Relapsing fever differential diagnosis: Difference between revisions

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==Differentiating Relapsing fever from other Diseases==
==Differentiating Relapsing fever from other Diseases==
The following infectious diseases should be considered in someone with recurrent episodes of a febrile illness:<ref name="pmid2252381">{{cite journal |vauthors=Barbour AG |title=Antigenic variation of a relapsing fever Borrelia species |journal=Annu. Rev. Microbiol. |volume=44 |issue= |pages=155–71 |date=1990 |pmid=2252381 |doi=10.1146/annurev.mi.44.100190.001103 |url=}}</ref>
The following infectious diseases should be considered in someone with recurrent episodes of a [[Febrile Disease|febrile illness]]:<ref name="pmid2252381">{{cite journal |vauthors=Barbour AG |title=Antigenic variation of a relapsing fever Borrelia species |journal=Annu. Rev. Microbiol. |volume=44 |issue= |pages=155–71 |date=1990 |pmid=2252381 |doi=10.1146/annurev.mi.44.100190.001103 |url=}}</ref>
*Colorado tick fever
*[[Colorado tick fever]]
*Infectious [[mononucleosis]]
*Infectious [[mononucleosis]]
*Ascending (intermittent) [[cholangitis]]
*[[Ascending cholangitis|Ascending (intermittent) cholangitis]]
*[[Yellow fever]]
*[[Yellow fever]]
* [[Viral  hemorrhagic fever|African hemorrhagic fever]]s
* [[Viral  hemorrhagic fever|African hemorrhagic fever]]s
* Lymphocytic choriomengitis
* [[Lymphocytic choriomeningitis]]
*[[Dengue fever]]
*[[Dengue fever]]
*[[Leptospirosis]]
*[[Leptospirosis]]
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*[[Brucellosis]]
*[[Brucellosis]]
*[[Rat bite fever]].
*[[Rat bite fever]].
*In a febrile patient in or from Africa, who has all the classic features of LBRF – jaundice, petechial rash, epistaxis, hepatosplenomegaly, thrombocytopenia, coagulopathy, and elevated serum aminotransferases – severe [[falciparum]] [[malaria]] is the most differential diagnosis.  
*In a [[febrile]] patient in or from Africa, who has all the classic features of [[Louse-borne relapsing fever|LBRF]] ([[jaundice]], [[petechial rash]], [[epistaxis]], [[hepatosplenomegaly]], [[thrombocytopenia]], [[coagulopathy]], and elevated serum [[aminotransferase]]), severe [[falciparum]] [[malaria]] is the most [[differential diagnosis]].  
*In the Horn of Africa, [[yellow fever]] and other [[viral hemorrhagic fevers]] such as [[Rift Valley Fever]] and [[viral hepatitis]], [[rickettsial]] infections, especially louse-borne [[typhus]] must be considered.
*In the Horn of Africa, [[yellow fever]] and other [[viral hemorrhagic fevers]] such as [[Rift Valley Fever]] and [[viral hepatitis]], [[rickettsial]] infections, especially [[Typhus|louse-borne typhus]] must be considered.
* If there is evidence of acute kidney injury, leptospirosis is more likely.
* If there is evidence of [[acute kidney injury]], [[leptospirosis]] is more likely.
* Trench fever (Bartonella Quintana), transmitted by lice, can also cause episodic recurrent [[fever]] with headache and pains in the shins, but it lacks the bleeding and [[jaundice]] that is seen in LBRF.  
* [[Trench fever]] (Bartonella Quintana), transmitted by [[lice]], can also cause episodic recurrent [[fever]] with [[headache]] and pains in the shins. Still, it lacks the [[bleeding]] and [[jaundice]] that is seen in [[Louse-borne relapsing fever|LBRF]].  
*In endemic areas, complicating bacterial infections, particularly [[typhoid]], or coinfection with malaria should be considered.
In endemic areas, complicating bacterial infections, particularly [[typhoid]], or coinfection with [[malaria]], should be considered.
*In refugees diagnosed in Europe, [[P. falciparum malaria]], sepsis, [[leptospirosis]], and [[meningitis]] have been cited as leading differential diagnoses of LBRF.<ref name="pmid30869050">{{cite journal |vauthors=Warrell DA |title=Louse-borne relapsing fever (Borrelia recurrentis infection) |journal=Epidemiol. Infect. |volume=147 |issue= |pages=e106 |date=January 2019 |pmid=30869050 |pmc=6518520 |doi=10.1017/S0950268819000116 |url=}}</ref>
*In refugees diagnosed in Europe, [[P. falciparum malaria]], sepsis, [[leptospirosis]], and [[meningitis]] have been cited as leading [[differential diagnosis]] of [[Louse-borne relapsing fever|LBRF]].<ref name="pmid30869050">{{cite journal |vauthors=Warrell DA |title=Louse-borne relapsing fever (Borrelia recurrentis infection) |journal=Epidemiol. Infect. |volume=147 |issue= |pages=e106 |date=January 2019 |pmid=30869050 |pmc=6518520 |doi=10.1017/S0950268819000116 |url=}}</ref>


