Relapsing fever typically refers to malaria-like illnesses caused by various spirochetes belonging to Borrelia species and characterized by recurrent fevers, chills, and malaise. The causative organism and associated vector vary based on the geographic area of exposure. Borrelia recurrentis is the cause of epidemic relapsing fever, which is reported most frequently in northern and eastern Africa. Tick-borne relapsing fever is reported in the United States and can be caused by several species, including Borrelia hermsii, Borrelia turicatae, and Borrelia parkeri. Regardless of the specific causative organism, relapsing fever is treated with doxycycline 100 milligrams (mg) twice a day for seven to ten days. In children under eight years of age, penicillin or erythromycin may be preferred agents due to the concern of dental staining with doxycycline use. It is important to observe patients for several hours after the initiation of antibiotic therapy, as Jarisch-Herxheimer reaction is common. Jarisch-Herxheimer reaction is a sepsis-like response to the release of inflammatory contents from within the bacteria after lysis by antibiotics. It is rarely fatal and managed with supportive care. This reaction is more common in adolescents than in younger children. Borrelia infections may also be self-limited and resolve without treatment in some cases.
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