Chapter 16 : Relapsing Fever

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Relapsing fever is an arthropod-borne infection that occurs in two forms: tick-borne relapsing fever (TBRF) and louse-borne relapsing fever (LBRF). The etiologic agents of relapsing fever are several species of spirochetes in the genus . TBRF is usually a zoonosis and is endemic on most continents, each with a characteristic species. Examples are in North America and in Africa. LBRF is caused by a single species, . The multiple episodes of fever and disease relapses in both TBRF and LBRF are due to antigenic variation by the spirochetes. But elucidation of the pathogenesis and genetics of relapsing fever agents awaited the developments in the field of molecular biology. This chapter first talks about biology, genetics, phylogenetic classification, life cycle and ecology of relapsing fever species. Antigenic variation by relapsing fever spp. is among the most extensive of any vector-borne bacterial or protozoal parasite. Its characteristics most closely resemble the antigenic variation manifested by African trypanosomes. The chapter ends with a discussion on epidemiology, clinical manifestations, diagnosis, treatment, and prevention of relapsing fever.

Citation: Barbour A. 2005. Relapsing Fever, p 268-291. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch16
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Figure 1

Unrooted, distance criterion phylogram of partial 16S ribosomal RNA genes of selected relapsing fever and other species ( ). The species known to cause relapsing fever of humans are underlined. Representative arthropod vectors are shown in parentheses by each species; all the vectors are soft ticks ( and ) or hard ticks (, , and ), except for the human louse, . . . of . was isolated in Japan ( ), and the sensu lato organism of . was isolated in the northeastern United States ( ). The “Owl” sp. was isolated from a northern spotted owl in the northwestern United States ( ).

Citation: Barbour A. 2005. Relapsing Fever, p 268-291. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch16
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Figure 2

Body temperature (in degrees Centigrade) of a patient with tick-borne relapsing fever over time and in relation to exposure to ticks in the northwestern United States. Adapted from Thompson et al. ( ).

Citation: Barbour A. 2005. Relapsing Fever, p 268-291. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch16
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Figure 3

Schematic representation of three mechanisms for changing expression of a variable major protein gene of during relapsing fever: intermolecular gene conversion, intramolecular DNA rearrangement, and in situ activation of a promoter. For each mechanism, the states and locations of selected genes on two linear plasmids before and after a change (downward arrow) in a serotype are shown. The genotype of the expressed variable major protein gene, which is downstream of an active promoter (P →), and the serotype phenotype of the spirochete are indicated by the same fill pattern. Other genes are designated by other fill patterns. In the middle, an intramolecular DNA recombination between two direct repeats (short white bars) of tandemly arrayed variable major protein genes is shown. A product of this recombination is a nonreplicative circle ( ).

Citation: Barbour A. 2005. Relapsing Fever, p 268-291. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch16
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Figure 4

Nymphs and an adult of , the vector of .

Citation: Barbour A. 2005. Relapsing Fever, p 268-291. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch16
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Figure 5

Collection of , , and ticks from the western United States and Canada. Figure adapted from Boyer et al. ( ), who used the data of Cooley and Kohls ( ). The identification of in western Montana was reported by Schwan et al. ( ).

Citation: Barbour A. 2005. Relapsing Fever, p 268-291. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch16
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Table 1

species that cause relapsing fever and related species

Citation: Barbour A. 2005. Relapsing Fever, p 268-291. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch16

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