[[File:DDX Relapsing fever.jpg]]
[[File:DDX Relapsing fever.jpg]]

Revision as of 06:45, 24 September 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The following infectious diseases should be considered in someone with recurrent episodes of a febrile illness: Colorado tick fever,Infectious mononucleosis, Ascending (intermittent) cholangitis, Yellow fever, African hemorrhagic fevers, Lymphocytic choriomengitis, Dengue fever, Leptospirosis, Infections with echovirus 9, Malaria, Chronic meningococcemia, Infections with Bartonella species, Brucellosis, Rat bite fever.

Differentiating Relapsing fever from other Diseases

The following infectious diseases should be considered in someone with recurrent episodes of a febrile illness:[1]

In endemic areas, complicating bacterial infections, particularly typhoid, or coinfection with malaria, should be considered.

Disease Organism Vector Symptoms
Bacterial Infection
Borreliosis (Lyme Disease) [3] Borrelia burgdorferi sensu lato complex and B. mayonii I. scapularis, I. pacificus, I. ricinus, and I. persulcatus Erythema migrans, flu-like illness(fatigue, fever), Lyme arthritis, neuroborreliosis, and carditis.
Relapsing Fever [4] Tick-borne relapsing fever (TBRF): Borrelia duttoni, Borrelia hermsii, and Borrelia parkerii Ornithodoros species Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental status, painful urination, rash, and rigors.
Louse-borne relapsing fever (LBRF) : Borrelia recurrentis Pediculus humanus
Typhus (Rickettsia)
Rocky Mountain Spotted Fever Rickettsia rickettsii Dermacentor variabilis, Dermacentor andersoni Fever, altered mental status, myalgia, rash, and headaches.
Helvetica Spotted Fever [5] Rickettsia helvetica Ixodes ricinus Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
Ehrlichiosis (Anaplasmosis) [6] Ehrlichia chaffeensis, Ehrlichia ewingii Amblyomma americanum, Ixodes scapularis Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).
Tularemia [7] Francisella tularensis Dermacentor andersoni, Dermacentor variabilis Ulceroglandular, glandular, oculoglandular, oroglandular, pneumonic, typhoidal.
Viral Infection
Tick-borne meningoencephalitis [8] TBEV virus Ixodes scapularis, I. ricinus, I. persulcatus Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.
Colorado Tick Fever [9] CTF virus Dermacentor andersoni Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents in nearly 50% of infected patients.
Crimean-Congo Hemorrhagic Fever CCHF virus Hyalomma marginatum, Rhipicephalus bursa Initially infected patients will likely feel a few of the following symptoms: headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat petechiae of the palate, and potentially changes in mood as well as sensory perception.
Protozoan Infection
Babesiosis [10] Babesia microti, Babesia divergens, Babesia equi Ixodes scapularis, I. pacificus Non-specific flu-like symptoms.

References

  1. ↑ Barbour AG (1990). "Antigenic variation of a relapsing fever Borrelia species". Annu. Rev. Microbiol. 44: 155–71. doi:10.1146/annurev.mi.44.100190.001103. PMID 2252381.
  2. ↑ Warrell DA (January 2019). "Louse-borne relapsing fever (Borrelia recurrentis infection)". Epidemiol. Infect. 147: e106. doi:10.1017/S0950268819000116. PMC 6518520 Check |pmc= value (help). PMID 30869050.
  3. ↑ Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
  4. ↑ Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
  5. ↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
  6. ↑ Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
  7. ↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
  8. ↑ General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
  9. ↑ General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
  10. ↑ Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.
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