the infected lice
thus inoculating Borreliae into the skin.

22. • The borreliea multiply rapidly in the blood during
febrile phases and invade most tissues especially
the liver, spleen and meninges.
EPIDEMIOLOGY: the disease occurs worldwide with
epidemics seen in Central, East and South Africa.
CLINICAL FEATURES
• Sudden onset of fever
• Temperature(39.5-40.5C)
• Headache
• Herpes labialis, generalised body aching and
• Injected conjunctivae.

23. • Thrombocytopenia associated with petichea rash
and epistasis.
In advanced disease:
• Tender hepatosplenomegaly, jaundice and elevated
transaminases
• Serosal and intestinal heamorrhages
• Delirium and menigism
The fever ends between 4th
and 10th
day associated
with profuse sweating, hypotension and cardiac
failure.
With out treatment the mortality rate is 40%especially
in malnourished and older patients.

24. Investigation and management.
• Do a ground microscopy of a wet film.
TREATMENT:
IM procaine penicillin 300mgs the followed by
500mg tetracycline.(effective and prevents
relapse) OR doxycycline 200mgs OD
Free the patients clothings from lice.
Improve patient’s nutrition status
Chloramphenicol and ceftriaxone can also be used

25. Tick- borne relapsing fever.
• Soft tick (Ornithodoros spp.) transmit B. duttoni
through saliva while feeding on their hosts.
• The spirochete pass into the ovary of the tick and
its off springs are automatically infected(vertical
transmission) and so is infectious for life.
• Rodents are the reservoirs except in East Africa
where the humans are the reservoirs.
People living in mud houses are at high risk.
Once a house has been infested, remains a danger for
many years if no intervention

26. Similar clinical manifestations to those of the
louse borne disease.
THOUGH a dark film microscopy may not detect
the micro organism in most patients.
TREATMENT
• A 7- day course Treatment with tetracycline
500mgs qid OR
• Erythromycin 500mgs qid

27. Jarisch-Herxheimer Reaction(JHR)
• Some deaths occur after starting treatment as a
result of Jarisch-Herxheimer reaction.
• Common in all spirochete infections.
• JHR results when the antibiotics suddenly kill a large
number of spirochetes which release toxins into the
blood causing the patient to collapse.(common with
large doses of broad spectrum antibiotics).
• JHR is characterized by a fall in blood pressures,
chills and rapid breathing.
• Patient must be nursed, given adequate fluids and
bed rest for at least 24hrs.

28. • To prevent JHR, use prednisolone 10-20mgs TDS
for 3 days then start treatment 24hrs later.
Prognosis: with antibiotic treatment, the mortality
rate decreases from (10%-40% to 2%-4%). Lower
rates in tick –borne than louse-borne relapsing
fever.
Differential diagnosis. (all infectious diseases)
• Malaria
• Leptospirosis
• Yellow fever
• Brucellosis
• Ehrilichiosis

29. References.
• Davidsons-principles-and-practice-of-
medicine-2022-pgs 304, 305.
• https://www.ncbi.nlm.gov/books
• Geneva E Guarin, MD, MBA Resident
physician, I MED, Einstein Medical Center
Philadelphia. (med scape)