[Relapsing fever: an almost forgotten disease in focus again]

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• Relapsing fevers are uncommon in Germany and often overlooked in febrile patients.
• Recent months have seen over forty cases of louse-borne relapsing fever in asylum seekers in Germany.
• Some cases required intensive care, and one patient died despite treatment.

Purpose of the Study:

• To highlight the re-emergence of louse-borne relapsing fever in Germany.
• To emphasize the importance of considering relapsing fever in the differential diagnosis of febrile illnesses, especially in migrant populations.
• To outline diagnostic and therapeutic strategies.

Main Methods:

• Diagnosis relies on direct detection of Borrelia spirochetes via microscopy or PCR from EDTA-blood.
• Malaria exclusion is also performed using blood smear microscopy.
• Treatment involves antibiotics such as tetracyclines and penicillin.

Main Results:

• High densities of Borrelia spirochetes can be found in patient blood.
• No acquired resistance to first-line antibiotics has been observed.
• Jarisch-Herxheimer reactions are common post-treatment initiation, necessitating hospitalization or intensive care.

Conclusions:

• Relapsing fever is an important differential diagnosis in febrile migrants.
• Management should not be exclusively outpatient due to potential complications.
• Early diagnostic testing and appropriate medical intervention are critical for patient outcomes.