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Borrelia hermsii (TBRF)

Name(s) of illness: Tick-borne Relapsing Fever (TBRF), Borreliosis

Caused by: infection with Borrelia hermsii, a species of bacteria that can be transmitted through the bite of the soft-bodied tick Ornithodoros hermsi (from which the bacterium gets its name). Borrelia are spirochetes, which means they have spiral-shaped cells. (The most famous spirochete is Treponema pallidum, the bacterium that causes syphilis.) The Borrelia genus also includes the Lyme-causing bacterium Borrelia burgdorferi and—ready for this?—36 other species of bacteria, many of which there are no blood tests for!

TBRF blood smear

Peripheral blood smear. The TBRF bacteria are long and spiral-shaped. The circular objects are red blood cells. The irregular purple object in the top right corner is a white blood cell. Image courtesy cdc.gov.

Symptoms of infection: episodes of fever lasting several days, followed by an interval without fever, followed by another episode of fever. This process can recur from 1 to 4 times. Along with fever, patients may experience generalized body aches, muscle pain, joint pain, headache, nausea, vomiting, anorexia, dry cough, light sensitivity, rash, neck pain, eye pain, confusion, and dizziness.

Long-term effects: patients with untreated or improperly treated infections can develop chronic fatigue, joint and muscle pain, and joint deterioration. Extreme episodes of fever can be fatal. Other long-term problems include iritis/uveitis (inflammation of the iris), cranial nerve and other neuropathies.

Diagnostic tests: Borrelia hermsii Ab panel, IFA—a blood test that measures both IgG and IgM antibodies. IFA stands for Immunofluorescence Assay. CPT code: 9816

Borrelia hermsii culture—a blood test. CPT code: 87081

Treated: orally with tetracycline 500 mg every 6 hours for 10 days or Erythromycin, 500 mg (or 12.5 mg/kg) every 6 hours for 10 days. Latent (long-term) infections, especially when there are neurologic symptoms, are treated with an IV drip of Ceftriaxone 2 grams per day for anywhere from 10 to 42 days, depending on the physician. (Based on my experience as a patient, I recommend at least 28 days.)

Diagnosis/treatment controversies: Some patients go untreated because they have only been tested for Borrelia burgdorferi (Lyme) with a western blot but not for Borrelia hermsii. Often, patients with hermsii infections will have one or two reactive bands on their western blot, which doctors consider to be negative for Lyme. Some patients given IV therapy using a PICC line suffer from secondary infections (which is why I am against PICC lines). In many cases, patients relapse following oral antibiotic therapy, and in some cases, patients relapse after several weeks of IV antibiotic therapy. (My theory: It’s possible that people are getting bitten again and re-infected!)

There are at least 3 other species of Borrelia besides Borrelia hermsiiBorrelia parkeri, Borrelia duttoni, and Borrelia miyamotoi–that cause Relapsing Fever in humans. Unfortunately, in the U.S. there are currently no commercially-available diagnostic tests for these species.

Want to read more? See the CDC’s page on TBRF.

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