Louse-Borne Relapsing Fever; A Clinical and Laboratory Study of 62 Cases in Ethiopia and a Reconsideration of the Literature
NAVAL MEDICAL RESEARCH UNIT NO 3 APO NEW YORK 09319 FIELD FACILITY
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Sixty-two patients with louse-borne relapsing fever in Addis Ababa, Ethiopia, from 1966 to 1968 were studied. The clinical presentation varied. Fever, headache, skeletal and abdominal pain, and the usual symptoms of acute infection were common. Tachypnoea and upper abdominal tenderness with a palpable liver and spleen were found in two-thirds of the patients, jaundice in one- third, and purpura in one-sixth. Thrombocytopenia was the rule. Biochemical evidence of hepatocellular damage was found in most patients. Myocardial damage was suspected in one third of them. Pulmonary ventilation and cardiac output were increased and there was evidence of impaired gas exchange. Evidence of renal and cerebral damage was less striking. The literature on the immune response has been reviewed in order to understand the phenomenon of the crisis. Treatment was with intravenous tetracycline, and was followed by a Jarisch- Herxheimer raction. The clinical and physiological features of this reaction are described. Spirochaete death and phagocytosis, resulting in the release of endogenous pyrogen, may be responsible for all its features. Hyperpyrexia in the chill phase and hypotension and cardiac failure in the flush phase can be fatal. The mortality was 5 per cent. The epidemic and pathological processes which determine the prognosis of this disease are discussed.
- Medicine and Medical Research