Tick-Borne Relapsing Fever

Tick-borne relapsing fever (TBRF), is a bacterial infection transmitted by ticks. The infection typically shows up as recurrent fever, headache and nausea, muscle and joint pain. Mainly it is reported in the Western region of the United States. It is generally linked with sleeping in rustic cottages in hilly areas.
Though not common, untreated TBRF can cause serious public health problems, even the death of the patient.

Common Signs & Symptoms of TBRF

The most common symptom of TBRF in the periodic fever that starts within 2 weeks after the bite of a tick. Multiple attacks of fever can happen and each attack can last for 3 days to a week. If the fever is left untreated the cycle can repeat itself several times.
Some other symptoms may include:
• Anorexia with headache
• Shudders
• Perspirations
• Muscle or joint pain
• Vomiting and nausea
In a few cases, the episodes of fever end in a stage named “crisis” consisting of shuddering chills, hypotension with intense sweating, and dropping body temperature.

Causes of TBRF

Tick-borne fever is usually caused by the bite of a tick and is most commonly reported in the United States of America. The ticks are called soft ticks to carry Borrelia bacteria causing TBRF and are classically found in higher altitudes of the western US but also present in the desert area of the Southwest.
There is a difference between the behavior of soft and hard ticks, likewise the ticks of dog or deer:
Soft ticks behave differently than “hard” ticks, such as dog ticks or deer ticks:
• The bite of the soft tick is short-term and brief lasting for half an hour.
• Soft ticks live in the nests of small animals e.g., rodents, and take feed from the sleeping of the rodent.
Tick-borne relapsing fever is usually associated with the sleeping of the rural people in rustic cabins. The rodents most commonly live in the walls, lofts, or crawl spaces of the cabins, and sift ticks live in the vicinity of their hosts. These ticks come out in the dark to get their feed. They bite the people sleeping in rustic cabins. The bite usually is painless and fast so you cannot feel the pain of being bitten by the tick.

Who is at risk of getting TBRF?

The communities living in the rustic cabins in the hilly areas of the Western US are at risk of TBRF infection. Anyone can be at the risk of TBRF if he/she is being bitten by the tick or if you have had any soft tick on your body in the last 3 weeks. People who are living outdoors in tick prevalent areas or have outdoor activity of work or recreation are the most risk associated populations for TBRF.

Diagnosis of TBRF

Tick-borne relapsing fever (TBRF) is diagnosed by a blood test or complete hematology. In case you have had any tick exposure in your past weeks, or been bitten by the ticks you must call your doctor urgently.

Prevention of TBRF

Tick-borne relapsing fever (TBRF) can be prevented through:
• Always be careful while choosing your bedding or cabin before sleep. Indication of rodents’ presence must be inspected. Avoid staying in the buildings where the infestation of ticks has been reported previously.
• Use insect repellents with DEET (at least 20%), put these on your clothing, or sprinkle them over the skin and around. But, avoid its spread over the face and hands of children.
• Treat your clothing and tents or other equipment with insect repellents having 0.5% permethrin.
• Other tick-borne diseases can be prevented by avoiding bites by the ticks. If you are outside from your home, you must follow these guidelines:
• Avoid visiting the areas that are forested, brushy, or have tall grass.
• Stride in the center of tracks.
• Avoid dark clothing and wear light colors as it makes it easier to look and remove the ticks from your attire.
• Wear long-sleeved shirts and long pants. Wearing socks or gumboots can give protection to the body.
• At home check everything for the presence of ticks.
• Check your body, can use a mirror, and take a bath or shower to remove any tick attached to your body. Common sites for tick attachment are; knees, ears, scalp, underarms, back area, and groin area.
• Check the kit you used, with coats, bags, or tents and shelters.


1. Kashif Hussain, Ph.D. Parasitology, University of Agriculture, Faisalabad.
2. Maria Kausar, M.Phil. Parasitology, University of Agriculture, Faisalabad.
3. Muhammad Sohail Sajid, Associate Prof., Dept. of Parasitology, University of Agriculture, Faisalabad.



