Relapsing fever natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
==Natural History== | ==Natural History== | ||
Most cases eventually resolve spontaneously. If left untreated, during the crisis up to 10% of patients with relapsing fever may progress to develop cerebral edema with seizures, cardiac failure, or death. Common complications of relapsing fever are iridocyclitis, meningitis, encephalitis, myocarditis, endocarditis, pneumonia, abnormal coagulation with hemorrhage and spontaneous abortion or transplacental transmission | |||
OR | |||
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%. | |||
Natural History, Complications, and Prognosis | |||
Natural History | |||
The symptoms of (disease name) usually develop in the first/ second/ third decade of life and start with symptoms such as ___. | |||
The symptoms of (disease name) typically develop ___ years after exposure to ___. | |||
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. | |||
Complications | |||
Common complications of [disease name] include: | |||
[Complication 1] | |||
[[File:Relapsing Fever 2.jpg]] | [[File:Relapsing Fever 2.jpg]] | ||
*sudden onset of high [[fever]], [[chills]], [[headache]], [[myalgias]], and [[weakness]], occur within 3-7 days (up to 18 days) after exposure. Less common symptoms include [[anorexia]], [[nausea]], [[vomiting]], [[abdominal pain]], [[arthralgias]], neck or back pain, [[confusion]], [[lethargy]], cough, [[rash]], sore throat, and swollen lymph nodes. In LBRF, the fever usually lasts 3-6 days and is usually followed by a single, milder episode. In TRBF, multiple episodes of fever occur and each may last up to 3 days.If left untreated, rapid defervescence usually occurs in 2-6 days (range 1-13 days), often with dramatic improvement in symptoms. | *sudden onset of high [[fever]], [[chills]], [[headache]], [[myalgias]], and [[weakness]], occur within 3-7 days (up to 18 days) after exposure. Less common symptoms include [[anorexia]], [[nausea]], [[vomiting]], [[abdominal pain]], [[arthralgias]], neck or back pain, [[confusion]], [[lethargy]], cough, [[rash]], sore throat, and swollen lymph nodes. In LBRF, the fever usually lasts 3-6 days and is usually followed by a single, milder episode. In TRBF, multiple episodes of fever occur and each may last up to 3 days.If left untreated, rapid defervescence usually occurs in 2-6 days (range 1-13 days), often with dramatic improvement in symptoms. Chronic relapsing fever may produce a clinical illness analogous to chronic Lyme disease. | ||
'''Crisis''' | '''Crisis''' | ||
* Occasionally, resolution by '''crisis''' which is a classic series of stages that a person will go through: | * Occasionally, resolution by '''crisis''' which is a classic series of stages that a person will go through: | ||
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* 2. Phase two is the flush phase. This is where the body temperature decreases rapidly and the person has drenching sweats. During this phase, the person's blood pressure can drop dramatically<ref>http://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_biology.htm http://www.cdc.gov/ncidod/dvbid/RelapsingFever/index.htmhttp://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_Symptoms.htm</ref> | * 2. Phase two is the flush phase. This is where the body temperature decreases rapidly and the person has drenching sweats. During this phase, the person's blood pressure can drop dramatically<ref>http://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_biology.htm http://www.cdc.gov/ncidod/dvbid/RelapsingFever/index.htmhttp://www.cdc.gov/ncidod/dvbid/RelapsingFever/RF_Symptoms.htm</ref> | ||
*During the crisis, patients may develop cerebral edema with seizures, cardiac failure, or death.This stage may result in death in up to 10% of people. | *During the crisis, patients may develop cerebral edema with seizures, cardiac failure, or death. This stage may result in death in up to 10% of people. | ||
*After several cycles of fever, some people may develop dramatic central nervous system signs such as seizures, stupor, and coma. The Borrelia organism may also invade heart and liver tissues, causing inflammation of the heart muscle (myocarditis) and liver (hepatitis). Widespread bleeding and pneumonia are other complications. | *After several cycles of fever, some people may develop dramatic central nervous system signs such as seizures, stupor, and coma. The Borrelia organism may also invade heart and liver tissues, causing inflammation of the heart muscle (myocarditis) and liver (hepatitis). Widespread bleeding and pneumonia are other complications. | ||
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*The clinical manifestations of tick-borne and louse-borne relapsing fever are similar but can be quite variable, depending on the infecting strain of Borrelia and the host's immunity. Patients typically present 3-7 days (up to 18 days) after exposure with sudden onset of high fever, chills, headache, myalgias, and weakness. | *The clinical manifestations of tick-borne and louse-borne relapsing fever are similar but can be quite variable, depending on the infecting strain of Borrelia and the host's immunity. Patients typically present 3-7 days (up to 18 days) after exposure with sudden onset of high fever, chills, headache, myalgias, and weakness. | ||
