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Tick-borne relapsing fever in central Tanzania
1Mvumi Hospital, Dodoma, Tanzania.
Insights
Tick-borne relapsing fever (TBRF) significantly impacts young children and pregnant women in Tanzania. Early diagnosis and penicillin treatment are crucial for managing this infectious disease and reducing mortality.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Pediatrics
Background:
- Tick-borne relapsing fever (TBRF) is a significant health concern, particularly in endemic areas.
- Understanding the clinical presentation and outcomes of TBRF in vulnerable populations like children and pregnant women is essential for effective public health strategies.
Purpose of the Study:
- To describe the clinical features, management, and outcomes of tick-borne relapsing fever (TBRF) in children and pregnant women in Central Tanzania.
- To compare the clinical presentation of TBRF with malaria in a similar demographic to highlight diagnostic challenges.
Main Methods:
- A retrospective review of patients diagnosed with TBRF at Mvumi Hospital between October 1985 and September 1986.
- Clinical data of TBRF patients were compared with those of malaria patients (blood smear positive for malaria, negative for spirochaetes).
Main Results:
- TBRF predominantly affected children under 5 years old, with congenital infections noted in neonates.
- Common symptoms in children included high fever, splenomegaly, convulsions, and meningism, often mimicking malaria.
- Severe disease correlated with high spirochaete density; penicillin showed a 4.7% relapse rate, and child mortality was 1.6% (8.4% for admitted cases).
Conclusions:
- TBRF poses a considerable risk to young children and pregnant women in Tanzania, with significant morbidity and mortality in infants.
- Clinical differentiation from malaria can be challenging, emphasizing the need for diagnostic vigilance.
- Penicillin is an effective treatment, and management guidelines are recommended to improve patient outcomes.
Abstract:
Between October 1985 and September 1986, 488 children aged less than 15 years, 45 pregnant women, 21 other women and 18 men with tick-borne relapsing fever (TBRF) were seen at Mvumi Hospital, Central Tanzania. 88% of the children were less than 5 years old and 36% were less than 1 year. Twelve children were less than 1 month old and some of the 10 infants diagnosed at between 4 and 12 days of age were cases of congenital infection. The clinical features of TBRF in the children and pregnant women were compared with 129 children with a similar age distribution and 52 pregnant women, respectively, who had blood smears positive for malaria but negative for spirochaetes. The common presenting features in children with TBRF were a high fever, splenomegaly, convulsions, and meningism. The difficulty of differentiation from malaria is described. Severe disease in both children and adults was associated with high density of spirochaetes in blood smears. Of the 45 infected pregnant women, 22 (49%) went into labour. One of the deliveries was an abortion and 10 were preterm infants, 4 of whom died. There were no maternal deaths. The estimated overall mortality for children was 1.6%, and 2.3% for those aged less than 1 years; for the 95 children admitted it was 8.4%. Penicillin was a satisfactory treatment for all ages, with a relapse rate of 4.7%. Recommendations for patient management are given.