Relapsing Fever like

Causative Agent

Borrelia miyamotoi

Type of Organism

Spirochete Bacterial Species

Length of Attachment for Transmission

18-24 Hours

Initial Symptoms

• Symptoms will typically start within 2 weeks of transmission.
• Infected individuals will experience 3-5 days of symptoms followed by 1-2 weeks of wellness. The symptoms will then reappear and last for another 3-5 days. If untreated, this cycle of relapsing symptoms could occur up to 10 times over several weeks or months.
• Symptoms include:
• Chills, sweats, headache, dizziness, fatigue, nausea, vomiting, and fever.
• Joint and muscle pain.
• Disorientation, loss of memory, and lack of coordination.
• Severe symptoms may result if the disease is left untreated including the development of central nervous system symptoms such as meningoencephalitis.
• Low platelet count and kidney dysfunction can also occur.

Diagnosis and Testing

• Antibodies specific for Borrelia miyamotoi have been detected as early as 1 week after exposure using a nonspecific ELISA test.
• In addition to the ELISA test, a Western blot assay may be used to confirm results.
• Visualization of a thin or thick blood smear under a microscope may be utilized during the active period of symptoms.
• Polymerase Chain Reaction may also assist in diagnosis by detecting the presence of Borrelia miyamotoi DNA in serum.

CDC Treatment Recommendation

• Adults: Doxycycline 100mg- 2x daily, Cefuroxime axetil 500mg- 2x daily, or Amoxicillin 500mg- 3x daily for 10-21 days.
• Children: Doxycycline 4mg/kg divided into 2 doses daily, Cefuroxime axetil 30mg/kg divided into 2 doses daily, or Amoxicillin 50mg/kg divided into 2 doses daily for 10-21 days

Disease Pathogenesis

Once the pathogen enters the hosts blood stream, it travels throughout the body affecting multiple organs. The immune system will create antibodies against the surface of the pathogen reducing symptoms temporarily. Any remaining pathogens not destroyed by the immune system will change their surface structures so the immune system doesn’t recognize and/or respond. This gives the bacteria time to replicate and spread. Symptoms will appear again and the immune system will have to create new antibodies against the pathogen. Symptoms will appear again and the immune system will have to create new antibodies against the pathogen. The symptoms will be reduced and if any pathogens remain, they will change their surface structure and the immune system no longer recognizes or reponds. This cycle continues until the patient is treated with antibiotics.