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.