According to Alan Barbour in his application for a patent--
".......... For example, among patients with syphilis and in areas where a closely related relapsing fever Borrelia spp. co-exist with B. burgdorferi, serologic differentiation of Lyme disease from tick-borne relapsing fever is difficult.............

The antigen-antibody diagnostic approach has been found not to work as well in connection with Lyme disease as in connection with many other infectious diseases. ....."
_________________________
old posts on relapsing fever--

author: Patricia Coyle
title: "Neurological Complications of LymeDisease
"Lyme disease shares properties with other spirochetal infections
(syphilis, leptospirosis, and relapsing fever) that cause neurological
disease. Awareness of these similarities is helpful to predict disease features. Spirochetes first infect locally at their skin or mucous
membrane entry site. Subsequently there is early spirochetemia with wide
organ dissemination. Ultimately there is chronic infection of organs, with periods of clinical disease activity separated by periods of remission.
The clinical disease syndromes of these spirochetal infections are protean."

Here are some more references for Relapsing fever--another borrelia

Gilger, W.: Relapsing fever simulating poliomyelitis. Report of a case. S. Sfrican Med. J. 25: 622, 1951

Ercoli, N. Bobalik, G. and Stubbs, R. : Antibiotic RESISTANCE of relapsing fever spirochetes , in Antibiotics Annusl, Medical Encyclopedia, Inc. New York, 1956-57, p. 601.

Guggenheim, et al: The effect of thiamine deficiency on the resistance of rats to infection with spirochetes of relapsing fever. J. Infect. Dis., 90: 190, 1952

Babudieri, B. and Bocciarelli, D.: Electronmicroscope studies on relapsing fever spirochetes. J. Hyg., 46: 438, 1948

Briggs, L. H.: Relapsing fever in California J.A.M.A., 79;941,1922.

Calabi, O.: The presence of plasma inhibitors during the crisis phenomenon in experimental relapsing fever. J. Exp. Med., 110: 811, 1959

Charters, A.D.: tick-borne relapsing fever in Somaliland with special reference to the blood sedimentation rate. Trans. Roy. Soc. Trop. Med. Hyg.,43: 427, 1950 .

Kemp, H. A., Moursund, W. H. and Wright, H. E.: Relapsing fever in Texas, III.
Some notes on the biological characteristics of the causative organism. Amer. J. Trop. Med., 14: 163, 1934.

I found this article in the Lancet last year when I was reading about
relapsing fever. The article is written before relapsing fever was named a member of the genus Borrelia. (The 17th edition of Taber's Cyclopedic
Medical Dictionary has relapsing fever listed on the Table of Pathogenic Protozoa, In the 18th edition they have removed it from this list. No
wonder a lot of people don't know what's going on)

The Lancet Lieut. Colonel Scott: Neurological Complications of
Relapsing Fever
(pg. 436, Sept. 30, 1944)

The campaign in the Libyan Desert yielded cases of relapsing fever of
a type not previously known in Egypt. They were due to infection with a
strain of Treponema recurrentis, whose immunological characteristics have
not yet been determined, transmitted by the bite of an unamed argasid tick
of the genus ornithodorus, bearing a close resemblance to O. erraticus, the vector of the Tunisian strain of treponema ( Adler 1942). This tick
probably inhabited the burrows of desert rodents and infection was commonly acquired in caves, slit trenches and tombs.
Characteristic of this fever was the high proportion of cases in which
the central nervous system was invaded. Most descriptions of the disease include the comment that nervous sequelae occur and that they are more
common in the tick-borne than in the louse-borne fever; but their
frequency and variety are not generallly recognised. This paper is
concerned with a small series of such cases seen in 1941-1942; it'a observations consequently apply to the disease of the north- west African coast. It is likely, however, that this reservation is not absolute: the charateristics of Tr. recurrentis are so labile that strains from the same locality, and even from different relapses in the same case , may show immunological variations (Ashbel 1943). Thus the clinician is probably justified in discounting the importance of differences of strain and in regarding tick-borne relapsing fever as an entity, however heretical the immunologist may consider this view.