1. Kashif Hussain, Ph.D. Parasitology, University of Agriculture, Faisalabad.
2. Maria Kausar, M.Phil. Parasitology, University of Agriculture, Faisalabad.
3. Muhammad Sohail Sajid, Associate Prof., Dept. of Parasitology, University of Agriculture, Faisalabad.

What is Attention deficit hyperactivity disorder (ADHD)?

Attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental syndrome of children, is a condition in which an individual faces hardship to act consciously and control impetuous activities. The patient may be in fidgety and remains continually active[1]. The individual acts without considering the outcome of their doings. It mainly occurs during childhood and can be observed in adults [2]. It is a common disorder of children as about 5% of primary school students are patients of ADHD. Both the genome of an individual and environmental factors are playing a significant role in the occurrence of ADHD [5]. Genetic mutation in dopamine receptor (D4) and transporter (DAT1) gene leads to dysfunction of metabolism of noradrenaline and dopamine, and neurotransmission in cortical and subcortical regions. ADHD due to genetic cause may persist to adulthood [6]. The environmental influencers of ADHD are maternal strain, smoking, malnutrition, prematurity, and prenatal snags. The children with ADHD mainly belong to a chaotic environment. The strengths and difficulties questionnaire can be used as a screening tool for children with such psychiatric disorders [3].

What are the symptoms of Attention deficit hyperactivity disorder (ADHD)?

The condition is characterized by the presence of symptoms of hyperactivity, inattention, and impetuosity. It mainly occurs at age of lesser than 7 years and patients show impairments in various activities (schooling, friendship relation, and home activities). Three sub-groups of ADHD are identified by DSM IV including inattention, hyperactivity, and impetuosity [3]. Many ADHD symptoms, such as high activity levels, difficulty remaining still for long periods, and limited attention spans, are common to young children in general [7]. The variation in ADHD children is the noticeably higher hyperactivity and inattention concerning their age. The condition is diagnosed when the patient exhibit history of 6 months with the manifestation of clinical signs [8]. The condition may be a combination of inattentiveness, and hyperactivity or impetuousness, or any of these types.
Inattentiveness type in an individual observed as
• There is no focus on details and insensible mistakes are encountered during job or schooling.
• Have difficulties to focus on numerous activities or tasks during conversations, lectures, and reading.
• Did not pay attention to listen when talking to them.
• Did not follow instructions to complete schoolwork or job responsibilities.
• Start their job eagerly but lose focus quickly on completion of a task.
• Unable to organize the assigned tasks concerning time management.
• Avoid or hamper to complete tasks that need mental efforts viz, report completion or form filling.
• Losses daily life utilities like keys, books, wallet, school papers, eyeglasses, and cell phone.
• Easily detracted from prime tasks.
• Daily tasks are forgotten viz, running errands and chores, response to phone calls, bills payment, and appointment taking.
Hyperactive or impulsive type exhibit the following symptoms.
• Plays with hands or feet or wriggles in a seat.
• Unable to stay in sitting position during the class or workshop.
• Runs or climbs when it is unsuitable.
• Perform leisure activities silently.
• Too much talking behavior.
• Love to go on the long drive.
• Exclaims the answer before the completion of the question or instant speaking.
• Cannot wait for their turn when standing in a line.
• Interfere others while they were talking and start their own conversation.
There is no specific laboratory test for diagnosis of ADHD, and it can only be diagnosed through history of mental health and psychological behaviour [2, 7].

