Volume 25, Number 4—April 2019
Tick-Borne Relapsing Fever in the White Mountains, Arizona, USA, 2013–2018
Neema Mafi, Hayley D. Yaglom, Craig Levy, Anissa Taylor, Catherine O’Grady, Heather Venkat, Kenneth K. Komatsu, Brentin Roller, Maria T. Seville, Shimon Kusne, John Leander Po, Shannon Thorn, and Neil M. Ampel
Tick-borne relapsing fever (TBRF) is a bacterial infection transmitted by tick bites that occurs in several different parts of the world, including the western United States. We describe 6 cases of TBRF acquired in the White Mountains of Arizona, USA, and diagnosed during 2013–2018. All but 1 case-patient had recurrent fever, and some had marked laboratory abnormalities, including leukopenia, thrombocytopenia, hyperbilirubinemia, and elevated aminotransaminases. One patient had uveitis. Diagnosis was delayed in 5 of the cases; all case-patients responded to therapy with doxycycline. Two patients had Jarisch-Herxheimer reactions. The White Mountains of Arizona have not been previously considered a region of high incidence for TBRF. These 6 cases likely represent a larger number of cases that might have been undiagnosed. Clinicians should be aware of TBRF in patients who reside, recreate, or travel to this area and especially for those who sleep overnight in cabins there.
Do you see the trend yet? Ticks, pathogens, and disease where they aren’t supposed to exist. Yet they do. This study also demonstrates that the Lyme caused by B. burgdorferi is NOT the only borrelia spirochete we need to be concerned about. While the study states,
“In the United States, B. hermsii is thought to be the most common cause of TBRF, and transmission is associated with the bite of soft O. hermsi ticks. Ornithodoros spp,”
they are not the sole perps as seen below. A U.S. solider acquired TBRF with the B. turicatae strain and in Europe the strain was caused by B. corocidurae. The truly frightening aspect is the potential rapid transmission.
A population persists in the salivary glands allowing for rapid transmission to mammalian hosts during tick feeding.
Much can be learned about Borrelia turicatae by reading this case study: https://wwwnc.cdc.gov/eid/article/23/5/16-2069_article
- Ornithodoros turicata soft bodied ticks, are endemic to Texas and Florida
- They are found in caves and ground squirrel or prairie dog burrows https://madisonarealymesupportgroup.com/2018/04/23/tick-borne-relapsing-fever-found-in-austin-texas-caves/
- Once infected, they remain infected for the rest of their lives, which can be up to ten years.
- Attachment is painless
- They are rapid night feeders (5-60min)
- Due to their rapid feeding they are rarely found or leave lesions
- Patient in study suffered with headache, nausea, & pain behind knees
- Had numerous lesions which resolved after 6 days (without treatment)
- Developed persistent fever
- Developed thrombocytopenia (low platelets)
- Developed elevated Erythrocyte sedimentation rate & C-reactive protein
- Improved rapidly with doxycycline
- Platelet count normalized within 2 weeks
- Asymptomatic soldiers with similar exposure were treated prophylactically
- TBRF is a neglected and probably underdiagnosed disease
- Published cases in Texas have been supported by serology for the TBRF group, exposure location, and tick collections, but the authors state successful identification of B. turicatae in a human has not been reported
- Military training groups in Israel have declared certain caves off limits because of heavy tick presence https://madisonarealymesupportgroup.com/2017/10/27/israeli-kids-get-lyme-disease-from-ticks-in-caves/ and have prophylactically administered doxycycline to those suspected to have been exposed
- Asymptomatic patients given doxy don’t have a Jarisch-Herxheimer reaction but those with active illness do
ANOTHER STUDY DEMONSTRATING THE WILY AND ADAPTABLE NATURE OF SPIROCHETES.