ABSTRACT
This chapter focuses on growing points and growing challenges in the control of louse-borne relapsing fever. The diagnosis of louse-borne relapsing fever is made when spirochetes of Borrelia recurrentis are seen on the blood film. Although the transmission of relapsing fever is understood, very little is known of its epidemiology, and this whole area is ripe for study. Whereas tick-borne relapsing fever is widespread in Africa, the louse-borne infection is largely limited to Ethiopia, Somalia, and Sudan, where it is endemic with limited epidemics. Relapsing fever can be ominous in pregnancy, dangerous to the mother and often fatal to the fetus. The most severe and sometimes fatal form of the Jarisch-Herxheimer reaction (J-HR) yet described occurs following antibiotic treatment in relapsing fever. The profound pathophysiological changes recorded in the J-HR of relapsing fever made this the paradigm for investigation.
