You are planning to go for a camp in a famous mountain terrain and are excited about it. You have packed everything needed and all friends are just set to leave. You fear last minute that you may fall sick, and the diseases in those areas may be different. You have often heard how people develop fever after such vacations, and you are feeling scared. Awareness and precaution can help to make your trip a safe one.
About tick borne relapsing fever
Tick borne relapsing fever (TBRF) is a disease condition characterized by recurrent episodes of fever and headaches, muscle and joint pain, caused by a spiral-shaped bacteria of the Borrelia family. This includes bacteria like Borrelia duttoni, Borrelia hermsii, and Borrelia parkerii. TBRF is so called, as it is transmitted to humans by the bite of infected soft ticks which act as vectors for the disease. The tick called Ornithodoros occurs in Africa, Spain, Saudi Arabia, Asia, and certain areas in the western United States and Canada.
People who explore caves for adventure or work in mountain caves or buildings or handle dead rats are at risk for TBRF. The ticks are found in forested foothill and mountain areas, and dwell in dark, cool places such as rodent nests, shaded wood piles outside buildings, and between walls or beneath floorboards inside buildings. They bite humans at night. TBRF mainly occurs in summers when more humans go to mountain regions for a cool vacation. TBRF may also occur in winters when people may seek shelter in caves and start fires to keep themselves warm.
Symptoms
The most prominent symptom in TBRF is fever. Within 2 weeks of infection, sudden fever sets in and lasts 3 to 6 days. This may then disappear to again return after a fever-free interval of about 2 weeks. The febrile episodes end in a ‘crisis’ of shivering or chills followed by sweating, and fall in body temperature and blood pressure. The fever may be accompanied by headache, muscle, or body ache and pain in the eyes, joints, or neck. Some other late symptoms may include a sick feeling, vomiting, lack of appetite, skin rash, confusion, or dizziness. After several cycles of fever, people may develop convulsions or coma. The bacteria may even invade the heart or liver and cause inflammation in these organs. It may spread to the lung and cause tissue destruction leading to pneumonia. Widespread bleeding may occur in severe cases. Some cases end in death.
Diagnosis
TBRF is diagnosed by blood tests. The most certain diagnosis of TBRF is made when the spiral bacteria are observed in smears made from blood, bone marrow samples or fluid drawn from spine of symptomatic people. These are visible under a microscope and can be better detected with special stains like Wright-Giemsa or acridine orange. Though the bacteria may not be always present in the blood samples taken from febrile people, it can be detected in up to 70% of the time and the number of circulating bacteria decreases with successive episodes. The bacteria can be isolated in the laboratory using special media and techniques. Additionally, the blood can be tested for antibodies, special proteins produced in the body in response to the infection. These tests may have variable results and are not so specific. Blood for these may be collected either 7 or 21 days after the symptoms to detect the early and late responses of the body. Treatment with medicines can blunt the responses. The numbers of blood cells and the bleeding and clotting times may be disturbed.
Treatment
TBRF is treated with medicines called antibiotics which help to fight infection by either arresting the growth of bacteria or by killing them. The commonly used antibiotics are tetracycline, doxycycline, erythromycin, chloramphenicol, or penicillin. Erythromycin or penicillin may be used in children and pregnant women. With the use of antibiotics, toxins may be released from the bacteria that are undergoing destruction. These can cause symptoms similar to relapsing fever and should not be confused for another cycle of fever. Medical help should be sought if any complaints exaggerate after antibiotics are taken. This is called a Jarisch-Herxheimer reaction.
Prevention
TBRF can be prevented by avoiding the rat-infested buildings and caves. Alternatively, one should approach these areas only after wearing protective clothing that covers the entire body to avoid any tick bites. Tick bites can be limited by using repellents containing DEET or permethrin, which can be used on the skin, clothing, or equipment. Buildings should be fumigated to destroy the ticks. This should be done with people engaged in pest control. Homes should be free of animal burrows, squirrels, and chipmunks. Newspapers, wood piles, and other debris should be regularly cleared away and food should be kept in well-sealed containers. Gloves should be worn when handling dead animals. People working in areas with high tick populations or camping in such regions should conduct an examination of the body and remove the ticks. Adventures and vacations to mountains can be made safe and fun with proper precautions to avoid some common infections acquired by ticks.
