ARDS A POTENTIAL COMPLICATION OF TICKBORNE RELAPSING FEVER
22 October 2007 (Reuters Health)—Public health officials report that, in patients with
tickborne relapsing fever, acute respiratory distress syndrome (ARDS) might occur more
frequently than previously thought.
Tickborne relapsing fever is endemic in the western United States, particularly in
mountainous regions. It is caused by Borrelia infections transmitted by tick bites. Rodents
are the typical environmental reservoir.
In the Morbidity and Mortality Weekly Report for 19 October, Dr. F. K. Murphy at the
Sierra Infectious Diseases in Reno, Nevada, and colleagues describe 3 cases of ARDS in
patients with tickborne relapsing fever.
All 3 patients had presented at local hospital emergency departments with fever,
generalized pain, nausea, and tachypnea. Within hours of antibiotic treatment, they
developed symptoms of Jarisch-Herxheimer reaction, an acute exacerbation of symptoms
attributed to rapidly decreasing bacterial numbers and massive cytokine release that can
occur with effective treatment of spirochetal infections.
The patients all required treatment in intensive care units, with mechanical ventilation for
up to 12 days. Diagnoses were made based on the presence of spirochetes in peripheral
blood smears. Patients were treated with multiple antibiotics, and in 2 cases, with
drotrecogin- , a recombinant form of activated protein C.
To determine the frequency of ARDS among patients with tickborne relapsing fever, Dr.
Murphy and associates reviewed cases of tickborne relapsing fever reported between 1995
and 2005 to state and local health departments. They identified 65 cases in California and
Nevada and 46 in Washington state. Since 2001, 5% of patients were diagnosed with ARDS.
Officials at the Centers for Disease Control and Prevention point out that tickborne
relapsing fever is not a nationally notifiable disease. Nevertheless, they advise health care
professionals to report suspected cases of tickborne relapsing fever to local or state health
departments.
Source: MMWR CDC Surveill Summ 2007; 56:1073–6.