Relapsing fever natural history, complications and prognosis: Difference between revisions

	Relapsing fever Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Relapsing fever from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Relapsing fever natural history, complications and prognosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Relapsing fever natural history, complications and prognosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Relapsing fever natural history, complications and prognosis
CDC on Relapsing fever natural history, complications and prognosis
Relapsing fever natural history, complications and prognosis in the news
Blogs on Relapsing fever natural history, complications and prognosis
Directions to Hospitals Treating Relapsing fever
Risk calculators and risk factors for Relapsing fever natural history, complications and prognosis

VisualWikitext

Latest revision as of 19:36, 24 September 2020

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

Overview

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. With early treatment, the death rate is reduced. Those who have developed coma, myocarditis, liver problems, or pneumonia are more likely to die.

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.

Complications

Most cases resolve spontaneously. but after several cycles of fever, some people may develop dramatic central nervous system signs such as seizures, stupor, and coma. Also, the Borrelia organism may also invade heart and liver tissues, causing inflammation of the heart muscle (myocarditis), endocarditis, and liver (hepatitis), pneumonia are other complications such as iridocyclitis, meningitis, encephalitis, abnormal coagulation with hemorrhage and spontaneous abortion or transplacental transmission.

TBRF in pregnancy

TBRF during pregnancy can cause spontaneous abortion, [[premature birth, and neonatal death (Melkert and Stel 1991). The maternal-fetal transmission of Borrelia is believed to occur either transplacentally (Steenbarger 1982) or while traversing the birth canal. In one study, perinatal infection with TBRF was shown to lead to lower birth weights, younger gestational age, and higher perinatal mortality.

Prognosis

Given appropriate treatment, most patients recover within a few days. The death rate for untreated LBRF ranges from 10 - 70%. In TBRF, it is 4 -10%. With early treatment, the death rate is reduced.
Poor prognostic signs include severe jaundice, severe change in mental status, severe bleeding, and prolonged QT interval on ECG.

References

@@ Line 3: / Line 3: @@
 {{CMG}}
 ==Overview==
-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. 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.
+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|transplacental transmission]]. With early treatment, the death rate is reduced. Those who have developed [[coma]], [[myocarditis]], [[liver]] problems, or [[pneumonia]] are more likely to die.
 ==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 c[[erebral edema]] with [[seizures]], [[cardiac failure]], or death.
-The symptoms of Relapsing fever usually develop within 3-7 days after exposure and start with sudden onset of high [[fever]], [[chills]], [[headache]], [[myalgias]], and [[weakness]], followed by afebrile periods. Occasionally, resolution ensues by Crisis. 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, but most cases eventually resolve spontaneously.
+==Complications==
+* Most cases resolve spontaneously. but after several cycles of fever, some people may develop dramatic [[central nervous system]] signs such as [[seizures]], stupor, and [[coma]]. Also, the Borrelia organism may also invade heart and liver tissues, causing inflammation of the heart muscle (myocarditis), endocarditis, and liver (hepatitis), pneumonia are other complications such as [[iridocyclitis]], [[meningitis]], [[encephalitis]], [[abnormal coagulation]] with [[hemorrhage]] and spontaneous [[abortion]] or [[transplacental]] [[transmission]].
-[[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. Chronic relapsing fever may produce a clinical illness analogous to chronic Lyme disease.
-'''Crisis'''
-* Occasionally, resolution ensues 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 [[fever]]s 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.
+''TBRF in pregnancy''
-* 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>
+TBRF during pregnancy can cause [[spontaneous abortion]], [[premature birth, and neonatal death (Melkert and Stel 1991). The maternal-fetal transmission of Borrelia is believed to occur either transplacentally (Steenbarger 1982) or while traversing the [[birth canal]].   In one study, perinatal infection with TBRF was shown to lead to lower birth weights, younger gestational age, and higher perinatal mortality.
-*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.
+*Given appropriate treatment, most patients recover within a few days. The death rate for untreated [[Louse-borne relapsing fever|LBRF]] ranges from 10 - 70%. In TBRF, it is 4 -10%. With early treatment, the death rate is reduced.
+*Poor prognostic signs include severe [[jaundice]], severe change in [[mental status]], severe [[bleeding]], and prolonged [[QT interval]] on [[ECG]].
 ==References==