*The afebrile interval usually lasts 1 week (up to 60 days) before relapse with symptoms similar to the first episode. Patients with louse-borne relapsing fever will typically have 1-2 relapses | *The afebrile interval usually lasts 1 week (up to 60 days) before relapse with symptoms similar to the first episode. Patients with louse-borne relapsing fever will typically have 1-2 relapses | ||
(range 0-6) with each subsequent relapse usually less severe than the previous one. Patients with tick-borne relapsing fever usually have 3-5 relapses (range 0-22). Most cases eventually resolve spontaneously. Serious complications are more common with louse-borne than tick-borne disease and include iridocyclitis, meningitis, encephalitis, myocarditis, endocarditis, pneumonia, abnormal coagulation with hemorrhage and spontaneous abortion or transplacental transmission [13] | (range 0-6) with each subsequent relapse usually less severe than the previous one. Patients with tick-borne relapsing fever usually have 3-5 relapses (range 0-22). Most cases eventually resolve spontaneously. Serious complications are more common with louse-borne than tick-borne disease and include iridocyclitis, meningitis, encephalitis, myocarditis, endocarditis, pneumonia, abnormal coagulation with hemorrhage and spontaneous abortion or transplacental transmission [13]. | ||
==Complications== | ==Complications== | ||
Revision as of 18:33, 9 August 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
Most cases eventually resolve spontaneously. If left untreated, during the crisis up to 10% of patients with relapsing fever may progress to develop cerebral edema with seizures, cardiac failure, or death. Common complications of relapsing fever are iridocyclitis, meningitis, encephalitis, myocarditis, endocarditis, pneumonia, abnormal coagulation with hemorrhage and spontaneous abortion or transplacental transmission
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis Natural History The symptoms of (disease name) usually develop in the first/ second/ third decade of life and start with symptoms such as ___. The symptoms of (disease name) typically develop ___ years after exposure to ___. If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. Complications Common complications of [disease name] include: [Complication 1]
- sudden onset of high fever, chills, headache, myalgias, and weakness, occur within 3-7 days (up to 18 days) after exposure. Less common symptoms include anorexia, nausea, vomiting, abdominal pain, arthralgias, neck or back pain, confusion, lethargy, cough, rash, sore throat, and swollen lymph nodes. In LBRF, the fever usually lasts 3-6 days and is usually followed by a single, milder episode. In TRBF, multiple episodes of fever occur and each may last up to 3 days.If left untreated, rapid defervescence usually occurs in 2-6 days (range 1-13 days), often with dramatic improvement in symptoms. Chronic relapsing fever may produce a clinical illness analogous to chronic Lyme disease.
Crisis
- Occasionally, resolution by crisis which is a classic series of stages that a person will go through:
- 1. Phase one is the chill phase, with the person experiencing high fevers up to 41.5°C (106.7°F). With this high temperature, a person can develop delirium, agitation, and confusion. In addition, other signs of an increased metabolic rate are noted, such as a fast heart rate and breathing rate. This phase lasts between 10 and 30 minutes.
- 2. Phase two is the flush phase. This is where the body temperature decreases rapidly and the person has drenching sweats. During this phase, the person's blood pressure can drop dramatically[1]
- During the crisis, patients may develop cerebral edema with seizures, cardiac failure, or death. This stage may result in death in up to 10% of people.
- After several cycles of fever, some people may develop dramatic central nervous system signs such as seizures, stupor, and coma. The Borrelia organism may also invade heart and liver tissues, causing inflammation of the heart muscle (myocarditis) and liver (hepatitis). Widespread bleeding and pneumonia are other complications.
- The clinical manifestations of tick-borne and louse-borne relapsing fever are similar but can be quite variable, depending on the infecting strain of Borrelia and the host's immunity. Patients typically present 3-7 days (up to 18 days) after exposure with sudden onset of high fever, chills, headache, myalgias, and weakness.
- The afebrile interval usually lasts 1 week (up to 60 days) before relapse with symptoms similar to the first episode. Patients with louse-borne relapsing fever will typically have 1-2 relapses
(range 0-6) with each subsequent relapse usually less severe than the previous one. Patients with tick-borne relapsing fever usually have 3-5 relapses (range 0-22). Most cases eventually resolve spontaneously. Serious complications are more common with louse-borne than tick-borne disease and include iridocyclitis, meningitis, encephalitis, myocarditis, endocarditis, pneumonia, abnormal coagulation with hemorrhage and spontaneous abortion or transplacental transmission [13].
Complications
- Coma
- Facial droop
- Liver dysfunction
- Meningitis
- Myocarditis -- may lead to arrhythmias
- Pneumonia
- Seizures
- Shock related to taking antibiotics (Jarisch - Herxheimer's reaction, in which the rapid death of very large numbers of Borrelia organisms induces shock)
- Weakness
- Widespread bleeding
Prognosis
The death rate for untreated LBRF ranges from 10 - 70%. In TBRF, it is 4 -10%. With early treatment, the death rate is reduced. Those who have developed coma, myocarditis, liver problems, or pneumonia are more likely to die.