Pharmacological treatment of ADHD

The therapy of ADHD includes training by parents, support by the school, and a pharmacological approach. The specified medicines are prescribed by child specialists and long-term medication by GPs, but principal pharmacological therapy includes atomoxetine, methylphenidate, and dexamphetamine [4].
1. Atomoxetine, a specified nor-adrenaline re-uptake inhibitor, is appropriately used as the first line of the therapeutic agent but its specified mechanism of action in ADHD is unknown. It is particularly used when the child did not respond to stimulant therapy. It does not interfere with the motor activity (dopamine level in the striatum) so, it did not aggravate Tourette’s. It acts as a sedative agent and prescribes to be taken during the evening because it imposes sleeping. It has a long duration of action up to 24 hours and clinical impacts become fully evident in six weeks following the administration. It has no contraindication when administered with stimulants [9].
2. Methylphenidate is prescribed as the first line of treatment in children against ADHD and about 60 to 80% recovery rate noticed. It acts within 30 minutes following their administration and its side effects include headache, stomach aches, appetite suppression, and sleep disturbance. Whenever there is an emergence of psychotic symptoms methylphenidate should be withdrawn and atomoxetine can be administered [10].
3. Dexamphetamine is rarely prescribed in case of ADHD when atomoxetine and methylphenidate are in effective or when epilepsy worsens [11].


Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental syndrome of children, in which child faces hardship to act consciously and control impetuous activities. It is a common disorder of children as about 5% of children are patients of ADHD. Both the genome of an individual and environmental factors are playing a significant role in the occurrence of ADHD. The condition is characterized by the presence of symptoms of hyperactivity, inattention, and impetuosity. The therapy of ADHD includes parent training, school support, and pharmacological administrations. There is more than 80% recovery rate with early pharmacological therapy and principal pharmacological therapeutic agents include atomoxetine, methylphenidate, and dexamphetamine.


1. https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/
2. https://www.psychiatry.org/patients-families/adhd/what-is-adhd
3. Ougrin, D., Chatterton, S. and Banarsee, R., 2010. Attention deficit hyperactivity disorder (ADHD): review for primary care clinicians. London journal of primary care, 3(1), pp.45-51.
4. Swanson, J.M. and Castellanos, F.X., 1998, November. Biological bases of attention deficit hyperactivity disorder: neuroanatomy, genetics, and pathophysiology. In NIH consensus development conference program and abstracts: Diagnosis and treatment of attention deficit hyperactivity disorder (pp. 37-42).
5. Swanson, J.M., Kinsbourne, M., Nigg, J., Lanphear, B., Stefanatos, G.A., Volkow, N., Taylor, E., Casey, B.J., Castellanos, F.X. and Wadhwa, P.D., 2007. Etiologic subtypes of attention-deficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Neuropsychology review, 17(1), pp.39-59.
6. Wu, J., Xiao, H., Sun, H., Zou, L. and Zhu, L.Q., 2012. Role of dopamine receptors in ADHD: a systematic meta-analysis. Molecular neurobiology, 45(3), pp.605-620.
7. Simonoff, E., Pickles, A., Wood, N., Gringras, P. and Chadwick, O., 2007. ADHD symptoms in children with mild intellectual disability. Journal of the American Academy of Child & Adolescent Psychiatry, 46(5), pp.591-600.
8. Scheres, A., Dijkstra, M., Ainslie, E., Balkan, J., Reynolds, B., Sonuga-Barke, E. and Castellanos, F.X., 2006. Temporal and probabilistic discounting of rewards in children and adolescents: effects of age and ADHD symptoms. Neuropsychologia, 44(11), pp.2092-2103.
9. Wernicke, J.F. and Kratochvil, C.J., 2002. Safety profile of atomoxetine in the treatment of children and adolescents with ADHD. Journal of Clinical Psychiatry, 63(12), pp.50-55.
10. Matthijssen, A.F.M., Dietrich, A., Bierens, M., Kleine Deters, R., van de Loo-Neus, G.H., van den Hoofdakker, B.J., Buitelaar, J.K. and Hoekstra, P.J., 2019. Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: a randomized placebo-controlled discontinuation study. American Journal of Psychiatry, 176(9), pp.754-762.
11. Ernst, M., Zametkin, A.J., Matochik, J.A., Liebenauer, L., Fitzgerald, G.A. and Cohen, R.M., 1994. Effects of intravenous dextroamphetamine on brain metabolism in adults with attention-deficit hyperactivity disorder (ADHD): preliminary findings. Psychopharmacology Bulletin.