Last update: October 2022
TBRFs are caused by different Borrelia species. They are endemic in temperate and warm regions of the word, especially in Africa (Tanzania, DRC, Senegal, Mauritania, Mali, the Horn of Africa) and mainly in rural areas. TBRF is a major cause of morbidity and mortality in children and pregnant women. The mortality rate for untreated TBRF ranges from 2 to 15%.
The clinical manifestations and complications of TBRF are similar to those of LBRF but central nervous system (CNS) involvement (particularly lymphocytic meningitis) is more frequent than in LBRF and the number of relapses is higher.
The clinical diagnosis is difficult, especially during the first episode: cases occur sporadically rather than in outbreaks; the tick bite is painless and usually unnoticed by the patient; symptoms are very similar to those of malaria, typhoid fever, leptospirosis, certain arbovirosis (yellow fever, dengue) or rickettsiosis, and meningitis.
- As for LBRF, the diagnosis is confirmed by detection of Borrelia in the patient’s blood.
- Repeat the examination if the first smear is negative despite strong clinical suspicion.
- In all cases, rapid test for malaria in endemic regions (and antimalarial treatment if needed, see Malaria, Chapter 6).
- Antibiotic treatment:
doxycycline PO for 7 to 10 days
Children under 45 kg: 2.2 mg/kg (max. 100 mg) 2 times daily
Children 45 kg and over and adults: 100 mg 2 times daily
azithromycin PO for 7 to 10 days (if doxycycline is contra-indicated or not available)
Children: 10 mg/kg (max. 500 mg) once daily
Adults: 500 mg once daily
ceftriaxone IV a Citation a. For IV administration of ceftriaxone, dilute with water for injection only. for 10 to 14 days (for pregnant women or in case of CNS involvement)
Children: 50 to 75 mg/kg (max. 2 g) once daily
Adults: 2 g once daily
- Treatment of pain and fever (paracetamol PO) and prevention or treatment of dehydration in the event of associated diarrhoea.
- (a)For IV administration of ceftriaxone, dilute with water for injection only.