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Published on: August 31, 2013
[Neurological complications of tick-borne relapsing fever]
L Castilla-Guerra1, M C Fernandez-Moreno2, S Vergara-Lopez2
1Hospital Universitario Virgen Macarena, Sevilla, Espana.
Introduction:
Tick-borne relapsing fever (TBRF) can cause neurological complications. There are hardly any studies in Spain on this subject.
Aim:
To study the prevalence and clinical characteristics of neurological complications of patients with TBRF.
Patients And Methods:
We retrospectively reviewed all the patients attended with TBRF over 12 years (2004-2015) in a hospital in a rural area of southern Spain.
Results:
We included 75 patients, 42 males (56%). Mean age: 33 years (range: 14-72 years). Tick bites were observed in 9 patients (12%). The most common symptoms were: fever in 64 (85.3 %) patients, headache in 41 (54.6%) patients, and vomits in 26 (34.6%) patients. Manifestations suggesting meningeal involvement were noted in 9 (12%) of the patients, and 3 patients (4%) had clear meningeal signs on admission. All these patients underwent lumbar puncture. None of the patients presented facial palsy or other neurologic manifestation. Cerebrospinal fluid abnormalities were found in the three patients with meningismus. In one case Borrelia were found in the cerebrospinal fluid. In those cases with neurologic involvement the treatment used was penicillin G in one case and ceftriaxone in two patients. All patients recovered completely.
Conclusions:
TBRF is one of the less severe forms of borreliosis and less than 5% of patients present neurological complications. However, physicians should know that Borrelia can cause meningitis in subjects exposed to ticks in endemic regions of TBRF.
Insights
Tick-borne relapsing fever (TBRF) can cause neurological issues, though rarely. This study found less than 5% of TBRF patients had neurological complications, but meningitis is possible in tick-exposed individuals.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Tick-borne relapsing fever (TBRF) is a spirochetal infection transmitted by ticks.
- Neurological complications associated with TBRF are not well-documented, particularly in Spain.
- Understanding the prevalence and clinical spectrum of neurological involvement is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To determine the incidence and clinical features of neurological complications in patients diagnosed with TBRF.
- To highlight the potential for Borrelia species to cause meningitis in endemic areas.
Main Methods:
- A retrospective review of TBRF patients treated between 2004 and 2015 was conducted.
- Data collected included patient demographics, symptoms, tick bite history, and neurological examination findings.
- Lumbar puncture and cerebrospinal fluid analysis were performed for patients with suspected meningeal involvement.
Main Results:
- Of 75 TBRF patients, 9% reported tick bites. Common symptoms included fever (85.3%), headache (54.6%), and vomiting (34.6%).
- Neurological manifestations, such as meningismus, were observed in 12% of patients, with 4% showing clear meningeal signs.
- Cerebrospinal fluid abnormalities were present in patients with meningismus, and Borrelia was identified in one CSF sample. No cases of facial palsy were reported. All patients recovered fully.
Conclusions:
- TBRF is generally a mild form of borreliosis, with neurological complications occurring in less than 5% of cases.
- Physicians must be aware of the potential for Borrelia to cause meningitis in individuals with a history of tick exposure in TBRF-endemic regions.
- Prompt recognition and appropriate antibiotic treatment (penicillin G or ceftriaxone) lead to complete recovery.
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