Neurotropic Character of Tr. recurrentis
In the animal the neurotropism of this treponema is well established.
Ashbel (1943), investigating 17 strains of Tr. persica, found that
organisms could be isolated from the brains of guineapigs 117-398 days
after apparent recovery from the infection. In some cases this cerebral invasion proved fatal and post-mortem examination showed small perivascular haemorrhages and infiltrations with lymphocytes, monocytes and macrophages.
The neurotropism of various strains has been shown to be equally great in other animals. (Heronimus 1928).
This prediliction of treponema for nervous tissue in the animal
raises the question whether it is similarly neurotropic in man. Data are
not plentiful; but as long ago as 1874 Ponffick reported petechial haemorrhages in the brains of cases dying in the Berlin epidemic. Belezky
and Umanskaja (1930) have recorded the findings in 8 fatal
cases:..........In all instances microscopy showed a patchy infiltration of
the pia with monocytes, lymphocytes and plasma cells, and in places the cerebral vessels were encircled by a similar cellular halo. In three cases treponemata were found in the brain substance, diffusely distributed and in
no constant relation to vessels.
More recently, Ungar has described the case of a woman dying in the puerperium with relapsing fever and cerebral symptoms. The post-mortem findings included a cholesteatoma of the lateral recess, oedema of the cisternal pia-archanoid and haemorrhages in the caudal part of the pons and
the floor of the 4th ventricle. Sections showed the Virchow-Robin spaces distended with erythrocytes, lymphocytes and monocytes; treponemata were recovered from the cerebrospinal fluid and from the tumor..........................
These observations show that Tr. recurrentis has neurotropic
characters in man as well as in the animal, and they furnish a morbid anatomical foundation for the varied neurological guises the disease may assume. The histological changes described are perivascular infiltrations
with mononuclear cells, occuring both in the pia-arachnoid and in the brain substance, sometimes associated with haemorrhages. The lesions are
therefore meningovascular; a fact which could have been predicted from the clinical picture, for, indeed, the disease presents parallels with meningovascular syphilis..................
Lieut.-Colonel Scott goes on to describe 9 cases of military employees infected with the Western Desert treponema.

Discussion

It is evident that neurological complications may appear at any time
during the course of relapsing fever.....These phenomena may be
unaccompanied by fever or first be manifest during pyrexial relapse; they
often show periodic recurrence.
From the clinical standpoint the neurological complications of
relapsing fever fall into three groups.
The first....is characterised by meningitis without evidence of focal damage to nervous tissue. In some ....the features are those of
intracranial hypertension rather than of menigeal irritation.....It is, perhaps, permissable to regard the process as similar to the cerebral
invasion which may prove fatal in the experimentally infected animal and to draw a parallel between this condition and acute syphilitic meningitis.
The second compromises cases with signs of focal damage to nervous
tissue but WITHOUT CLINICAL EVIDENCE of meningitis......They are comprable
with meningovascular syphilis and case 7 had the hallmarks of a
cerebrovascular accident. Facial palsy has been noted as a common
complication (Manson-Bahr 1940).......
In the third signs of meningitis are associated with those of focal
nervous damage; of this combination case 9 is an example............................
Prognosis- It is not easy to assesss the prognosis in a disease of
long duration under the conditions necessarily operative in military
practice; so many patients are transferred to other hospitals before full recovery. None of this series died; ......case 9 illustrates the
frequency of repeated relapses and the chronic ill-health which may result
from this disorder........

---------------------------

".Tick-borne borreliae remain viable in their natural tick vectors for
up to 12 years, and this represents the optimal method for maintaining
organisms......"


From Mandell, Douglas and Bennett's Principles and Practice of Infectious
Diseases Fourth Edition

Borrelia Species (Relapsing Fever)

Warren D. Johnson, Jr.

"Relapsing fever is caused by arthropod-borne spirochetes of the genus Borrelia
and is clinically characterized by recurrent episodes of fever and
spirochetemia........

Etiology

The genus Borrelia belongs to the family Treponemataceae, which contains all
spirochetal pathogens, including the genera Treponema and Leptospira.
Borreliae are helical,...,are actively motile, and divide by transverse
fission. They are readily stained with aniline or acid dyes, but strains
cannot be distinguished by morphological characteristics. Borreliae have an
outer slimelike layer, a cell wall, and cytoplasmic membrane, and numerous
internal fibrils. They are promptly killed by dessication and ultraviolet
rays but survive and retain their virulence when frozen at -73 degrees
centigrade for many months.
..........Tick-borne borreliae remain viable in their natural tick vectors for
up to 12 years, and this represents the optimal method for maintaining
organisms......
Tick borne relapsing fever is caused by at least 15 Borrelia spp. and is
transmitted to man by soft ticks of the genus Ornithodoros. Many rodents and
small animals serve as natural resovoirs for these borreliae (chipmunks,
suirrels, rabbits, rats, mice, owls, lizards) ...Transovarial passage of
borreliae to the tick progeny is an important mechanism for perpetuation of
the spirochete, because ticks can survive for up to 15 years without
feeding........"

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