So, having talked at length about Lyme disease
which is what we most often experience as a Borrelia disease worldwide,
there are other forms of Borrelia that we do need to be aware of,
typically associated with Borrelia recurrentis or a related species in the Borrelia family.
These entities are known as Relapsing fevers or sometimes tick associated or vector associated relapsing fever.
Borrelia recurrentis, as you see there, is associated with a lice or louse borne epidemic relapsing fever
and patient’s typical have a single relapse and then they’ll be done.
Other tick borne relapsing fevers, however, may have multiple relapses which keep going on and going on.
The febrile phase of the relapsing fever is typically in abrupt onset,
very high fevers. Temperature is associated with shaking chills, the rigors and the muscle aches.
So again, you may be thinking that just sounds like the really bad flu I had last winter.
Well, yes, you're right. So the febrile phase almost is like very severe flu like illness
and it lasts similar to the flu from three to seven days.
Then the patient's free the sigh of relief.
They have entered the afebrile, the clinically healthy stage and this lasts for about a week
and then unfortunately the same thing happens again -
the febrile symptoms return just as bad as they were before.
In the Borrelia recurrentis it's typically a single relapse
and the tick associated illness its ongoing relapses as the Borrelia organism undergoes small antigenic changes
in its outer structure each time of which triggers a separate and new immune reaction.
So you're basically blessed or cursed with ongoing trigger of the immune system because of this.
I mentioned before that one can do dark field microscopy
but it’s very difficult to find the organism even in biopsy of a primary lesion for Lyme disease
and in the recurring fevers there's nothing specific to biopsy.
So one can actually perform for Borrelia burgdorferi to diagnose Lyme disease
and enzyme immunoassay looking for both immunoglobulin M and immunoglobulin G,
EI antibodies and confirm those with Western blot analysis.
In this schematic, you can see on the far right of the schematic the typical bands,
what you're seeing is positive for an IgG, immunoglobulin G, to Borrelia burgdorferi
and then compare the different lanes of the patient one through seven
and match up how many the bands occur in correlation with the known bands,
the known positive bands for Borrelia burgdorferi.
And there are standards established in the states for the Centers for Disease Control
and the other parts of the world as well in which one has two or more positive IgM bands
and three or more positives specific IgG bands and that constitutes a positive diagnosis
so very important to make the accurate and proper diagnosis
so that the treatment can be appropriately administered.
For the recurring fevers, however, it’s easier to do a Wright stain or a Giemsa stain of a blood smear,
and look for presence of the organisms within the erythrocytes.
As you can see, if you focus closely on this image, within the erythrocytes,
there are several darker purple dots which represent infection of those specific cells.
Serologic tests as noted by the slide are useless,
again, because the Borrelia undergoes antigenic variation
so one would never be able to make a single antibody
to cover all the different potential types of variating antigen discovery.
So, that is what we know about Borrelia burgdorferi as the cause of Lyme disease recurrentis
and other types of Borrelia causing recurring fevers all these are vector associated,
all these are unfortunate things that you have to come across in the woods
when all you simply want is a peaceful walk through the woods with your dog.