Louse-borne relapsing fever (Borrelia recurrentis infection)

Area of Science:

• Medical Entomology
• Infectious Diseases
• Epidemiology

Background:

• Louse-borne relapsing fever (LBRF) has a long history, with endemic foci in the Horn of Africa and recent re-emergence in Europe due to refugee migration.
• Borrelia recurrentis, the causative agent, is closely related to tick-borne relapsing fever spirochaetes, considered ecotypes of a single genomospecies.
• Transmission occurs via the human body louse (Pediculus humanus corporis) through inoculation of infected louse fluids or feces.

Purpose of the Study:

• To provide a comprehensive overview of Louse-borne relapsing fever (LBRF).
• To detail the historical context, transmission, clinical manifestations, diagnosis, and control of LBRF.
• To highlight the re-emergence of LBRF in Europe and its public health implications.

Main Methods:

• Review of historical records and epidemiological data on LBRF outbreaks.
• Analysis of the biological characteristics of Borrelia recurrentis and its vector, Pediculus humanus corporis.
• Description of clinical features, diagnostic methods (microscopy, PCR), and treatment outcomes.

Main Results:

• LBRF is characterized by recurrent febrile episodes due to antigenic variation of Borrelia recurrentis.
• Severe manifestations include shock, myocarditis, ARDS, bleeding, and high mortality without treatment (exceeding 40%).
• Antibiotic therapy reduces case-fatality to below 5%, but Jarisch-Herxheimer reactions are common.

Conclusions:

• LBRF remains a significant public health concern, particularly with its re-emergence in Europe.
• Effective control relies on louse elimination through clothing sterilization, pediculicides, and improved hygiene.
• Rapid diagnosis and prompt antibiotic treatment are crucial for managing LBRF and preventing severe outcomes.