https://www.ncbi.nlm.nih.gov/pubmed/32014353/
Tick-borne relapsing fever : An unrecognized cause of fever in travelers
Author information
Abstract
INTRODUCTION:
Tick-borne relapsing fever is a usual cause of fever in West Africa. Except relapsing febrile episodes, there are no pathognomonic signs and diagnosis is difficult because Borrelia density in patient’s blood is low.
CASE REPORTS:
Tick-borne relapsing fever was revealed by the presence of spirochetes in a blood sample to search malaria in two men, 24 and 31 year-old, returned from Mali.
CONCLUSION:
This diagnosis should be evocated in patients having fever after a trip in infested area, as malaria, both infections can be associated.
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**Comment**
I got news for you. Borrelia density is low in many patients’ blood. This is a common problem and one of the reasons why patients continue to test negative.