Relapsing Fever

By | June 8, 2022

Relapsing fever is transmitted by lice or ticks infected with Lyme disease bacteria. The disease can usually be treated well with antibiotics, but there is an obligation to report to the responsible authorities in the event of suspicion and diagnosis.

What is relapsing fever?

Relapsing fever is a bacterial infection caused by Borrelia. While the disease was still widespread around the world in the early 19th century, it is now only found in areas where hygiene conditions are very poor. For everything about cancer, please visit

There are two different types of relapsing fever: tick and lice relapsing fever. The former occurs in Central and South America, Asia and Africa, as well as in Spain and Portugal. The latter mostly occurs in refugee camps or in prisons in Asia, South America and Africa. Overall, the disease is found in tropical and subtropical areas.

Lice relapsing fever is also known as epidemic relapsing fever, tick relapsing fever as endemic. The disease belongs to the Lyme disease group. It was discovered in 1868 by the German doctor Otto Obermeier.


Lice relapsing fever is caused by the bacteria Borrelia recurrentis. They are transmitted to humans via lice. The pathogens can enter the body through small injuries to the skin, such as fine scratches. Injuries that are so small that people do not even notice them are sufficient for the pathogens. Infection from person to person is not possible.

Tick ​​relapsing fever is transmitted through leather tick bites. Here, the pathogens are other Borrelia species, such as Borrelia hermii. The pathogens can also get into the body through a laboratory infection or infected blood transfusions, but this only occurs very rarely.

Once the pathogens have entered, they are distributed throughout the body via the blood and lymphatic system. They can enter different organs, stay there and continue to multiply.

Symptoms, Ailments & Signs

After an infection with Lyme disease pathogens, the typical fever symptoms first appear: an increased body temperature, chills, joint, muscle and headache pains and exhaustion. Jaundice occurs as a result of the enlargement of the liver and spleen. Icterus is expressed by itching, skin changes and an increasing feeling of illness.

The typical feature of relapsing fever is its recurrence. After a strong fever with occasional febrile cramps occurs in the first phase of the disease, there are subsequent episodes of fever that become weaker. In relapsing lice fever, there are usually four attacks of decreasing intensity and duration.

Up to eleven fever attacks are possible in tick relapsing fever. Regardless of the trigger, the first signs of the disease appear three to four days after infection. After 18 days at the latest, the disease reaches its peak. In individual cases, there is a risk of a severe course of the disease with further complications. Then it comes again and again to clouding of consciousness and inflammation of the meninges and heart muscle.

Physically weakened people are at risk of life-threatening organ failure. Externally, relapsing fever cannot be distinguished from a normal fever. However, the symptom picture of increased body temperature, jaundice and impaired consciousness indicates a serious infection that urgently needs to be clarified.

Diagnosis & History

The first indication of relapsing fever is provided by recurring fever episodes lasting three to seven days. A definitive diagnosis is made by examining blood under a microscope. However, the Borrelia can only be seen in the blood during fever attacks.

The fever-free phases become longer after each fever attack, the fever attacks become shorter and lighter. Four fever attacks are normal in relapsing lice fever, and up to eleven recurrences can occur in tick-borne relapsing fever. Accompanying symptoms are headache and body aches, a skin rash the size of a pinhead, chills and jaundice. The spleen and liver also often enlarge. The first symptoms appear about four to 18 days after infection.

Possible complications are clouded consciousness and, in the worst case, inflammation of the meninges, the brain or the heart. Liver failure or multiple organ failures can also be serious complications.


As a rule, relapsing fever can be treated relatively well, so that the complications only arise if the disease is not treated. Those affected suffer from a high fever and the usual symptoms of flu or a cold. This leads to severe pain in the head and also to aching limbs.

As the disease progresses, jaundice may also develop, accompanied by chills. Those affected also suffer from a skin rash due to the disease, which is associated with itching. If the affected person scratches themselves frequently, this can lead to the formation of scars. The liver and spleen also become enlarged in relapsing fever, so there may be pain in these areas. Furthermore, the disease can lead to inflammation of the brain, which can irreversibly damage the brain.

Usually, relapsing fever can be treated easily and without complications. However, the person concerned should be isolated from other people. If the treatment is successful, the life expectancy of the person affected will not be reduced. In severe cases, relapsing fever can also lead to circulatory shock, so that the person concerned has to be hospitalized.

