Tick-Borne Relapsing Fever

Last Updated February 2021 | This article was created by familydoctor.org editorial staff and reviewed by Peter Rippey, MD, CAQSM

What is tick-borne relapsing fever?

Tick-borne relapsing fever (TBRF) is a bacterial infection spread by ticks. The infection normally shows up as repeated episodes of fever, along with headache, muscle and joint aches, and nausea. It occurs in the western United States. It is usually associated with sleeping in rustic cabins in mountainous areas.

Though not common, it is possibly for untreated TBRF to cause serious health problems, even death.

Symptoms of TBRF

The main symptom of TBRF is a sudden fever that comes on within 2 weeks of being bitten by a tick. Multiple bouts of fever happen. Each can last about 3 days. The fever then goes away for about 1 week before returning. If left untreated, the cycle can continue several times.

Some other symptoms of TBRF may include:

  • Headache
  • Chills
  • Sweats
  • Muscle or joint aches
  • Nausea
  • Vomiting

In some cases, the fever ends in a “crisis” stage. This consists of shaking chills, intense sweating, falling body temperature, and low blood pressure.

What causes TBRF?

In the United States, TBRF is usually caused by a bite from certain types of ticks. These ticks, called “soft” ticks, carry the Borrelia bacteria. They are typically found in higher elevations of the western states. This includes the mountains of the West and the high deserts and plains of the Southwest.

Soft ticks behave differently than “hard” ticks, such as dog ticks or deer ticks:

  • Their bite is brief, usually lasting less than half an hour.
  • They don’t search for prey in tall grass or brush. Instead, they live in the nests of rodents and small animals. They feed on the rodent as it sleeps.

TBRF is often associated with sleeping in rustic cabins. The soft ticks live in the nests of rodents that live in the cabin’s walls, attics, or crawl spaces. The ticks come out at night briefly to feed. The bites are quick and painless. You usually don’t know you’ve been bitten.

Who is at risk for TBRF?

People at highest risk for TBRF are those who stay in rustic cabins in the mountainous areas of the West where soft ticks live. You are also at risk for TBRF if you have had a tick bite or if you have found any ticks on your body in the past 3 weeks. People who spend time outdoors in areas where ticks are common, either for work or recreation, are at higher risk of getting any tick-borne disease.

How is TBRF diagnosed?

TBRF and other tick-borne diseases can be diagnosed with a blood test. If you have been exposed to ticks and you are having repeated episodes of fever, call your doctor right away.

Can TBRF be prevented or avoided?

The best ways to prevent getting TBRF are to:

  • Be careful when choosing a cabin or building to sleep in. Look for evidence of rodents. This could include nests or droppings. Avoid staying in buildings where you see these signs of infestation.
  • Use an insect repellent with at least 20% DEET. It can be put on clothing or sparingly on the skin. Don’t apply it to the face or hands of children.
  • Treat clothing, tents, or other gear with repellents containing 0.5% permethrin.

You can prevent other tick-borne diseases by avoiding being bitten by ticks. When you are outdoors, follow these guidelines:

  • Avoid areas that are wooded, brushy, or have tall grass.
  • Walk in the center of trails.
  • Wear light-colored clothing. This makes it easier to see and remove ticks from your clothes.
  • Wear a long-sleeved shirt and long pants. Tuck your pant legs into your socks or boots for added protection.

After you get home, check everything and everyone for ticks.

  • Bathe or shower as soon as you can to wash off any ticks that have not attached to you.
  • Check your entire body for ticks. Use a mirror for places you can’t see. Check your children and your pets. Common tick locations include the back of the knees, groin area, underarms, ears, scalp, and the back of the neck.
  • Check any gear you used, including coats, backpacks, or tents.
  • Tumble dry clothes or blankets on high heat in the dryer for 10 to 15 minutes. This should kill any ticks. If clothes are dirty, wash them in hot water and dry on high heat for 60 minutes.

TBRF treatment

What do I do if I find a tick on my skin?

Don’t panic. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Pull up with steady, even pressure. Be careful not to squeeze or twist the tick body. Sometimes parts of the tick remain in the skin. You can leave them alone or carefully remove them the same way you would a splinter. Do not use heat (such as a lit match), petroleum jelly, or other methods to try to make the tick “back out” on its own. These methods are not effective.

Wash the area where the tick was attached thoroughly with soap and water. Keep an eye on the area for a few weeks and note any changes. Call your doctor if you develop a fever or other symptoms of TBRF. Be sure to tell your doctor that you were bitten by a tick and when it happened.

How is TBRF treated?

If you have TBRF, your doctor will most likely prescribe antibiotics to fight the bacteria. It is important that you take all of your antibiotic medicine as your doctor prescribes, even if you are feeling better. This will ensure that you get rid of the disease completely. It also helps prevent building up a resistance to antibiotics.

Living with TBRF

If treated early, many people with TBRF are cured with the antibiotics. They don’t have any lasting effects from the illness. But some people experience complications. These can include:

  • Drooping of the face
  • Heart inflammation
  • Inflammation around the brain and spinal cord
  • Liver problems
  • Pneumonia
  • Seizures
  • Widespread bleeding
  • Coma
  • Death

It is very important to see your doctor right away if you think you may have TBRF. Early treatment can prevent complications and improve your outlook for recovery.

Questions to ask your doctor

  • I’ve been bitten by a tick. Do I need any treatment?
  • Which form of treatment is best for me
  • Is there anything I can do to avoid developing complications?
  • What tick or insect repellent should I use for my child?
  • Which tick or insect repellent is best for me?
  • I have HIV. Should I avoid areas where ticks may live?
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