When should you go to the doctor?

Relapsing fever should always be treated by a doctor. There can be serious complications from this condition if the condition is not treated properly. A doctor should be consulted if the person concerned suffers from a very high fever. The usual signs and symptoms of the flu or a cold also appear, which have a very negative impact on the quality of life of the person affected.

It also causes severe itching and, in some cases, jaundice. The liver and spleen can also enlarge from relapsing fever. Those affected may suffer from disturbances of consciousness or even heart problems.

If these symptoms occur, a doctor should be consulted immediately. Relapsing fever can be diagnosed by a general practitioner or in a hospital. In the further treatment, there are usually no complications.

Treatment & Therapy

Both forms of relapsing fever are treated with antibiotics, with tetracycline and doxycycline having proven effective. The medication is taken for about a week. The person affected may become isolated from fellow human beings. If left untreated, relapsing fever can be fatal.

When antibiotics are administered, a so-called Jarisch-Herxheimer reaction can occur. After eliminating many bacteria at once, the organism releases endogenous substances that initiate inflammatory reactions in the body. These so-called “inflammatory mediators” include, for example, histamine and serotonin. Symptoms of a Jarisch-Herxheimer reaction are high fever, nausea, headache, joint and muscle pain and skin rashes, i.e. symptoms that are very similar to those of relapsing fever.

These increased symptoms usually only last a few hours, but they can also last for several days. In particularly severe, rare cases, circulatory shock can occur. In order to prevent this reaction or at least to weaken it, glucocorticoids are administered before administration of the antibiotic, i.e. certain hormones that influence the sugar metabolism in their natural task.


There is currently no vaccine against relapsing fever. As a precaution, areas with low hygiene standards should be avoided, such as unclean hotels. To protect yourself against tick bites, you should wear long-sleeved and long-legged clothing, socks and sturdy shoes. Insect repellent, available as a lotion or spray, is also a good preventive measure. In the distribution areas of relapsing lice fever, the lice species that can transmit the pathogen are combated.


Such an infection is very stressful for the affected patient’s body, especially if antibiotic therapy cannot be initiated immediately. The patient is therefore still convalescent, even if there are no longer any symptoms such as fever or itching. For those affected, this means that they should continue to take it easy during the aftercare period.

The body’s immune system has to be rebuilt. This is best done with extended rest and a healthy, fresh diet that is prepared daily and is high in vitamins, minerals, and fiber. Because eighty percent of all immune cells are located in the intestine, the administration of probiotics can be considered. Appropriate dietary supplements are available without a prescription in pharmacies or drugstores.

They contain living microorganisms (usually lactic acid bacterial cultures) that nest and multiply in the intestine and are intended to ensure a healthy immune system. Sport is almost as important as intestinal care when it comes to building up the immune system. Lots of exercise regulates the metabolism and stimulates the heart, circulation and immune system.

If the patients with relapsing fever have also suffered from extensive skin rashes, intensive skin care is recommended in these areas. Depending on the extent of the remaining symptoms, the skin must be replenished with fat and/or moisture. In some cases, scar treatment with appropriate oils is also recommended.

You can do that yourself

To protect against infection, the person concerned should take special care in everyday life. Since the pathogens can already spread from one person to the next with minor injuries, it is particularly important to ensure that no transmission can take place in the case of open wounds. It is a notifiable disease that is highly contagious.

In addition to preventive measures, the possibilities for self-help are limited to strengthening the body’s own defense system. To ensure that the organism receives the best possible support in the healing process, it is important to ensure a healthy and balanced diet. A diet rich in vitamins strengthens the immune system and promotes recovery. One of the symptoms of relapsing fever is an elevated body temperature. The symptoms can be alleviated with cold compresses and sufficient fluid intake. The patient needs an adequate supply of oxygen. Therefore, the premises should be ventilated as well as possible at regular intervals. In addition, sleep hygiene should be optimized and adapted to natural needs.

Overexertion, stress or additional burdens are to be kept away from the patient. Physical activities are to be reduced to a minimum. These can otherwise lead to complications and further deterioration of health. If itching is present, particular attention must be paid to the possible risk of infection. If possible, avoid scratching.

Relapsing Fever